Described herein are systems and methods for tracking a target tissue during therapy delivery. A system for identifying an anatomical structure and tracking the motion of the anatomical structure using imaging before and during delivery of a therapy to a patient includes an imaging module and a therapy module. In some cases, the imaging module is configured to identify a region of the anatomical structure in an image, and the therapy module is configured to deliver the therapy to a target tissue. A method for imaging during delivery of a therapy includes acquiring an image, identifying a region of an anatomical structure, tracking the region of the anatomical structure, integrating the tracking, generating a unique template library, determining if a pre-existing template matches the results or if the results should be updated as a new template, and delivering the therapy to the target tissue.