The flat-panel detector (FPD) is the state-of-the-art detector for digital radiography. The FPD can acquire images in real-time, has superior spatial resolution, and is free of the problems of x-ray image intensifiers-veiling glare, pin-cushion and magnetic distortion. However, FPDs suffer from poor signal to noise ratio performance at typical fluoroscopic exposure rates where the quantum noise is reduced to the point that it becomes comparable to the fixed electronic noise. It has been shown previously that avalanche multiplication gain in amorphous selenium (a-Se) can provide the necessary amplification to overcome the electronic noise of the FPD. Avalanche multiplication, however, comes with its own intrinsic contribution to the noise in the form of gain fluctuation noise. In this article a cascaded systems analysis is used to present a modified metric related to the detective quantum efficiency. The modified metric is used to study a diagnostic x-ray imaging system in the presence of intrinsic avalanche multiplication noise independently from other noise sources, such as electronic noise. An indirect conversion imaging system is considered to make the study independent of other avalanche multiplication related noise sources, such as the fluctuations arising from the depth of x-ray absorption. In this case all the avalanche events are initiated at the surface of the avalanche layer, and there are no fluctuations in the depth of absorption. Experiments on an indirect conversion x-ray imaging system using avalanche multiplication in a layer of a-Se are also presented. The cascaded systems analysis shows that intrinsic noise of avalanche multiplication will not have any deleterious influence on detector performance at zero spatial frequency in x-ray imaging provided the product of conversion gain, coupling efficiency, and optical quantum efficiency are much greater than a factor of 2. The experimental results show that avalanche multiplication in a-Se behaves as an intrinsic noise free avalanche multiplication, in accordance with our theory. Provided good coupling efficiency and high optical quantum efficiency are maintained, avalanche multiplication in a-Se has the potential to increase the gain and make negligible contribution to the noise, thereby improving the performance of indirect FPDs in fluoroscopy.