OBJECTIVE Acquisition of high-quality x-ray images using low patient exposures requires detectors with high detective quantum efficiency (DQE). We describe a novel apodized-aperture pixel (AAP) design that increases high-frequency modulation transfer function (MTF) and DQE values. The AAP design makes a separation of physical sensor elements from image pixels by using very small sensor elements (e.g., 0.010-0.025 mm) to synthesize desired larger image pixels (e.g., 0.1-0.2 mm). METHODS A cascaded systems model of signal and noise propagation is developed to describe the benefits of the AAP approach in terms of the MTF, Wiener noise power spectrum (NPS), and DQE. The theoretical model was validated experimentally using a CMOS/CsI detector with 0.05 mm sensor elements to synthesize 0.20 mm image pixels and a clinical Se detector with 0.07 mm sensor elements to synthesize 0.28 mm pixels. A Monte Carlo study and x-ray images of a star-pattern and rat leg are used to visually compare AAP images. RESULTS When used with a high-resolution converter layer and sensor elements one quarter the size of image pixels, the MTF is increased by 53% and the DQE by a factor of 2.3× at the image sampling cut-off frequency. Both simulated and demonstration images show improved detectability of high-frequency content and removal of aliasing artifacts. Evidence of Gibbs ringing is sometimes seen near high-contrast edges. CONCLUSIONS It is shown that the AAP approach preserves the MTF of the small sensor elements and attenuates frequencies above the image sampling cut-off frequency. This has the double benefit of improving the MTF while reducing both signal and noise aliasing, resulting in an increase of the DQE at high spatial frequencies. For optimal implementation, the converter layer must have very high spatial resolution and the detector must have low readout noise.