In order to provide recommendations regarding implementation of computed tomography (CT) screening in Europe the ESTS established a working group with eight experts in the field. On a background of the current situation regarding CT screening in Europe and the available evidence, ten recommendations have been prepared that cover the essential aspects to be taken into account when considering implementation of CT screening in Europe. These issues are: (i) Implementation of CT screening in Europe, (ii) Participation of thoracic surgeons in CT screening programs, (iii) Training and clinical profile for surgeons participating in screening programs, (iv) the use of minimally invasive thoracic surgery and other relevant surgical issues and (v) Associated elements of CT screening programs (i. e. smoking cessation programs, radiological interpretation, nodule evaluation algorithms and pathology reports). Thoracic Surgeons will play a key role in this process and therefore the ESTS is committed to providing guidance and facilitating this process for the benefit of patients and surgeons.