Evidence-based medicine (EBM) is medicine that seeks and applies evidence. It requires the explicit application of available reliable evidence to diagnostic decisions, and the triad of patient rights, values, and expectations in order to develop the best treatment plan. And imaging is the medicine of seeking and applying evidence. In clinical medicine, the role of “scout” cannot be underestimated; it has an important value and high status in helping clinical decision-making and image-guided treatment. Therefore, in the practice of medical imaging diagnosis and differential diagnosis, objective scientific basis and results should be used as evidence. We need to make logical reasoning, meticulous analysis, clinical integration, and perfect conclusion from the surface to the inside, and from the crude to the refined, and from the false to the true. Recent rapid advances in chest imaging have had a highly effective, intelligent, and intuitive impact on clinical medicine, resulting in a fundamental shift in the paradigm and value of diagnostic information. Image-guided procedures (IGP) and surgical navigation (IGS) are the full range of clinical applications of modern medical imaging technology. This has led to a deeper understanding of the interpretation of imaging information by clinicians. However, there are 3 points that should be paid attention to in the chest imaging diagnosis. First, focus on the intuitiveness of chest imaging information Intuitive, that is, the visualization of images, requires the search for visual evidence and the application of this credible evidence. In clinical practice, the detection of malignant cells in bronchi and sputum, but no lesion is seen on imaging or bronchoscopy is called occult lung cancer (Tx). In modern CT, a very thin layer thickness (0.5 or 0.625 mm) can be used for multi-planar reformation (MPR), a post-processing method that is fully capable of detecting or finding such microscopic lesions hidden in the bronchial lumen at the millimeter level. This visualization of the images is a reliable evidence for clinical solutions to determine the surgical site and protocol. To cite a case of occult lung cancer (Tx), a conventional CT cross-sectional scan, fibrinoscopy, and PET/CT were performed and no lesion was found. The patient was clinically at a loss as to what to do with this finding and was confused as to what to do next. Then, a multi-layer spiral CT scan, MPR and CT virtual endoscopy (CTVE) were performed to find that the lumen of the posterior right upper lobe was significantly narrowed and that the thickening of the wall of the posterior right upper lobe was due to the presence of a 3 mm diameter micronodule in the lumen of the posterior right upper lobe, thus clarifying the surgical site. The surgical site was thus clarified. The surgical pathology was small cell carcinoma of the lung (T1N0M0). Second, pay attention to the multiplicity of chest imaging information Currently, chest imaging diagnosis is different from the past, when only a single diagnostic imaging mode was selected, and the diagnostic mode of comprehensive imaging has been clinically recognized as the preferred method for the diagnosis of chest diseases. The emergence of many new examination techniques has greatly improved the diagnostic accuracy and diagnostic level of chest diseases, and the previous single diagnostic mode can no longer meet the current needs of diagnostic imaging. However, multiple examinations may lead to different conclusions in a single case. When interpreting these multiple (CT, MRI, DSA, PET-CT) imaging signs, clinicians should learn to pay attention to the multiple signs from the surface to the inside, remove the rough and fine, remove the false and keep the true, analyze meticulously, identify carefully, combine with the clinic, find out the pattern, improve the strengths and avoid the weaknesses, verify each other, complement each other, make judgment and improve the conclusion. PET-CT, as one of the advanced tumor diagnostic tools, realizes the fusion of PET and CT images on the same machine, providing unique information from both imaging methods. PET imaging provides dynamic physiological and biochemical functional information of the body, while CT provides precise anatomical information, and the fused images of both can precisely locate and complement each other. In another case, a PET/CT physical examination revealed a small nodule in the right upper lung, less than 2 cm in diameter, with a hypermetabolic SUV (standardized uptake value) of 3.8. The diagnosis was small peripheral lung cancer, which required surgery. To verify this diagnosis, thin-section CT and MPR were subsequently performed again, and it was observed that the images showed multifocal, disconnected small lesions in the cross-sectional, coronal, and sagittal planes, which are characteristic of tuberculosis. In the CT diagnosis of pulmonary tuberculosis, special emphasis is placed on the regular features of “three more” and “three less”, i.e., tuberculosis foci are multifocal, polymorphic, calcified, less massy, less aggregated, and less enhanced. These six features are precisely the evidence and key points for a precise differential diagnosis with peripheral lung cancer. In addition, the nodule of tuberculosis proliferation itself can be hypermetabolic, thus CT negates the diagnosis of lung cancer, and surgical pathology confirms that it is tuberculosis, not lung cancer. Therefore, at 2.5, it is more important to observe the reconstructed images of the sagittal and coronal planes of the MPR of CT than the cross-sectional planes. Third, pay attention to the specificity of chest imaging diagnosis Medical imaging diagnostic thinking belongs to the category of logical reasoning. If the more imaging information and clinical data obtained, the more disease types usually mastered, the more anatomical knowledge and normal variation understood, the more logical the reasoning is, and the more perfect and accurate the diagnosis is. Therefore, scientific evidence seeking is the key; correct authentication, dialectic and interpretation is the bridge; rich knowledge of anatomy, pathology and imaging is the foundation; necessary clinical information and diagnostic experience is the guarantee. According to the theory that the outer zone of the tumor is the area of proliferation and active growth of cancer cells according to the different distribution of lung cancer vascular configuration, the CT angiography technique can show that the rich microvascular branching structure of the outer zone of the tumor in the marginal area of lung cancer can be enhanced to form a very special “tumor microvascular CT imaging sign”. The central part of the tumor, where the lung tissue is destroyed/reconstructed, does not show this sign. Thus, this is a very important evidence to differentiate small peripheral lung cancer less than 2 cm in diameter from other solitary lung nodules. This is diagnostic specificity and its application can significantly improve the correct preoperative diagnosis of small lung cancer. With the continuous updating of medical imaging digital equipment, new diagnostic modes such as low-dose, high-resolution, spectral imaging of the chest have been developed in medical imaging. In particular, spectral imaging, as a kind of functional imaging, can provide more and more comprehensive pathological information, and CT spectral technology can improve the detection rate of small and multiple lesions in the lung through material separation, and also identify the benign and malignant lesions. With the widespread development of this technology and the recognition and understanding of the characteristic curves of various material energy spectra, the medical community will have great breakthroughs in imaging diagnosis, efficacy assessment and prevention of lung tumors. Medical imaging at this stage of development has expanded from providing macroscopic information to providing microscopic information, keeping pace with and ahead of each other with the development of genetic/genetic, molecular biology and computer technology. In the next 5 to 10 years, it will affect a fundamental change in the entire medical paradigm.