Abstract: Methods and apparatus for measuring perfusion using transmission laser speckle imaging are provided. The apparatus comprises a coherent light source and a detector configured to measure transmitted light associated with an unfocused image at one or more locations. The coherent light source and detector are positioned in a transmission geometry. The apparatus further comprises means for securing the coherent light source and the detector to the tissue sample in a fixed transmission geometry relative to the tissue sample. The apparatus may further comprise at least one processor to receive information from the detector and process detected variations in transmitted light intensity to determine a single metric of perfusion. The method may comprise the steps transilluminating a tissue sample with coherent light, recording spatial and/or temporal variations in the transmitted light signal, determining speckle contrast value(s), and computing a metric of perfusion.