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Article History

Received: 6 October 2025

Accepted: 26 January 2026

First Online: 24 March 2026

Competing interests

: D.R.B. declares honoraria for speaking and education from AstraZeneca and Boehringer Ingelheim, unrelated to the current study. He has received research grants from the National Institute of Health Research, Cancer Research UK, Horizon Europe, Ruth Strauss Foundation, SBRI, Innovate UK, Yorkshire Cancer Research, the Royal Castle Foundation, and UK Research and Innovation. N.W. declares consultancy fees from InHealth, Apollo Radiology (UK) and SMR Health & Tech unrelated to the current study and a travel grant from Qure.ai Technologies to attend the European Congress of Radiology 2023. R.W.L. is funded by the Royal Marsden National Institute for Health and Care Research (NIHR) Biomedical Research Centre and The Royal Marsden Cancer Charity; his institution receives compensation for time spent in a secondment role with NHS England for the Lung Health Check Programme and as National Specialty Lead for the National Institute for Health and Care Research; he has received research funding from Cancer Research UK, Innovate UK (cofunded by GE Healthcare, Roche Diagnostics, Optellum, Elliptica and RNA Guardian), SBRI (including as a co-applicant with Qure.ai), RM Partners Cancer Alliance and NIHR (including co-applicant on grants with Optellum); he has received honoraria, speaker and advisory fees, and/or hospitality and travel expenses from Cancer Research UK, Roche Diagnostics, Johnson & Johnson, Guardant Health, AstraZeneca and King Faisal Specialist Hospital and Research Centre, Saudi Arabia; and he also undertakes private medical practice. These activities are unrelated to the present study, aside from the SBRI funding received in collaboration with Qure.ai. N.N. is supported by a Medical Research Council Clinical Academic Research Partnership (MR/T02481X/1). N.N. has also received grant funding from the National Institute of Health Research, Cancer Research UK, Horizon Europe, Ruth Strauss Foundation, and the Engineering and Physical Sciences Research Council. This work was partly undertaken at University College London Hospitals NHS Foundation Trust/University College London, which received a proportion of funding from the UK Department of Health’s NIHR Biomedical Research Centre’s funding scheme. N.N. reports honoraria for nonpromotional educational talks, conference attendance or advisory board participation from Amgen, AstraZeneca, AXANA, BeiGene, Boehringer Ingelheim, Bristol Myers Squibb, EQRx, Fujifilm, Guardant Health, Intuitive, Janssen, Eli Lilly and Company, Merck Sharp & Dohme, Olympus Corporation, Roche and Sanofi. The remaining authors declare no competing interests.