A method is described for determining and correcting the spatial distortion affecting images acquired with image‐intensified video systems. The distortion is separated into two physically distinct components, a predominant one originating from the projection of the x‐ray image onto the curved input phosphor, and a smaller component corresponding to the mapping from the input phosphor to the output phosphor and the digital image matrix. The former is determined geometrically and the latter is modeled with four empirical parameters. A method for determining the two components from calibration images of a grid phantom is presented. The model of the image intensifier distortion was found to be in good agreement with the measured distortion in the images. The correction is applicable to arbitrary angulations of the x‐ray beam with respect to the image intensifier tube, and consequently is directly applicable to digital tomosynthesis. The correction allows one to obtain accurate positional information with fluorography and may also be useful in radiation therapy treatment planning and quantitative digital subtraction angiography.