The early detection of lung cancer using thoracic CT has been widely demonstrated in multiple international trials to objectively increase cure rates. Now the international focus is on effective and economical implementation. Increasingly, it is emerging that thoracic CT screening is also detecting a range of early tobacco-related diseases including cardiovascular disease and chronic obstructive pulmonary disease. These three diseases comprise the ‘BIG3’, as they collectively account for close to half of the premature deaths globally. Thoracic CT screening presents a unique opportunity to integrate care for this high risk cohort with a single imaging examination. We plan to develop optimized protocols for evaluation of these major diseases, explore challenges and define solutions in enabling implementation, especially for economically disadvantaged countries across the world. A core strategy in achieving this ambitious goal is to leverage the use of AI processes across the continuum of care, including its use for risk assessment, disease detection and managing disease interventions.