This paper introduces new high-resolution amorphous Silicon (a-Si) image sensors specifically configured for demonstrating film-quality medical x-ray imaging capabilities. The devices utilizes an x-ray phosphor screen coupled to an array of a-Si photodiodes for detecting visible light, and a-Si thin-film transistors (TFTs) for connecting the photodiodes to external readout electronics. We have developed imagers based on a pixel size of 127 micrometer X 127 micrometer with an approximately page-size imaging area of 244 mm X 195 mm, and array size of 1,536 data lines by 1,920 gate lines, for a total of 2.95 million pixels. More recently, we have developed a much larger imager based on the same pixel pattern, which covers an area of approximately 406 mm X 293 mm, with 2,304 data lines by 3,200 gate lines, for a total of nearly 7.4 million pixels. This is very likely to be the largest image sensor array and highest pixel count detector fabricated on a single substrate. Both imagers connect to a standard PC and are capable of taking an image in a few seconds. Through design rule optimization we have achieved a light sensitive area of 57% and optimized quantum efficiency for x-ray phosphor output in the green part of the spectrum, yielding an average quantum efficiency between 500 and 600 nm of approximately 70%. At the same time, we have managed to reduce extraneous leakage currents on these devices to a few fA per pixel, which allows for very high dynamic range to be achieved. We have characterized leakage currents as a function of photodiode bias, time and temperature to demonstrate high stability over these large sized arrays. At the electronics level, we have adopted a new generation of low noise, charge- sensitive amplifiers coupled to 12-bit A/D converters. Considerable attention was given to reducing electronic noise in order to demonstrate a large dynamic range (over 4,000:1) for medical imaging applications. Through a combination of low data lines capacitance, readout amplifier design, optimized timing, and noise cancellation techniques, we achieve 1,000e to 2,000e of noise for the page size and large size arrays, respectively. This allows for true 12-bit performance and quantum limited images over a wide range of x-ray exposures. Various approaches to reducing line correlated noise have been implemented and will be discussed. Images documenting the improved performance will be presented. Avenues for improvement are under development, including higher resolution 97 micrometer pixel imagers, further improvements in detective quantum efficiency, and characterization of dynamic behavior.