The Dutch-Belgian Randomized Lung Cancer Screening Trial (Dutch acronym: NELSON study) was designed to investigate whether screening for lung cancer by low-dose multidetector computed tomography (CT) in high-risk subjects will lead to a decrease in 10-year lung cancer mortality of at least 25% compared with a control group without screening. Since the start of the NELSON study in 2003, 7557 participants underwent CT screening, with scan rounds in years 1, 2, 4 and 6. In the current review, the design of the NELSON study including participant selection and the lung nodule management protocol, as well as results on validation of CT screening and first results on lung cancer screening are described.