This chapter explores two separate components of on-treatment imaging for geometric verification. The first is the commissioning of such equipment, techniques, and the processes involved. The second examines the oncology management system, often termed internationally as the record and verify system, its expanding role in radiotherapy, and how on-treatment imaging is fully integrated into its functionality. For radiotherapy equipment, the commissioning phase will follow the formal acceptance process; a stage that has both legal and financial implications for the manufacturer and the customer. The commissioning tests and checks establish the baseline for clinical operation and routine quality assurance and define the expected standard values for quality-control checks undertaken routinely for daily, weekly, monthly, and annual checks. The literature is a mine of information for key writings on commissioning and clinical implementation for on-treatment imaging equipment and techniques. The origin of reference data must be considered for both integrated and third-party treatment planning systems and software.