Project Summary / Abstract Radiation therapy is an effective component of the treatment strategy for patients suffering from smoking- related cancers. Advanced techniques such as intensity modulated radiation therapy (IMRT) improve outcomes relative to conventional approaches. Access to this modern treatment modality is limited in Eastern Kentucky, Appalachia and other geographically isolated populations throughout low- and middle-income countries. The broad, long-term objective of this research is improving the accessibility and safety of advanced radiation techniques for patients low-resource settings globally. Quality assurance (QA) programs are required to ensure safe and accurate treatment. The complexity of QA devices is such that their use requires highly specialized human resources (i.e., medical physicists) who must be physically present to collect and analyze data. Providers in these low-resource settings struggle to recruit the necessary staff. This can prevent such clinics from providing IMRT to their patients, even when they own accelerators that are IMRT-capable. Medical Physics Innovations (MPI) proposes to design and construct a user-friendly, affordable QA device that will make high quality QA and precision RT treatments in these low-resource settings more accessible and safe. This proposal will establish feasibility via two specific aims: 1) Build and test the 3 primary subcomponents of an integrated device and 2) Construct and test a clinical prototype. The consolidation of multiple device functions combined with the ease of use and measurement precision enable a paradigm shift if how medical physics services and quality assurance are rendered. Sparse but efficient daily QA protocols will be replaced with comprehensive data collection and automated analysis, at no additional cost in time or staffing. High precision radiation treatments can be safely brought to rural and underserved areas, with safety, efficiency and precision improved in any center using the innovation.