Both imaging and image-directed biopsy play a major:role in evaluating solitary pulmonary nodules. Imaging is used to determine whether the nodule is actually, solitary or if multiple nodules are present. Once a nodule has been detected, imaging techniques can be used to characterize the nodule in terms of whether it is likely benign or malignant. As technology has improved, smaller nodules are now more easily detected, which may create a management dilemma, With the advent of video-assisted thoracoscopic techniques, however, sampling of these lesions has become much easier. Once a solitary pulmonary nodule is detected, image-guided biopsy is often considered, which can be undertaken using CT or fluoroscopy. Technical limitations, the location of the solitary pulmonary nodules, and clinical conditions must be considered when determining the role of image-guided biopsy. Other concerns include:thf role of on-site cytology and the use of mole recent technical advances. Image-guided biopsy should be used as part of a multimodality approach to patient management, and decisions should be-discussed with the radiologist and other caregivers to determine the cost-effectiveness and safety of the procedure for each patient.