Starting with a brief history of the two stage diagnostic radiological technique, the development of x-ray image intensifiers with the aim of achieving improved fluoroscopy, with reduced exposure rates is discussed. The characteristics and limitations of these older image intensifiers are given. After these considerations about the performance of contemporary image intensification systems, the possibilities of improving these devices, as regards quantum detection efficiency, improved electron optics design using modern high speed computers, and improved output phosphor screen preparation are considered. In particular a discussion of sodium activated cesium iodide as the input scintillator, first reduced to practice by this author in 1967 is given. Some preliminary results on an experimental 210 mm input 70 mm output x-ray image intensifier tube are given which suggests that such a tube with a 100 mm output might be an adequate replacement for the presently used x-ray image intensifier screen-film combination.