Why do thoracic surgeons need training in decision making? Many of us who have weathered harrowing residencies in surgery feel that, after such experiences, decision making is a natural extension of our selves. While this is no doubt true, correct de- sion making is something that many of us have yet to master. The impetus to develop a text on evidence-based decision making in thoracic surgery was stimulated by a conference for cardiothoracic surgical trainees developed in 2004 and sponsored by the American College of Chest Physicians. During that conference it became clear that we as thoracic surgeons are operating from a very limited fund of true evidence-based information. What was also clear was the fact that many of the decisions we make in our everyday practices are not only uninformed by evidence-based medicine, but often are contradictory to existing guidelines or evidence-based recommendations. The objectives of this book are to explain the process of decision making, both on the part of the physician and on the part of the patient, and to discuss speci? c clinical problems in thoracic surgery and provide recommendations regarding their mana- ment using evidence-based methodology. Producing a text that will purportedly guide experienced, practicing surgeons in the decision-making process that they are acc- tomed to observe on a daily basis is a daunting task.