Abstract: A videofluoroscopy device having a rotatable and vertically moveable c-arm, with an x-ray device mounted thereupon, is connected to a system for producing a picture-in-a-picture (PIP) real time motion x-ray image. A video camera mounted on the videofluoroscopy device c-arm, proximal to the x-ray device, permits an operator to view an external picture of the patient while simultaneously viewing the x-ray image. An electrical circuit coupled to the system converts the two video signals into one PIP image. The single PIP image can be recorded on video tape and/or viewed on a monitor. In the preferred embodiment, the "full-screen" image is the motion z-ray image while the overlaid smaller image, placed in a box in the corner of the video frame, is that of an external view of the patient corresponding to the portion of the body being x-rayed.