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To evaluate the role that artificial intelligence (AI) could play in assisting radiologists as the first reader of chest radiographs (CXRs), to increase the accuracy and efficiency of lung cancer diagnosis by flagging positive cases before passing the remaining examinations to standard reporting. A dataset of 400 CXRs including 200 difficult lung cancer cases was curated. Examinations were reviewed by three FRCR radiologists and an AI algorithm to establish performance in tumour identification. AI and radiologist labels were combined retro