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OBJECTIVE: To compare fluoroscopic freeze-frame digital images with conventional 105-mm spot films during voiding cystourethrography (VCUG) with regard to diagnostic quality and radiation dose. MATERIALS AND METHODS: VCUG was performed on 57 consecutive children by a commercially available fluoroscopic digital system. Both freeze-frame digital images and conventional 105-mm spot films were obtained during 90 s of fluoroscopy. Skin radiation dose was assessed separately for spot films and for both fluoroscopy and spot films, employing thermoluminescent crystals on the anterior surface of the body. Patients were classified into three age groups: group A younger than 12 months, group B 1-5 years old and group C 5-12 years of age. RESULTS: Digital and conventional images provided diagnostically identical results in 108 out of 114 ureters examined (94.7%). Percentage reductions in skin radiation dose due to the fluoroscopic hard copies compared with the four 105-mm radiographs were 53.8%, 50.5% and 57.1% for groups A, B and C, respectively. CONCLUSION: Substitution of conventional 105-mm spot films during VCUG with digital fluoroscopic hard copies resulted in a substantial reduction in radiation dose. Digital images were as accurate as the conventional films in excluding vesicoureteric reflux (VUR). The two methods correlated well in diagnosing and grading VUR.