The present disclosure is directed to a combined photoacoustic (PA) and ultrasound imaging system capable of generating PA and ultrasound images simultaneously. These images can be combined and displayed in real-time. The PA images are acquired by firing a illumination system into a sample being imaged and beamforming the received photoacoustic signals. Ultrasound images are formed by transmitting ultrasound energy into the object and beamforming the reflected signals. The present disclosure describes a timing controller to allow the illumination system and ultrasound transmissions to be timed relative to one another. This allows both modalities to operate at close to their maximum frame rates while preventing signal interference.