This position paper presents recommendations for low dose computed tomography (LDCT) scan protocols and reading in lung cancer screening (LCS), as LDCT has been proven to decrease lung cancer mortality in smokers and former smokers. Several Italian initiatives are offering LCS and smoking cessation to high-risk subjects. The paper details fundamentals for classifying lung nodules and other findings at LDCT tests, along with international guidelines for their reporting and management in LCS. The Italian College of Thoracic Radiologists aims to establish a homogenous, evidence-based approach to LDCT tests in Italy. Although the software is not directly mentioned, screen captures from AVIEW COPD were used in the article.