A prototype system optimized for automatic registration of CT scans and applications such as subtraction enhancement and CT angiography was evaluated. Co-registration was performed on 50 studies of various types, including CT angiograms. Mean registration speed was 109 s; accuracy was 2.0 mm. Examples of subtraction enhancement and automatic extraction of the vascular tree are provided. Unattended registration was demonstrated in routine application. Subtraction-enhanced images and extraction of the vascular tree may be useful in clinical practice.