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A major advance in the delivery of accurate radiation therapy is the integration of the linear accelerator with the ability to take rapid, high quality images of the target just before and/or during treatment. This allows the radiation oncologist to exactly adjust the field for minor movements of the target. For example, the prostate moves daily depending on the fullness of the bladder and rectum. At Martha Jefferson, both of our Varian linear accelerators provide kilovoltage, fluoroscopic and cone beam CT imaging through On Board Imagers. At many centers, while the images are taken pre-treatment, the radiation oncologist does not review them until the end of the day. Our radiation oncologists review the images in real time prior to each image-guided treatment, to optimize the use of this leap forward in precision.