The present invention relates to a system and method to aid the placement of surgical devices under radiographic image guidance. More particularly, embodiments of the invention relate to a system utilizing radiopaque markers, an external light source projected onto the skin or surgical site in conjunction with a target guide holder. Using a radiographic image to identify landmarks for skin entry and bone entry points to facilitate the accurate placement of surgical devices. An exemplary system utilizes a radiopaque marker, target guide holder and external laser markers to determine intra-operative angles, trajectories and positioning coordinates to facilitate placement of needles, guide wires, surgical hardware, trocars and cannulae for the surgical placement of orthopedic implantation devices.
