Abstract.A photon-cell interactive Monte Carlo (pciMC) that tracks photon migration in both the extra-and intracellular spaces is developed without using macroscopic scattering phase functions and anisotropy factors, as required for the conventional Monte Carlos (MCs). The interaction of photons at the plasma-cell boundary of randomly oriented 3-D biconcave red blood cells (RBCs) is modeled using the geometric optics. The pciMC incorporates different photon velocities from the extra-to intracellular space, whereas the conventional MC treats RBCs as points in the space with a constant velocity. In comparison to the experiments, the pciMC yielded the mean errors in photon migration time of 9.8 ± 6.8 and 11.2 ± 8.5% for suspensions of small and large RBCs (RBC small , RBC large ) averaged over the optically diffusing region from 2000 to 4000 μm, while the conventional random walk Monte Carlo simulation gave statistically higher mean errors of 19.0 ± 5.8 ( p < 0.047) and 21.7 ± 19.1% (p < 0.055), respectively. The gradients of optical density in the diffusing region yielded statistically insignificant differences between the pciMC and experiments with the mean errors between them being 1.4 and 0.9% in RBC small and RBC larger , respectively. The pciMC based on the geometric optics can be used to accurately predict photon migration in the optically diffusing, turbid medium. C 2010 Society of Photo-Optical Instrumentation Engineers.