A few diagrams to help people understand why these specialist lenses exist in the first place, and why they are so heavy and rugged.
Basically they help transport the X-ray image into safe viewing positions. The final image can be recorded to [cine] film or TV media.
The first lens is the collimating lens and the second is the recording lens. Due to the construction and placement, there is no conjugate loss of light.
For X-ray screening, limiting the exposure to unhealthy radiation is a primary concern. Hence the use of ultrafast lenses in the imaging system.