This book constitutes the proceedings of the International Workshop on Shape in Medical Imaging, ShapeMI 2024, which took place in Marrakesh, Morocco, on October 6, 2024, held in conjunction with MICCAI 2024. The 16 full papers included in this book were carefully reviewed and selected from 24 submissions. They focus on shape and spectral analysis, geometric learning and modeling algorithms, and application-driven research.