We have been developing a digital fluoroscopic imaging system to replace the portal films that are currently used to verify patient positioning during radiotherapy treatments. Our system has a number of modifications compared to previously reported devices. The detector, which consists of a copper plate with Gd2O2S:Tb phosphor bonded directly to the copper, has been designed to maximize light output from the phosphor by increasing the phosphor thickness. The operation of the T.V. camera has been modified so that the light signal is accumulated on the target of the T.V. camera for periods of 0.2-2.0 seconds. Accumulation of the light increases the video signal relative to the fixed noise current generated by the camera, and thus minimizes the camera noise. The resulting image quality is comparable to film, so the imaging system represents a promising alternative to film as a method of verifying patient positioning in radiotherapy.