Medical X-ray sources now and for the future

This paper focuses on the use of X-rays in their largest field of application: medical diagnostic imaging and image-guided therapy. For this purpose, vacuum electronics in the form of X-ray tubes as the source of bremsstrahlung (braking radiation) have been the number one choice for X-ray production in the range of photon energies between about 16 keV for mammography and 150 keV for general radiography. Soft tissue on one end and bony structures on the other are sufficiently transparent and the contrast delivered by difference of absorption is sufficiently high for this spectral range. The dominance of X-ray tubes holds even more than 120 years after Conrad Roentgen's discovery of the bremsstrahlung mechanism. What are the specifics of current X-ray tubes and their medical diagnostic applications? How may the next available technology at or beyond the horizon look like? Can we hope for substantial game changers? Will flat panel sources, less expensive X-ray “LED's”, compact X-ray Lasers, compact synchrotrons or equivalent X-ray sources appear in medical diagnostic imaging soon? After discussing the various modalities of imaging systems and their sources of radiation, this overview will briefly touch on the physics of bremsstrahlung generation, key characteristics of X-ray tubes, and material boundary conditions, which restrict performance. It will discuss the deficits of the bremsstrahlung technology and try to sketch future alternatives and their prospects of implementation in medical diagnostics.