Over the last several years, there has been a marked increase in the availability of technologies intended to improve the therapeutic ratio of thoracic radiation. We will review these technologies (e.g., 3-dimensional planning, image guidance, tracking, adaptive therapy, radiosurgery, IMRT etc.), and their associated utilities and potential shortcomings. At the conclusion of this activity, the learner will be able to do the following: 1. Discuss the utility and potential shortcomings associated with 3-dimensional radiation treatment planning and intensity modulated radiation. 2. Explain the utility and potential shortcomings associated with motion management (e.g. gating). 3. Outline the utility and potential shortcomings associated with adaptive radiotherapy.