Perovskite materials have attracted significant attention as innovative and efficient X-ray detectors due to their unique properties compared to traditional X-ray detectors. This review provides an in-depth analysis of X-ray detection technologies using organic–inorganic hybrids (OIHs), all-inorganic and lead-free perovskite-based single crystals (SCs), thin/thick films, and wafers. It systematically examines the advancements in synthesis methods, structural modifications, and device architectures to enhance radiation sensing performance. The review also critically analyzes factors affecting device performance, revealing that single crystallization techniques significantly improve film and wafer growth techniques. SC-based devices exhibit lower trap density, higher resistivity, large carrier mobility, and lifetime compared to film- and wafer-based devices, leading to outstanding sensitivity and the lowest detectable dose rate (LDDR). These results surpass traditional detectors like amorphous selenium and CZT. Film-based devices suffer from bulk defects, while wafer-based devices have poor performance due to voids. Structural modifications have enabled high-performance and stable devices. This review serves as a roadmap for addressing challenges in perovskite materials for X-ray detection and imaging, offering insights into recent progress, challenges, and future directions. The review highlights the potential of perovskite materials in X-ray detection due to their high average atomic number, appropriate bandgap, high resistivity, large mobility–lifetime product, low production cost, and tolerance to defects. The review discusses the fundamentals of radiation detection materials and devices, including radiation attenuation ratio, ionization energy, charge collection efficiency, dark current, sensitivity, limit of detection, mobility-lifetime product, and response time. It also covers fabrication techniques for perovskite materials, including single crystal growth, thin or thick film growth, and wafer fabrication. The review highlights the promising potential of perovskite materials in X-ray detection and imaging, with a focus on their unique properties and performance advantages over traditional materials.Perovskite materials have attracted significant attention as innovative and efficient X-ray detectors due to their unique properties compared to traditional X-ray detectors. This review provides an in-depth analysis of X-ray detection technologies using organic–inorganic hybrids (OIHs), all-inorganic and lead-free perovskite-based single crystals (SCs), thin/thick films, and wafers. It systematically examines the advancements in synthesis methods, structural modifications, and device architectures to enhance radiation sensing performance. The review also critically analyzes factors affecting device performance, revealing that single crystallization techniques significantly improve film and wafer growth techniques. SC-based devices exhibit lower trap density, higher resistivity, large carrier mobility, and lifetime compared to film- and wafer-based devices, leading to outstanding sensitivity and the lowest detectable dose rate (LDDR). These results surpass traditional detectors like amorphous selenium and CZT. Film-based devices suffer from bulk defects, while wafer-based devices have poor performance due to voids. Structural modifications have enabled high-performance and stable devices. This review serves as a roadmap for addressing challenges in perovskite materials for X-ray detection and imaging, offering insights into recent progress, challenges, and future directions. The review highlights the potential of perovskite materials in X-ray detection due to their high average atomic number, appropriate bandgap, high resistivity, large mobility–lifetime product, low production cost, and tolerance to defects. The review discusses the fundamentals of radiation detection materials and devices, including radiation attenuation ratio, ionization energy, charge collection efficiency, dark current, sensitivity, limit of detection, mobility-lifetime product, and response time. It also covers fabrication techniques for perovskite materials, including single crystal growth, thin or thick film growth, and wafer fabrication. The review highlights the promising potential of perovskite materials in X-ray detection and imaging, with a focus on their unique properties and performance advantages over traditional materials.