At the Department of Radiotherapy, Medical University of Vienna 3D imaging for brachytherapy has been intensively investigated during the last decade. An open magnetic resonance image (MRI) scanner (0.2T Siemens Magnetom Open-Viva®) was installed in 1997/1998 at the division of brachytherapy in order to support image-guided brachytherapy, particularly for the treatment of gynecological cancers and prostate cancer. The MRI device was adapted to the needs of external beam radiotherapy (EBRT) and brachytherapy [1]. Specific image acquisition protocols were developed for prostate and gynecologic brachytherapy [1, 2]. At the beginning, the translation of the traditional experience based on X-ray assisted treatment planning into image-guided treatment planning was studied [3]. Finally, gynecological brachytherapy was performed MR image-guided [4, 5, 7, 10]. In cooperation with the GYN-GEC ESTRO group, concepts and terms for delineation of gross tumor volume (GTV) and clinical target volume (CTV) and organs at risk (OAR) [8], treatment plan optimization by adaptation of dwell times and locations [5, 7], integration of biological modeling [18], development of 3D image-based parameters to potentially evaluate dose volume relations for GTV and CTV as well as for OAR [9] and for dose escalation, as appropriate and feasible were developed [9, 10]. During these years, the departmental protocol for cervix cancer radiotherapy, and in particular for image-guided brachytherapy, was continuously developed [10]. Since 2001, a systematic approach, which enables prospective application of the different parameters for improvement of target coverage and dose escalation, is applied [10]. In 2007, based on the clinical experience collected during 1998–2003, the first mono-institutional study with clinical results on 145 patients treated with MR image-guided brachytherapy was published [10]. Since 2008, dose-effect relationships for the target volumes and the OARs are available for this patient series [11–14]. [ABSTRACT FROM AUTHOR]