C-arm X-ray imaging devices are commonly used for minimally invasive cardiovascular or other interventional procedures. Calibrated state-of-the-art systems can, however, not only be used for 2D imaging but also for three-dimensional reconstruction either using tomographic techniques or even stereotactic approaches. To evaluate the accuracy of X-ray object localization from two views, a simulation study assuming an ideal imaging geometry was carried out first. This was backed up with a phantom experiment involving a real C-arm angiography system. Both studies were based on a phantom comprising five point objects. These point objects were projected onto a flat-panel detector under different C-arm view positions. The resulting 2D positions were perturbed by adding Gaussian noise to simulate 2D point localization errors. In the next step, 3D point positions were triangulated from two views. A 3D error was computed by taking differences between the reconstructed 3D positions using the perturbed 2D positions and the initial 3D positions of the five points. This experiment was repeated for various C-arm angulations involving angular differences ranging from 15o to 165o. The smallest 3D reconstruction error was achieved, as expected, by views that were 90o degrees apart. In this case, the simulation study yielded a 3D error of 0.82 mm ± 0.24 mm (mean ± standard deviation) for 2D noise with a standard deviation of 1.232 mm (4 detector pixels).The experimental result for this view configuration obtained on an AXIOM Artis C-arm (Siemens AG, Healthcare Sector, Forchheim, Germany) system was 0.98 mm ± 0.29 mm, respectively. These results show that state-of-the-art C-arm systems can localize instruments with millimeter accuracy, and that they can accomplish this almost as well as an idealized theoretical counterpart. High stereotactic localization accuracy, good patient access, and CT-like 3D imaging capabilities render state-of-the-art C-arm systems ideal devices for X-ray based minimally invasive procedures.