Imaging is an important component for the monitoring of therapeutic success and disease control in patients with IBD. Colonoscopy is still the gold standard for imaging of disease activity. It is questionable, however, whether 'standard' or 'routine' imaging procedures max contribute to improved IBD therapy. There are good arguments for a problem driven imaging approach in IBD. Subsequently, the schedule of monitoring examinations should depend on the disease course (mild vs. severe) and the treatment used. Bowel ultrasound where available may substitute for endoscopy in many circumstances. New endoscopic techniques will be available at specialized centers for specific management questions. Applying these individualized strategies, imaging/monitoring will pay off for better disease control and better quality of life for IBD patients in the future.