Advancements in imaging techniques have led to a rapid growth of available imaging data. Interpretation of the imaging data and extraction of biologically, physiologically and/or medically relevant information, however, remains challenging. In contrast, mechanistic computational modelling provides a means to formalise and dissect mechanisms governing the behaviour of complex systems. However, its application often is limited due to the lack of relevant data for model building and validation. Exploitation of the imaging data to build, parameterise and validate computational models gives rise to an image-based modelling approach. In this chapter, we introduce the basics of the mechanistic image-based modelling approach and review its application in developmental biology and biomedical research as well as for medical device development and drug discovery and development. Implementation of image-based modelling in pharmaceutical industry holds promise to further advance model-informed drug discovery and development and aids substantially in our understanding of drug pharmacokinetic, pharmacodynamic and ultimately de-risk drug development.