The organisers of this conference have kindly provided me with the forum to look forward and examine the future of medical imaging. My view of the future is informed by my own research directions; thus, I illustrate my vision of the future with results from my own research, and from the research that has motivated me over the last few years. As such, the results presented are specific to the field of breast imaging; however, I believe that the trends presented have general applicability, and hope that this discourse will motivate new research. My vision of the future can be summarised in accordance with three broad trends: (1) increased prevalence of low-dose tomographic X-ray imaging; (2) continuing advances in functional and molecular X-ray imaging; and (3) novel image-based biomarker discovery.