Since the discovery of X-rays over a century ago the techniques applied to the engineering of X-ray sources have remained relatively unchanged. From the inception of thermionic electron sources, which, due to simplicity of fabrication, remain central to almost all X-ray applications, there have been few fundamental technological advances. However, with the emergence of ever more demanding medical and inspection techniques, including computed tomography and tomosynthesis, security inspection, high throughput manufacturing and radiotherapy, has resulted in a considerable level of interest in the development of new fabrication methods. The use of conventional thermionic sources is limited by their slow temporal response and large physical size. In response, field electron emission has emerged as a promising alternative means of deriving a highly controllable electron beam of a well-defined distribution. When coupled to the burgeoning field of nanomaterials, and in particular, carbon nanotubes, such systems present a unique technological opportunity. This review provides a summary of the current state-of-the-art in carbon nanotube-based field emission X-ray sources. We detail the various fabrication techniques and functional advantages associated with their use, including the ability to produce ever smaller electron beam assembles, shaped cathodes, enhanced temporal stability and emergent fast-switching pulsed sources. We conclude with an overview of some of the commercial progress made towards the realisation of an innovative and disruptive technology.