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Purpose. The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer.Methods. Since starting in 1993, the ELCAP has enrolled 1,000 asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term highresolution CT follow-up for the smallest nodules.Baseline Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA. Telephone: 212-746-2529; Fax: 212-746-2811 Received October 10, 2000 accepted for publication February 23, 2001. ©AlphaMed Press 1083-7159/2001 INTRODUCTIONIn the United States, the cure rate of lung cancer is a dismal 10%, and the 5-year survival rate is only slightly higher than the cure rate. In stage I lung cancer, by contrast, the 5-year survival rate upon resection is as high as 70%; but if left unresected, that rate is again of the order of a mere 10% [1,2]. While these rates imply that the cure rate of lung cancer can be substantially enhanced by screening and its associated earlier intervention, results of randomized trials have been interpreted as indicating that this is not the case [3].This paradox points to the possibility that the negative results of the randomized trials were a consequence of flaws in their design, execution and/or analysis. To quantify the