In general, every imaging test has theoretical potential for false positives and/or false negatives.
Low-dose CT chest is typically reserved for lung cancer screening in patients with significant history of smoking (e.g., greater than 30 pack-years) in a certain age range (e.g., 55-77 yrs old). The reasoning is that these patients at higher risk of lung cancer may benefit from surveillance with CT chest, but because they will be getting these scans every year or so, the scan will be performed at a lower dose to minimize radiation. With lower dose, the images will be a little bit more fuzzy/less clear, but still should be able to detect large pulmonary nodules aka lung cancer.