We present a method for measurement dynamic in vivo carpal motion patterns. The method consists of a 4-D rotational X-ray (RX) with improved image quality and image processing for accurate detection in vivo wrist motion measurements. Dynamic 3-D imaging yields a number of volume reconstructions of the wrist at different phases of its cyclic motion. Next, the carpal reconstructions are registered to their static acquired and segmented counterpart in all phases. With this information, the relation between the applied motion and carpal kinematic behavior is acquired, i.e., the motion patterns. We investigated the precision of the image acquisition and processing and tested it on three healthy subjects. The precision of the image acquisition and image processing is in the range of submillimeters and subdegrees, respectively, which is better than existing systems and sufficient for clinical investigations. Reproducibility measurements show some more deviation ( > 1 degrees). This method was tested on four human volunteers and agrees for the greater part with previously done invasive and nondynamic measurements. In vivo motion pattern measurement with 4-D-RX imaging and processing is accurate and noninvasive. The motion patterns can reveal disorders that could not have been detected in either video fluoroscopy, computed tomography, or MRI.