Background: Lung cancer remains one of the leading causes of cancer-related deaths worldwide. Artificial intelligence (AI) holds significant potential roles in enhancing the detection of lung nodules through chest X-ray (CXR), enabling earlier diagnosis and improved outcomes. Methods: Papers were identified through a comprehensive search of the Web of Science (WOS), Scopus, and Ovid Medline databases for publications dated between 2020 and 2024. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 34 studies that met the inclusion criteria were selected for quality assessment and data extraction. Results: AI demonstrated sensitivity rates of 56.4–95.7% and specificities of 71.9–97.5%, with the area under the receiver operating characteristic (AUROC) values between 0.89 and 0.99, compared to radiologists’ mean area under the curve (AUC) of 0.81. AI performed better with larger nodules (>2 cm) and solid nodules, showing higher AUC values for calcified (0.71) compared to non-calcified nodules (0.55). Performance was lower in hilar areas (30%) and lower lung fields (43.8%). A combined AI-radiologist approach improved overall detection rates, particularly benefiting less experienced readers; however, AI showed limitations in detecting ground-glass opacities (GGOs). Conclusions: AI shows promise as a supplementary tool for radiologists in lung nodule detection. However, the variability in AI results across studies highlights the need for standardized assessment methods and diverse datasets for model training. Future studies should focus on developing more precise and applicable algorithms while evaluating the effectiveness and cost-efficiency of AI in lung cancer screening interventions.