Patients with lesions on the chest radiograph should be discussed in a multidisciplinary meeting with a respiratory physician and radiologist at a minimum. There are relative contraindications to PTLB and the balance of benefit against risk for the procedure should be assessed at a multidisciplinary meeting. All patients with FEV1 <35% predicted should not undergo needle biopsy without further assessment by the multidisciplinary team. Recent chest radiographs and CT scans and all previous radiological investigations should be reviewed to decide if a biopsy is appropriate and must be available to the radiologist at time of the biopsy. The decision on the type of needle used will be made by the operator and will be dependent on operator experience, available cytological support, and the position of the lesion. On site attendance of the cytopathologist will increase the success rate of the PTLB.The operator should be able to identify and appropriately manage the complications of lung biopsy procedures. Resuscitation facilities and chest drain equipment should be immediately available.