A medical diagnostic imaging system (100) includes an X-ray source and X-ray detector, sensors (123, 126) tracking a position of at least one of a surgical instrument (122) and the X-ray detector, and an integrated imaging and navigation workstation (102). The integrated imaging and navigation workstation (102) includes at least one processor executing fluoroscopic imaging based on an output of the X-ray detector and navigation tracking of positions of a surgical instrument (122) and positions of an X-ray detector with respect to a coordinate system. The integrated imaging and navigation workstation (102) also includes an input (114) receiving surgical instrument tracking signals from the sensors, an input (116) receiving detector tracking signals from the sensors, and a display (133) for displaying fluoroscopic images with a displayed instrument superimposed. In particular, one or more relations of the displayed instrument with respect to the fluoroscopic image (e.g., coordinate location and rotation) corresponds to the relation of the surgical instrument (122) to the patient. <；IMAGE>；
