Sectional imaging has played an important role in the management of cervical cancer, in particular for staging, and is now considered for image-guided treatment planning, in particular for brachytherapy. Image-based three-dimensional brachytherapy is a relatively new approach that is increasingly replacing the traditional two-dimensional X-ray-based method. This overview focuses on the potential and some practicalities of this approach. The pros and cons of computed tomography- and magnetic resonance imaging-based brachytherapy are considered and an overview of the current state of research is given. The first encouraging clinical results are presented and future perspectives are discussed.