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Our overall research goal is to devise a robust method of tracking and compensating patient motion by combining an emission data based approach with a visual tracking system (VTS) that provides an independent estimate of motion. Herein, we present the latest hardware configuration of the VTS, a test of the accuracy of motion tracking by it, and our solution for synchronization between the SPECT and the optical acquisitions. The current version of the VTS includes stereo imaging with sets of optical network cameras with attached light sources, a SPECT/VTS calibration phantom, a black stretchable garment with reflective spheres to track chest motion, and a computer to control the cameras. The computer also stores the JPEG files generated by the optical cameras with synchronization to the list-mode acquisition of events on our SPECT system. Five Axis PTZ 2130 network cameras (Axis Communications AB, Lund, Sweden) were used to track motion of spheres with a highly retroreflective coating using stereo methods. The calibration phantom is comprised of seven reflective spheres designed such that radioactivity can be added to the tip of the mounts holding the spheres. This phantom is used to determine the transformation to be applied to convert the motion detected by the VTS into the SPECT coordinates system. The ability of the VTS to track motion was assessed by comparing its results to those of the Polaris infrared tracking system (Northern Digital Inc., Waterloo, ON, Canada). The difference in the motions assessed by the two systems was generally less than 1 mm. Synchronization was assessed in two ways. First, optical cameras were aimed at a digital clock and the elapsed time estimated by the cameras was compared to the actual time shown by the clock in the images. Second, synchronization was also assessed by moving a radioactive and reflective sphere three times during concurrent VTS and SPECT acquisitions and comparing the time at which motion occurred in the optical and SPECT images. The results show that optical and SPECT images stay synchronized within a 150-ms range. The 100-Mbit network load is less than 10%, and the computer's CPU load is between 15% and 25%; thus, the VTS can be improved by adding more cameras or by increasing the image size and/o- r resolution while keeping an acquisition rate of 30 images per second per camera.