Registration of a preoperative CT (3D) image to one or more X-ray projection (2D) images, a special case of the pose estimation problem, has been attempted in a variety of ways with varying degrees of success. Recently, there has been a great deal of interest in intensity-based methods. One of the drawbacks to such methods is the need to create digitally reconstructed radiographs (DRRs) at each step of the optimization process. DRRs are typically generated by ray casting, an operation that requires Ç´Ò ¿ µ time, where we assume that Ò is approximately the size (in voxels) of one side of the DRR as well as one side of the CT volume. We address this issue by extending light field rendering techniques from the computer graphics community to generate DRRs instead of conventional rendered images. Using light fields allows most of the computation to be performed in a preprocessing step; after this precomputation, very accurate DRRs can be generated in Ç´Ò ¾ µ time. Another important issue for 2D-3D registration algorithms is validation. Previously reported 2D-3D registration algorithms were validated using synthetic data or phantoms but not clinical data. We present an intensity-based 2D-3D registration system that generates DRRs using light fields; we validate its performance using clinical data with a known gold standard transformation.