Direct radionuclide cystography (DRC) is a widely recommended and valuable imaging modality for diagnosing and monitoring patients with vesicoureteral reflux (VUR). Compared with voiding cystourethrography (VCUG), it offers several clear advantages, including more accurate detection of intermittent reflux, higher overall sensitivity, and lower radiation exposure. DRC involves bladder catheterization followed by dynamic imaging of bladder filling with saline mixed with a radiopharmaceutical, full-bladder static imaging, dynamic imaging during voiding, and post-void assessment. Each phase contains important information and must be reviewed carefully. Using illustrative clinical cases, this atlas shows the clinical importance of completing all study phases and precise frame-by-frame reviewing of the images for accurate interpretation. It also highlights common interpretive challenges and potential pitfalls, such as anatomical variants and technical errors. This atlas provides practical insights aimed at increasing interpretive confidence and optimizing the clinical utility of DRC in the evaluation and management of patients with suspected or known VUR.