Technical improvements in computed tomography and magnetic resonance imaging as well as the wider availability of biological imaging have facilitated the implementation of high-precision 3-dimensional conformal and intensity-modulated radiotherapy (RT) in head and neck cancer. The integration of recent advances in functional and molecular imaging has already improved RT delivery, response prediction, and follow-up. Rational clinical use of all modalities should be encouraged, especially in the setting of imaging-intensive investigational RT protocols such as adaptive therapy. An expanded development of imaging markers that can predict radioresistance or outcome could further customize treatment. The continued successful use of innovative imaging in routine clinical practice will ultimately depend on well-designed clinical studies with adequate follow-up.

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