Last few years has witnessed significant advances in linac technology and therapeutic dose delivery method. Digital linacs equipped with high dose rate flattening -filter free (FFF) beams have been clinically implemented in a number of hospitals. Gated VMAT is becoming increasingly popular in treating tumors affected by respiratory motion. Simultaneously, MR guided radiation delivery systems such VewRay's Renaissance system and other novel image guided delivery system such as Vero SBRT system from BrainLab/Mitsubishi are being implemented clinically. This session is devoted to update the audience with these technical advances and to present our experience in clinically implementing the new linacs and dose delivery methods. Topics to be covered include, technical features of new generation of linacs from different vendors, dosimetric characteristics and clinical need for FFF-beam based IMRT and VMAT, respiration-gated VMAT, beam level imaging and onboard image guidance tools. Emphasis will be on providing fundamental understanding of the new treatment delivery and image guidance strategies, control systems, and the associated dosimetric characteristics. Commissioning experience on these new treatment delivery technologies will be reported. Clinical experience and challenges encountered during the process of implementation of the new treatment techniques will be highlighted. At the conclusion of this activity, the learner will be able to do the following: 1. Describe digital accelerators and new dose delivery technologies, as well as the onboard image guidance systems associated with the new type of LINACS. 2. List the dosimetric characteristics and pro-and-cons of high dose rate FFF (flattening-filter free) beams for radiation therapy and SBRT. 3. Explain clinical implementation of new treatment techniques from different vendors.