Disclosed herein are radiation therapy systems and methods. These radiation therapy systems and methods are used for emission-guided radiation therapy, where gamma rays from markers or tracers that are localized to patient tumor regions are detected and used to direct radiation to the tumor. The radiation therapy systems described herein comprise a gantry comprising a rotatable ring coupled to a stationary frame via a rotating mechanism such that the rotatable ring rotates up to about 70 RPM, a radiation source (e.g., MV X-ray source) mounted on the rotatable ring, and one or more PET detectors mounted on the rotatable ring.