Simple SummaryThe two most common cross-sectional imaging modalities, computed tomography (CT) and magnetic resonance imaging (MRI), have shown enormous utility in clinical oncology. The emergence of artificial intelligence (AI)-based tools in medical imaging has been motivated by the desire for greater efficiency and efficacy in clinical care. Although a growing number of new AI tools for narrow-specific tasks in imaging is highly encouraging, the effort to tackle the key challenges to implementation by the worldwide imaging community has yet to be appropriately addressed. In this review, we discuss a few challenges in using AI tools and offer some potential solutions with examples from lung CT and MRI of the abdomen, pelvis, and head and neck (HN) region. As we advance, AI tools may significantly enhance clinician workflows and clinical decision-making.AbstractCancer care increasingly relies on imaging for patient management. The two most common cross-sectional imaging modalities in oncology are computed tomography (CT) and magnetic resonance imaging (MRI), which provide high-resolution anatomic and physiological imaging. Herewith is a summary of recent applications of rapidly advancing artificial intelligence (AI) in CT and MRI oncological imaging that addresses the benefits and challenges of the resultant opportunities with examples. Major challenges remain, such as how best to integrate AI developments into clinical radiology practice, the vigorous assessment of quantitative CT and MR imaging data accuracy, and reliability for clinical utility and research integrity in oncology. Such challenges necessitate an evaluation of the robustness of imaging biomarkers to be included in AI developments, a culture of data sharing, and the cooperation of knowledgeable academics with vendor scientists and companies operating in radiology and oncology fields. Herein, we will illustrate a few challenges and solutions of these efforts using novel methods for synthesizing different contrast modality images, auto-segmentation, and image reconstruction with examples from lung CT as well as abdome, pelvis, and head and neck MRI. The imaging community must embrace the need for quantitative CT and MRI metrics beyond lesion size measurement. AI methods for the extraction and longitudinal tracking of imaging metrics from registered lesions and understanding the tumor environment will be invaluable for interpreting disease status and treatment efficacy. This is an exciting time to work together to move the imaging field forward with narrow AI-specific tasks. New AI developments using CT and MRI datasets will be used to improve the personalized management of cancer patients.