This book constitutes the proceedings of the Workshop on Shape in Medical Imaging, ShapeMI 2018, held in conjunction with the 21st International Conference on Medical Image Computing, MICCAI 2018, in Granada, Spain, in September 2018. The 26 full papers and 2 short papers presented were carefully reviewed and selected for inclusion in this volume. The papers discuss novel approaches and applications in shape and geometry processing and their use in research and clinical studies and explore novel, cutting-edge theoretical methods and their usefulness for medical applications, e.g., from the fields of geometric learning or spectral shape analysis. .