PURPOSE: A mobile radiography automatic grid alignment system (AGAS) has been developed by modifying a commercially available mobile unit. The objectives of this article are to describe the modifications and operation and to report on the accuracy with which the focal spot is aligned to the grid and the time required to achieve the alignment. METHODS: The modifications include an optical target arm attached to the grid tunnel, a video camera attached to the collimator, a motion control system with six degrees of freedom to position the collimator and x-ray tube, and a computer to control the system. The video camera and computer determine the grid position, and then the motion control system drives the x-ray focal spot to the center of the grid focal axis. The accuracy of the alignment of the focal spot with the grid and the time required to achieve alignment were measured both in laboratory tests and in clinical use. RESULTS: For a typical exam, the modified unit automatically aligns the focal spot with the grid in less than 10 s, with an accuracy of better than 4 mm. The results of the speed and accuracy tests in clinical use were similar to the results in laboratory tests. Comparison patient chest images are presented--one obtained with a standard mobile radiographic unit without a grid and the other obtained with the modified unit and a 15:1 grid. The 15:1 grid images demonstrate a marked improvement in image quality compared to the nongrid images with no increase in patient dose. CONCLUSIONS: The mobile radiography AGAS produces images of significantly improved quality compared to nongrid images with alignment times of less than 10 s and no increase in patient dose.