The widespread use of computed tomography and the obligation of early diagnosis and treatment of small lung nodules have increased in recent years. There are few localization techniques, ROLL seems one of the safest and most effective. The purpose of this study is to report our experience. We have retrospectively reviewed all patients with undetermined lung nodule that underwent radio-guided localization. The aim of the study was to evaluate the efficacy of the ROLL for the diagnosis and treatment of small lung nodules. The morning of the surgery, Tc99 macroaggregated albumin was injected guided by computer tomography. Afterwards a SPECT-CT was performed to check the correct localization of the tracer and the patient was brought into the operating room. During the surgery a gamma probe connected to a gamma ray was introduced and the lung surface scanned. After detecting the higher value area, a lung resection was performed and the lung is rescanned to check the residual activity (less than 10%). Between November 2011 and February 2019, 30 patients (22 male and 8 female) underwent radiotracer injection followed by lung resection surgery in our institute. Mean age was 66,3 years (range 52 to 76 years). The main complication was pneumothorax (9 patients, 30%), but no patient required chest drainage. There was one non-complicated aortic puncture. There were no other complications. The mean nodule size was 9,07mm +/- 4,35mm and the mean visceral pleural distance was 19,6mm +/-16,27mm. By radiology characteristics, 16 were ground glass opacities, 10 solid nodules and 4 partially solid nodules. The lesions were well detected in 100% cases. They were resected by wedge resection in all the cases. The final pathologic diagnosis confirmed 12 lung adenocarcinoma (6 lepidic growth adenocarcinoma, 3 adenocarcinoma in situ, 2 solid adenocarcinomas, 1 minimally invasive adenocarcinoma), 12 lung metastasis, 2 atypical adenomatous hyperplasia, 2 inflammatory nodules, 1 squamous carcinoma and 1 hamartoma. Clean margins were obtained in 28 patients (93,3%). There were not intraoperative and postoperative complications secondary to the procedure. The radio-guided localization is a simple, easy and safe procedure for the diagnosis and treatment of small lung nodules. There were not problems of radiotracer lung diffusion and misplacement.