X-ray imaging technology is critical to numerous different walks of daily life, ranging from medical radiography and security screening all the way to high-energy physics. Although several organic chromophores are fabricated and tested as X-ray imaging scintillators, they generally show poor scintillation performance due to their weak X-ray absorption cross-section and inefficient exciton utilization efficiency. Here, a singlet fission-based high-performance organic X-ray imaging scintillator with near unity exciton utilization efficiency is presented. Interestingly, it is found that the X-ray sensitivity and imaging resolution of the singlet fission-based scintillator are dramatically improved by an efficient energy transfer from a thermally activated delayed fluorescence (TADF) sensitizer, in which both singlet and triplet excitons can be efficiently harnessed. The fabricated singlet fission-based scintillator exhibits a high X-ray imaging resolution of 27.5 line pairs per millimeter (lp mm-1 ), which exceeds that of most commercial scintillators, demonstrating its high potential use in medical radiography and security inspection.