 With recent trends in modern radiation therapy moving towards escalating doses and decreasing margins a positioning system with high accuracy is essential. In order to deliver these therapeutic doses accurately, several localization systems have been developed for precise localization and positioning of patients utilizing radiographic and non-radiographic methods. Radiographic imaging systems are standard in modern delivery systems and include KV, MV, and CBCT imaging capabilities. While non-radiographic systems can range from simple room lasers to sophisticated systems using radiofrequency tracking and optical surface monitoring. Each of these systems usually consists of independent, vendor-specified QA phantoms and methods, increasing the time needed for QA, space for storage of phantoms, and reducing the reproducibility of setup. Additionally, performing QA on each system independently does not easily establish overall coincidence. By testing each positional system with a single phantom, we eliminate setup uncertainty and thus quantify the offset and coincidence of each system relative to the imaging isocenter. Our new phantom design encompasses all positional system QA into a single piece of equipment, laser alignment marks, raised letter S on the anterior surface for optical surface monitoring registration, radiofrequency beacons for RF tracking with articulation for rotational verification, isocentric bearing for the Winston-Lutz test, and tilt legs for optical surface monitoring rotational verification. Cross-validating the S-phantom against vendor-specified phantoms shows no significant differences from routine QA. However, the S-phantom additionally tests for rotational accuracy of both the optical surface and RF tracking systems. How about a demo? We begin by aligning the phantom to room lasers and initiating routine KV-MV-CPCT coincidence QA. Without entering the room, we can proceed to the Winston-Lutz test, simultaneously employing the optical surface system to determine its walkout with couch rotation. Next, deploying the radiofrequency system, we can test its coincidence to the imaging system without touching the phantom. Finally, we can use the internal rotational stage to verify a 10-degree roll of the RF beacons and deploy the tilting legs to verify the pitch of the optical surface monitoring system. In summary, the integrated phantom can simplify QA by reducing the number of phantoms and time needed for routine QA. It is an independent procedure from vendor-specific methods and clearly quantifies intra-system coincidence to ensure confident treatments. For more information, please visit Medical Physics to review the PDF of the study, including images and more information.