Fluorescence lifetime imaging (FLI) is a powerful tool for investigating molecular processes, microenvironmental parameters, and molecular interactions across tissue to (sub-)cellular levels. Despite its established value in numerous biomedical applications, conventional FLI techniques are hindered by long acquisition times. This limitation restricts their use in real-time scenarios, such as monitoring fast biological processes, studying live organisms, and in environments that require rapid imaging and immediate inference, such as clinical image-guided interventions. Here, we present a novel FLI approach that combines a large-format time-gated SPAD array with dual-gate acquisition capability, alongside a rapid lifetime determination algorithm. This integration allows for real-time fluorescence lifetime estimation through single-snapshot acquisitions, eliminating the need for traditional, time-consuming time-resolved data collection. We demonstrate the scalability and versatility of this method by achieving real-time FLI across challenging biomedical applications, ranging from capturing fast neural dynamics at the microscopic scale, performing multimodal 3D volumetric FLI of tumor organoids at the mesoscopic scale, to macroscale FLI in both direct and highly scattering regimes. Furthermore, we validate its utility in fluorescence lifetime-guided surgical procedures using tissue-mimicking phantoms. Overall, this new methodology significantly enhances the temporal and spatial capabilities of FLI, opening the door to the assessment of fast dynamic biomedical signals. It also enables the seamless integration of FLI into clinical workflows, particularly in applications like fluorescence-guided surgery.