Abstract: X-ray positioning apparatus is described for aligning an x-ray imaging device (16) relative to a patient (10) to permit the operator to select and obtain an x-ray image from a selected anatomical region. A plurality of light reflective markers (14) is located on the patient's body to define certain anatomical landmarks. The apparatus comprises an x-ray source (20) and a separate light source (30) and an image sensor (33). Light reflected from the markers are detected by the image sensor (33). The image data is processed by an image processing system (46) which provides a variety of functions including determining the actual position the image device should be located to obtain the desired image. Embodiments of the invention are described.