An image sensor for capturing X-ray image data and optical image data includes an X-ray absorption layer and a plurality of photodiodes disposed in a semiconductor layer. The X-ray absorption layer is configured to emit photons in response to receiving X-ray radiation. The plurality of photodiodes disposed in the semiconductor layer is optically coupled to receive image light to generate the optical image data, and is optically coupled to receive photons from the X-ray absorption layer to generate X-ray image data.