Minimally invasive techniques using endoscopes for image guided therapy are common in the surgical field and in internal medicine. Interventional procedures in the past were performed with either fluoroscopic, sonographic or CT-guidance, but now MRI-guided interventional procedures are being developed. Combining these technologies will improve surgical access and reduce complications. Today, tomographic 2 D and 3 D imaging (CT , EBT, MRI) can be used for precise and transparent guidance of endoscopes and surgical instruments inside the body for the field of minimally invasive therapy. 3 D imaging is helpful for anatomical , but not for morphological understanding. It has to be used interactivly with actual cross sectional imaging for instrument guidance. This will offer a safe and effective access into the body, especially in high risk areas and lead to the new field of “ Surgical Tomography”.