We present the Twente Optical Perfusion Camera (TOPCam), a novel laser Doppler Perfusion Imager based on CMOS technology. The tissue under investigation is illuminated and the resulting dynamic speckle pattern is recorded with a high speed CMOS camera. Based on an overall analysis of the signal-to-noise ratio of CMOS cameras, we have selected the camera which best fits our requirements. We applied a pixel-by-pixel noise correction to minimize the influence of noise in the perfusion images. We can achieve a frame rate of 0.2 fps for a perfusion image of 128×128 pixels (imaged tissue area of 7×7 cm2) if the data is analyzed online. If the analysis of the data is performed offline, we can achieve a frame rate of 26 fps for a duration of 3.9 seconds. By reducing the imaging size to 128×16 pixels, this frame rate can be achieved for up to half a minute. We show the fast imaging capabilities of the system in order of increasing perfusion frame rate. First the increase of skin perfusion after application of capsicum cream, and the perfusion during an occlusion-reperfusion procedure at the fastest frame rate allowed with online analysis is shown. With the highest frame rate allowed with offline analysis, the skin perfusion revealing the heart beat and the perfusion during an occlusion-reperfusion procedure is presented. Hence we have achieved video rate laser Doppler perfusion imaging.