Two reviews in the last 12 years have differed widely in their indications for the use of whole lung lavage (WLL) to remove plutonium from the lung, one recommending its use at relatively low radiation doses to prevent stochastic effects and the other recommending restricting its use to high doses to prevent deterministic effects only. Since the publication of these reviews significant data have accumulated demonstrating the increased safety of WLL, and there are additional data on stochastic and deterministic effects. We discuss deterministic and stochastic risks and the practical aspects of undertaking WLL. We recommend that each case be assessed individually.