Volumetric CT imaging systems usually comprise a point x-ray source and a 2D detector. Flat panel imager (FPI)-based cone beam CT (CBCT) has become an important online imaging modality for image-guided radiotherapy and intervention. However, due to excessive scatter photons and inferior detector performance, the image quality of current CBCT is significantly inferior to diagnostic fan-beam CT. We propose a novel tetrahedron beam computed tomography (TBCT) imaging system which consists of a linear scan x-ray source and a linear x-ray detector array. The linear x-ray tube and detector array are aligned perpendicular and parallel to the rotation plane, respectively. The x-ray beams are narrowly collimated into fan beams and focused on the linear detector array. The linear detector and linear x-ray source form a ‘tetrahedron’ volume instead of a ‘cone’ volume. TBCT is similar to CBCT in image reconstruction geometry; however, its image quality will be significantly superior to that of CBCT due to its scatter rejection mechanism and the use of high-performance discrete x-ray detectors. In this paper, we describe the design of the TBCT system for image-guided radiotherapy and some results of preliminary studies.