Head and neck squamous cell carcinoma represents an ideal model to investigate the application of recent advances in medical imaging to radiotherapy planning. Tumours usually remain localized, and are potentially curable with local radiation. The steep radiation dose-response relationships support the strategies of radiation dose escalation to increase local control. Two-dimensional simulator-based planning and CT planning have significant drawbacks in terms of accurate target volume definition. MRI has enhanced soft tissue delineation, but has to be fused with CT to allow dose calculation. Functional imaging using dynamic contrast enhanced CT or MRI sequences may allow improved knowledge of tumour function. Positron emission tomography (PET) may allow further physiological information to be determined. This review summarizes the current techniques in clinical development in this area.