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The purpose of this study is to develop a technique for computer-aided diagnosis (CAD) systems to detect lung nodules in helical X-ray pulmonary computed tomography (CT) images. The authors propose a novel template-matching technique based on a genetic algorithm (GA) template matching (GATM) for detecting nodules existing within the lung area; the GA was used to determine the target position in the observed image efficiently and to select an adequate template image from several reference patterns for quick template matching. In addition, a conventional template matching was employed to detect nodules existing on the lung wall area, lung wall template matching (LWTM), where semicircular models were used as reference patterns; the semicircular models were rotated according to the angle of the target point on the contour of the lung wall. After initial detecting candidates using the two template-matching methods, the authors extracted a total of 13 feature values and used them to eliminate false-positive findings. Twenty clinical cases involving a total of 557 sectional images were used in this study. 71 nodules out of 98 were correctly detected by the authors' scheme (i.e., a detection rate of about 72%), with the number of false positives at approximately 1.1/sectional image. The authors' present results show that their scheme can be regarded as a technique for CAD systems to detect nodules in helical CT pulmonary images.