We describe a custom multiple-module multiplexer integrated circuit (MMMIC) that enables the combination of discrete Electron multiplying charge coupled devices (EMCCD) based imaging modules to improve medical imaging systems. It is highly desirable to have flexible imaging systems that provide high spatial resolution over a specific region of interest (ROI) and a field of view (FOV) large enough to encompass areas of clinical interest. Also, such systems should be dynamic, i.e. should be able to maintain a specified acquisition bandwidth irrespective of the size of the imaged FOV. The MMMIC achieves these goals by 1) multiplexing the outputs of an array of imaging modules to enable a larger FOV, 2) enabling a number of binning modes for adjustable high spatial resolution, and 3) enabling selection of a subset of modules in the array to achieve ROI imaging at a predetermined display bandwidth. The MMMIC design also allows multiple MMMICs to be connected to control larger arrays. The prototype MMMIC was designed and fabricated in the ON-SEMI 0.5μm CMOS process through MOSIS (www.mosis.org). It has three 12-bit inputs, a single 12-bit output, three input enable bits, and one output enable, so that one MMMIC can control the output from three discrete imager arrays. The modular design of the MMMIC enables four identical chips, connected in a two-stage sequential arrangement, to readout a 3×3 collection of individual imaging modules. The first stage comprises three MMMICs (each connected to three of the individual imaging module), and the second stage is a single MMMIC whose 12-bit output is then sent via a CameraLink interface to the system computer. The prototype MMMIC was successfully tested using digital outputs from two EMCCD-based detectors to be used in an x-ray imaging array detector system.Finally, we show how the MMMIC can be used to extend an imaging system to include any arbitrary (M×N) array of imaging modules enabling a large FOV along with ROI imaging and adjustable high spatial resolution.