I enjoyed reading this recently published article from Michael Gould and colleagues in Annals of ATS. In this article, they reviewed the screening cohorts and 4 unique programs implementing lung cancer screening. What most struck me was how many ineligible patients were being screened at many sites! This article exposes some of the challenges of implementing this service in the real world that drive some of the research we are doing. I agree with the call to action to continue to study how screening is being implemented in real-world settings with the knowledge that there is much room for improvement.