Thoracic oncologic imaging interpretation includes evaluation of technical, patient, lung, and lesion features to reach leading differential considerations. Subsequent imaging-based management recommendations synthesize this evaluation of disease morphology with knowledge of histopathology and clinical outcomes. Challenges in thoracic oncologic imaging interpretation arise due to the variability in lung lesion growth rates, the range of imaging presentations of lung malignancies, the existence of pathologies with overlapping appearances, and the possibility of intercurrent neoplastic and nonneoplastic processes. Awareness of these features, as well as evolving algorithmic guidelines for the screening and surveillance of thoracic oncological diseases, can facilitate the accurate and standard reporting of oncologic findings.