A system automatically adaptively adjusts an enlarged region of interest presented as a zoomed image on a secondary live display in response to X-ray filter (e.g., collimator) adjustment. An X-ray medical image user interface system includes one or more displays for displaying medical images. At least one display concurrently presents, a first image window including an X-ray image overview of a portion of patient anatomy and a second image window including an enlarged region of interest within the X-ray image overview. A collimator position detector provides a collimator signal in response to a detected collimator position. An image data processor automatically identifies the enlarged region of interest within the X-ray image overview in response to the collimator signal. A display processor generates data representing an image comprising the enlarged region of interest of the X-ray image overview in response to the identification of the enlarged region of interest within the X-ray image overview.