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Abstract Over the past decade, lead halide perovskites have gained significant interest for ionizing radiation detection, owing to their exceptional performance, and cost-effective fabrication in a wide range of form factors, from thick films to large single crystals. However, the toxicity of lead, limited environmental and thermal stability of these materials, as well as dark current drift due to ionic conductivity, have prompted the development of alternative materials that can address these challenges. Bismuth-based compounds (including perovskite derivatives and nonperovskite materials) have similarly high atomic numbers, leading to strong X-ray attenuation, but have lower toxicity, tend to be more environmentally stable, and can have lower ionic conductivity, especially in low-dimensional materials. These materials are also advantageous over commercial direct X-ray detectors by being able to detect lower dose rates of X-rays than amorphous selenium by at least two orders of magnitude, are potentially more cost-effective to mass produce than cadmium zinc telluride, and can operate at room temperature (unlike high-purity Ge). Given the strong interest in this area, we here discuss recent advances in the development of bismuth-based perovskite derivatives (with 3D, 2D and 0D structural dimensionality), and other bismuth-based perovskite-inspired materials for direct X-ray detection. We discuss the critical properties of these materials that underpin the strong performances achieved, particularly the ability to detect low-dose rates of X-rays. We cover key strategies for enhancing the performance of these materials, as well as the challenges that need to be overcome to commercialize these emerging technologies. Graphical abstract