Semiconductor flat-panel detector arrays are being investigated for applications in digital x-ray medical imaging. This paper describes the system architecture and theoretical signal and noise processes of a proposed hybrid cadmium zinc telluride (CZT) based CMOS active pixel sensor (APS) array for fluoroscopy. Sim- ulations were performed using an 80-kVp-tungsten spectrum and a 200- m pixel. The proposed system appears to exhibit favor- able characteristics in terms of charge generation, lag, quantum noise, and other electronic sources of noise, and compared well with other direct conversion detectors. Overall, we expect the system to be x-ray quantum noise limited under diagnostic exposure condi- tions for fluoroscopy and conclude that the proposed imager ex- hibits promising characteristics for applications in diagnostic x-ray imaging.