 The standard treatment of locally advanced cervical cancer is radio-chemotherapy including external beam radiotherapy EBRT, brachytherapy BT and concomitant chemotherapy with weekly Cisplatin. While image based conformal EBRT is routinely used, prescription and reporting of BT is still based on specific dose points which are conventional radiography based surrogates for tumour Manchester point A prescription point and normal tissues International commission on Radiation Units and Measurements ICRU Bladder and Rectum point. This conventional radiography based planning has been adopted universally for ease of delivering safe doses with reasonably good local control rates stage IIB - 85; Stage IIIB - 65 and acceptable acute and late toxicities 10 grade IIIIV. Thus, for several decades conventional radiography based prescription has been standard of care universally. But these conventional radiography based surrogates have been proved to be only rough estimates and do not always correlate in 3 dimensional 3D anatomy for neither tumour nor normal tissues for actual doses delivered and outcomes in terms of control rates and toxicities respectively. Several studies have been published demonstrating limitations and criticizing this point based treatments. In 2006, a working group from Groupe Européen de Curiethérapie- European Society for Therapeutic Radiology and Oncology GEC-ESTRO has published recommendations on contouring of tumour target and organs at risk OAR as well as on dose volume parameters to be reported for image guided BT in definitive radiotherapy for locally advanced cervical cancer. These recommendations are mainly derived from retrospective single institution experience with Magnetic Resonance MR image based Intracavitary Brachytherapy ICBT. The major advantage of this technique is the possibility to conform the dose given by BT with regard to volume 3D for both tumour and critical normal tissues bladder, rectum, sigmoid mainly. Thus, by repetitive imaging performed before each BT treatment it is possible to adapt dose given as per the anatomy of each individual patient taking into account not only the position of OAR but also the tumour regression which often is obtained by preceding EBRT and chemotherapy. Clinical Outcome data from Vienna, Paris and Mumbai have shown potential in improved local control rates with acceptable toxicities so far. Prospectively treated more than 100 patients with image based brachytherapy from Vienna Group have shown improved local control rates across all stages with decreased toxicity on comparisons with historical series of patients treated with Conventional Radiography based BT 13-19. Also, a phase II multicentre intercontinental study using MR Image Based Brachytherapy EMBRACE: European study on MRI-guided Brachytherapy in Locally Advanced Cervical Cancer has been implemented and tested in various centres across the world including Tata Memorial Hospital, Mumbai. Over 600 patients have been recruited in the study so far. Based on the experience collected so far, the image based BT approach is expected to have a major impact on the clinical outcome for II B and III B increase in local control rates by 10-20 with concomitant decrease in the rates of late normal tissue toxicity 5 Grade 34, as compared to historical results for point based conventional treatment prescriptions 20. 