The role of fluoroscopic imaging is critical for diagnostic and image guided therapy. However, fluoroscopic imaging can require significant radiation leading to increased cancer risk and non-stochastic effects such as radiation burns. Our purpose is to reduce the exposure and dose to the patient by an order of magnitude in these procedures by use of the region of interest method. Method and Materials: Region of interest fluoroscopy (ROIF) uses a partial attenuator. The central region of the image has full exposure while the image periphery, there to provide context only, has a reduced exposure rate. ROIF using a static partial attenuator has been shown in our previous studies to reduce the dose area product (DAP) to the patient by at least 2.5 times. Significantly greater reductions in DAP would require improvements in flat panel detectors performance at low x-ray exposures or a different x-ray attenuation strategy. Thus we have investigated a second, dynamic, approach. We have constructed an x-ray shutter system allowing a normal x-ray exposure in the region of interest while reducing the number of x-ray exposures in the periphery through the rapid introduction, positioning and removal of an x-ray attenuating shutter to block radiation only for selected frames. This dynamic approach eliminates the DQE(0) loss associated with the use of static partial attenuator applied to every frame thus permitting a greater reduction in DAP. Results: We have compared the two methods by modeling and determined their fundamental limits.