An imager includes: an array of imager elements configured to generate image signals based on radiation received by the imager; and circuit configured to perform readout of image signals, wherein the circuit is configured to be radiation hard. An imager includes: an array of imager elements configured to generate image signals based on the radiation received by the imager; and readout and control circuit coupled to the array of imager elements, wherein the readout and control circuit is configured to perform signal readout in synchronization with an operation of a treatment beam source.