It has been known that the first generation quantitative coronary analysis systems overestimate small vessel sizes. In the 2nd generation the contour detection algorithms, e.g., of the new Cardiovascular Measurement System (CMS), were modified to correct for the limited resolution of the X-ray imaging chain. This study validated and compared the CMS with the well-known Coronary Angiography Analysis System (CAAS) and the vessel tracking program ARTREK in a phantom study and a clinical study. In addition, the influence of different acquisition media (cinefilm vs. digitally acquired angiograms) on the accuracy of quantitative analysis was examined. The phantom study comprised 19 stenotic or non-stenotic glass tubes with a diameter range from 0.54 mm to 4.9 mm. In the clinical study the mean diameters of 322 coronary segments were analysed and the results of the systems were compared among each other. The results of the phantom study were presented in terms of the mean difference (accuracy) between true and measured values. In the phantom study the overall accuracy of the CMS was -6 pm (ARTREK: 85 pm; CAAS: 35 pm) with an overestimation of small vessels of only -11 pm (ARTREK: 97 pm: CAAS: 51 pm). The clinical study showed that the CMS corrected the usually occurring overestimation of small coronary arteries and that the influence on the accuracy of different acquisition media is minor. Due to the modified algorithms the new CMS is able to measure coronary diameters down to 0.5 mm accurately. Therefore, the CMS seems to provide more precise measurements in quantitative analysis of small coronary diameters than CAAS and ARTREK.