Abstract: A system for tracking an instrument during a procedure on a patient is provided. The system includes a rotatable gantry, an x-ray imaging device, a processor, and a memory coupled to the processor. The processor is configured to: generate a three dimensional (3D) image based on a plurality of initial x-ray projections taken at a plurality of projection angles; generate an annotated 3D image of the 3D image including annotations of the target location and at least one planned instrument path on the 3D image; generate a plurality of two dimensional (2D) annotations based on the annotated 3D image at each projection angle; superimpose each 2D annotation onto the initial x-ray projection of the corresponding projection angle; obtain a plurality of subsequent x-ray projections of the patient at the plurality of projection angles; and co-register each subsequent x-ray projection with a corresponding annotated initial x-ray projection for each projection angle.