Biomedical implants play an important role in today's clinical practice. Unfortunately, biomedical implant-mediated host responses may lead to implant failure. Thus, all implants are tested for tissue compatibility prior to clinical trials. For that, after implantation in animals for different periods of time, the implants and surrounding tissues are isolated for histological analyses. Unfortunately, histological evaluation methods are labor intensive, time consuming, expensive and do not produce quantitative outcomes. With the advent of in vivo imaging technology, many imaging methods have been developed for evaluating biomedical implant-associated immune responses. In this review, we summarize the recent progress in the use of in vivo real-time imaging techniques for assessing acute phase foreign body reactions, including fibrin deposition, inflammatory cell recruitment and responses surrounding biomaterial implants. These new technologies may serve as powerful tools to characterize tissue compatibility of medical implants.