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Retrospective view on the past two decades of medical image registration.Classification of the field introduced in 1998 is still usable.Main changes: intensity-based, nonlinear registration, generic software packages.Urgent problems still: validation, clinical acceptance.A retrospective view on the past two decades of the field of medical image registration is presented, guided by the article “A survey of medical image registration” (Maintz and Viergever, 1998). It shows that the classification of the field introduced in that article is still usable, although some modifications to do justice to advances in the field would be due. The main changes over the last twenty years are the shift from extrinsic to intrinsic registration, the primacy of intensity-based registration, the breakthrough of nonlinear registration, the progress of inter-subject registration, and the availability of generic image registration software packages. Two problems that were called urgent already 20 years ago, are even more urgent nowadays: Validation of registration methods, and translation of results of image registration research to clinical practice. It may be concluded that the field of medical image registration has evolved, but still is in need of further development in various aspects.