A method for detecting markers within X-ray images includes applying directional filters to a sequence of X-ray image frames. Marker candidate pixels are determined based on the output of the directional filters. Candidate pixels are grouped into clusters and distances between each possible pair of clusters is determined and the most frequently occurring distance is considered an estimated distance between markers. A first marker is detected at the cluster that most closely resembles a marker based on certain criteria and a second marker is then detected at a cluster that is the estimated distance from the first marker. The pair of first and second marker detections is scored to determine detection quality. If the detected marker pair has an acceptable score then the detected marker pair is used.