It has been shown that intensity-modulated radiation therapy (IMRT) has clinical benefits to patients and that image-guided radiation therapy (IGRT) ensures the accurate delivery of planned doses to desired target volumes while sparing adjacent normal tissues and critical organs. IMRT and IGRT, therefore, should be widely implemented by radiation therapy clinics regardless of their size or staffing level. This article addresses the fundamental requirements and clinician responsibilities for implementing IMRT and IGRT in small radiation therapy clinics. This article also outlines routine quality assurance tests necessary for an ongoing IMRT/IGRT program.