Image-guided radiation therapy (IGRT) incorporates anatomical, functional, or biological information into radiation treatment design, planning, and delivery. The rationale for the use of IGRT in gynecologic malignancies includes three-dimensional assessment of tumor extent and surrounding organs, compensation for organ motion, adaptation to rapid tumor shrinkage, and potential dose escalation. The utilization of advanced imaging has led to improved target delineation and localization, more accurate reporting of dose to critical structures, and the ability to increase tumor dose in a way not possible before. Currently, computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography scan (PET-CT) are the most commonly used imaging methods in gynecologic IGRT with utilization largely based on resource availability and cost. IGRT has paved the way for technological advancements in radiation treatment and delivery including the emergence of intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), stereotactic body radiation therapy (SBRT), and image-guided adaptive brachytherapy (IGABT). IGRT is now largely regarded as standard of care in the treatment planning and delivery for most gynecologic malignancies. Since the introduction of IGRT in gynecologic cancer, strides have been made towards implementing daily adaptations through use of MRI-guided IGRT for more precise tumor targeting and incorporation of biological data to analyze and predict tumor response.