Lung ablation has emerged as a crucial intervention for managing both primary and metastatic lung tumors. While surgical resection remains the most effective treatment, only about 20% of lung lesions are operable due to advanced disease, comorbidities, poor functional status, and specific tumor characteristics (Scott et al., Chest 132 (3 suppl):234S–242S, 2007). For inoperable lesions, stereotactic body radiation therapy (SBRT) combined with adjuvant systemic therapy is a common alternative, albeit with significant side effects. Minimally invasive, image-guided percutaneous ablation offers a promising solution, providing effective treatment while preserving maximum functional lung volume and enhancing quality of life. Multiple medical societies endorse this method as a safe and effective lung-preserving treatment option for both primary lung cancer and metastases. The National Comprehensive Cancer Network (NCCN Guidelines 2024) supports thermal ablation for nonsmall cell lung cancer (NSCLC) in select patients with tumors up to T3 (up to 7 cm in diameter), although tumors larger than 3 cm have a higher risk of recurrence, and as one of the treatment options for dominant nodule in multifocal lung cancer (National Comprehensive Cancer Network. Non-small cell lung cancer (version 8.2020), 2020). The Society of Interventional Radiology (SIR) approves thermal ablation for patients with inoperable Stage IA NSCLC, recurrent NSCLC, and metastatic lung disease (Genshaft et al., J Vasc Interv Radiol 32:1241.e1–1241.e12, 2021). Available techniques include radiofrequency ablation, microwave ablation, cryoablation, laser ablation, and irreversible electroporation (IRE). Although comprehensive comparative studies are lacking, all methods demonstrate excellent tolerance and minimal complications. This chapter will explore the indications for lung ablation, various image-guided techniques, potential complications, and imaging follow-up.