This chapter comprehensively explains the evolution, principles, and technological advancements in fluoroscopic imaging, with a focus on both analog and digital modalities. It begins with the early era of fluoroscopy and highlighting lesser-known historical facts. Special emphasis is given to the unique technical and safety demands associated with fluoroscopic procedures. The core mechanisms of fluoroscopy, including instrumentation such as the image intensifier, X-ray tube, spot film device, and associated radiation protection devices, are thoroughly detailed. Modern modes of operation, including automatic brightness control, are explained in clinical context. The chapter advances into digital fluoroscopy, classifying flat panel detectors and comparing scintillator technologies. A detailed explanation of both indirect and direct detector systems such as Thin Film Transistor (TFT) and Charge-Coupled Device (CCD) is provided. Radiation dose optimization, equipment design, and room layout considerations are discussed in parallel with quality assurance protocols. Image artefacts, control procedures, and recent innovations are presented to guide clinical practice and ensure optimal image quality. The chapter concludes with targeted learning outcomes for understanding in fluoroscopy imaging and safety.