Monte Carlo techniques have become ubiquitous in medical physics over the last 50 years with a doubling of papers on the subject every 5 years between the first PMB paper in 1967 and 2000 when the numbers levelled off. While recognizing the many other roles that Monte Carlo techniques have played in medical physics, this review emphasizes techniques for electron-photon transport simulations. The broad range of codes available is mentioned but there is special emphasis on the EGS4/EGSnrc code system which the author has helped develop for 25 years. The importance of the 1987 Erice Summer School on Monte Carlo techniques is highlighted. As an illustrative example of the role Monte Carlo techniques have played, the history of the correction for wall attenuation and scatter in an ion chamber is presented as it demonstrates the interplay between a specific problem and the development of tools to solve the problem which in turn leads to applications in other areas.This paper is dedicated to W Ralph Nelson and to the memory of Martin J Berger, two men who have left indelible marks on the field of Monte Carlo simulation of electron-photon transport.