Organic scintillators have rapidly emerged in recent years for X-ray scintillation and imaging, benefiting from their inherent advantages of abundant raw materials, low-temperature processing, high mechanical flexibility, and easy of large-scale fabrication. However, conventional organic scintillators suffer from weak X-ray absorption and inefficient exciton utilization, limiting their commercial viability. To overcome these challenges, new-generation organic scintillators have recently been developed with innovative emission mechanisms to ensure exciton utilization efficiency and the incorporation of heavy atoms to improve X-ray absorption. In recent years, these advancements have led to remarkable progress in high-performance X-ray scintillation and imaging. Here, we present a concept article on new-generation organic scintillators with high exciton utilization efficiency, focusing on molecular design, emission mechanisms, scintillation performance, and X-ray imaging applications. We also discuss future development trends in organic X-ray scintillators.