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Due to vessel overlap and foreshortening, multiple projections are necessary to adequately evaluate the coronary tree with arteriography. Catheter-based interventions can only be optimally performed when these visualization problems are successfully solved. The traditional method provides multiple selected views in which overlap and foreshortening are subjectively minimized based on two dimensional (2-D) projections. A pair of images acquired from routine angiographic study at arbitrary orientation using a single-plane imaging system were chosen for three-dimensional (3-D) reconstruction. After the arterial segment of interest (e.g., a single coronary stenosis or bifurcation lesion) was selected, a set of gantry angulations minimizing segment foreshortening was calculated. Multiple computer-generated projection images with minimized segment foreshortening were then used to choose views with minimal overlapped vessels relative to the segment of interest. The optimized views could then be utilized to guide subsequent angiographic acquisition and interpretation. Over 800 cases of coronary arterial trees have been reconstructed, in which more than 40 cases were performed in room during cardiac catheterization. The accuracy of 3-D length measurement was confirmed to be within an average root-mean-square (rms) 3.5% error using eight different pairs of angiograms of an intracoronary guidewire of 105-mm length with eight radiopaque markers of 15-mm interdistance. The accuracy of similarity between the additional computer-generated projections versus the actual acquired views was demonstrated with the average rms errors of 3.09 mm and 3.13 mm in 20 LCA and 20 RCA cases, respectively. The projections of the reconstructed patient-specific 3-D coronary tree model can be utilized for planning optimal clinical views: minimal overlap and foreshortening. The assessment of lesion length and diameter narrowing can be optimized in both interventional cases and studies of disease progr- - ession and regression.