Magnetic resonance imaging (MRI)-guided brachytherapy for locally advanced cervical cancer was introduced at Aarhus University Hospital in December 2005. Until then two-dimensional (2D) X-ray based planning had been performed with prescription of dose to point A. After a short learning period of 2 months, we moved to full prospective MRI-guided dose planning and optimization for every brachytherapy fraction. Two fractions of pulsed dose rate (PDR) brachytherapy are given, and a planning MRI is obtained one week prior first brachytherapy in order to plan the application. An MRI compatible tandem-ring applicator is used. When parametrial extension would lead to insufficient coverage by an intracavitary application, a combined intracavitary-interstitial applicator is used with blunt-ended titanium needles.