This study investigates the visualization of translation reorganization in mammalian cells under persistent ribosome collision stress using cryo-electron tomography. The authors found that polysomes are compressed, with up to 30% of ribosomes in helical polysomes or collided disomes, some bound to the stress effector GCN1. The native collision interface extends beyond the 40S subunit, including the L1 stalk and eEF2, which may contribute to translocation inhibition. The accumulation of unresolved tRNA-bound 80S and 60S complexes, as well as aberrant 40S configurations, indicates potential limitations in collision responses. The study provides a global view of the translation machinery's response to persistent collisions and a framework for quantitative analysis of translation dynamics in situ. Key findings include the presence of tRNA bound to the Z site of elongating ribosomes, a larger and more constrained interface between collided ribosomes, and the accumulation of non-functional tRNA-bound 60S particles under persistent collision stress. These insights highlight the value of cryo-ET for integrating native conformational and spatial information in cells to discriminate between proposed models and generate hypotheses for future research.This study investigates the visualization of translation reorganization in mammalian cells under persistent ribosome collision stress using cryo-electron tomography. The authors found that polysomes are compressed, with up to 30% of ribosomes in helical polysomes or collided disomes, some bound to the stress effector GCN1. The native collision interface extends beyond the 40S subunit, including the L1 stalk and eEF2, which may contribute to translocation inhibition. The accumulation of unresolved tRNA-bound 80S and 60S complexes, as well as aberrant 40S configurations, indicates potential limitations in collision responses. The study provides a global view of the translation machinery's response to persistent collisions and a framework for quantitative analysis of translation dynamics in situ. Key findings include the presence of tRNA bound to the Z site of elongating ribosomes, a larger and more constrained interface between collided ribosomes, and the accumulation of non-functional tRNA-bound 60S particles under persistent collision stress. These insights highlight the value of cryo-ET for integrating native conformational and spatial information in cells to discriminate between proposed models and generate hypotheses for future research.