Fluoroscopy has emerged as a key technology in modern interventional endoscopy. When combined with standard video endoscopy, it dramatically increases our ability to obtain a global overview of therapeutic procedures in real-time. Despite the importance of fluoroscopy, few gastroenterologists have received formal training in the operation of radiologic equipment or manipulation of fluoroscopic images. A good understanding of the basics of fluoroscope setup and operation is critical to safely performing such procedures as push enteroscopy, double balloon endoscopy, and enteral stent placement using fluoroscopic guidance. This manuscript will review the fundamentals of fluoroscopy hardware, steps to minimizing radiation exposure to patients and staff, and specific modifications to general fluoroscopic techniques in specific clinical applications.