High-field MRI at 3.0T is rapidly gaining clinical acceptance and experiencing more widespread use. The superiority of high-field imaging has clearly been demonstrated for neurological imaging. The impact of 3.0T imaging of the musculoskeletal system has been less dramatic due to complex optimization issues. Areas under consideration include coil technology, protocol modification, artifact reduction, and patient safety. In this article we review these issues and describe our experience with 3.0T musculoskeletal MRI. Fundamentally, an increased signal-to-noise ratio (SNR) is responsible for improved imaging at higher field strength. Increased SNR allows more headroom to adjust parameters that affect image resolution and examination time. It has been established that T1 relaxation time increases at 3.0T, while T2 time decreases. Consequently, scanner parameters require adjustment for optimization of images. Chemical shift and magnetic susceptibility artifacts are more pronounced and require special techniques to minimize the effect on image quality. Spectral fat saturation techniques can take advantage of the increased chemical shift. The specific absorption rate (SAR) and acoustic noise thresholds must be kept in mind at these higher fields. We additionally present some of the clinical issues we have experienced at 3.0T. A decision must be made as to whether to trade higher resolution for reduced scanning time. In general, we believe that routine imaging at 3.0T increases diagnostic confidence, especially for evaluations of cartilaginous and ligamentous structures.