Image-based invasive intervention integrates personalised diagnosis and personalised treatment.Treatment response assessment with imaging will improve personalised treatment.Anatomical, functional and molecular imaging biomarkers affect decisions on the type and intensity of treatment.Personalised prevention will rely on image-based screening programmes.Medical imaging is a key component in personalised medicine.Radiologists need to be prepared for this new paradigm as it will mean changes in training, clinical practice and in research. Furthermore, imaging is essential to patient-tailored therapy planning, therapy monitoring and follow-up of disease, as well as targeting non-invasive or minimally invasive treatments, especially with the rise of theranostics. In addition, radiogenomics relate imaging biomarkers to these genetic and molecular features. Image-guided biopsy provides relevant tissue specimens for genetic/molecular characterisation. Treatment decisions are based on the in vivo visualisation of the location and extent of an abnormality, as well as the loco-regional physiological, biochemical and biological processes using structural and molecular imaging. Stratification based on imaging biomarkers can help identify individuals suited for preventive intervention. Screening for preclinical disease is done with imaging. Imaging procedures are tailored to the clinical problem and patient characteristics. It is instrumental in solving clinical differential diagnoses. Medical imaging has always been personalised and is fundamental to almost all aspects of PM. The future of medicine lies in early diagnosis and individually tailored treatments, a concept that has been designated ‘personalised medicine’ (PM), which aims to deliver the right treatment to the right patient at the right time.