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X-ray computed tomography fluoroscopy (CTF) enables image guidance of interventions, synchronization of scanning with contrast bolus arrival, and motion analysis. However, filtered backprojection (FB), the current method for CTF image reconstruction, is subject to motion and metal artifacts from implants, needles, or other surgical instruments. Reduced target lesion conspicuity may result from increased image noise associated with reduced tube current. In this report, the authors adapt the row-action expectation-maximization (EM) algorithm for CTF. Because time-dependent variation in images is localized during CTF, the row-action EM-like algorithm allows rapid convergence. More importantly, this iterative CTF algorithm has fewer metal artifacts and better low-contrast performance than FB.