diff --git a/crates/pdftract-cli/src/serve.rs b/crates/pdftract-cli/src/serve.rs
index 6198c24..6212fca 100644
--- a/crates/pdftract-cli/src/serve.rs
+++ b/crates/pdftract-cli/src/serve.rs
@@ -52,8 +52,9 @@ use axum::{
     routing::{get, post},
     Router,
 };
+use bytes;
 use pdftract_core::cache;
-use pdftract_core::extract::{extract_pdf, result_to_json};
+use pdftract_core::extract::{extract_pdf, extract_pdf_ndjson, result_to_json};
 use pdftract_core::options::{ExtractionOptions, ReceiptsMode};
 use serde::Deserialize;
 use std::path::{Path, PathBuf};
@@ -210,7 +211,10 @@ async fn root_handler() -> impl IntoResponse {
 
 /// Health check handler.
 async fn health_handler() -> impl IntoResponse {
-    (StatusCode::OK, "OK")
+    Json(serde_json::json!({
+        "status": "ok",
+        "version": env!("CARGO_PKG_VERSION")
+    }))
 }
 
 /// Extract handler - returns JSON with cache status in metadata.
@@ -331,61 +335,86 @@ async fn extract_text_handler(
     Ok(response)
 }
 
-/// Extract stream handler - returns NDJSON with X-Pdftract-Cache header (always "skipped" for streaming).
+/// Extract stream handler - returns true async streaming NDJSON.
+///
+/// This handler spawns a background task that extracts pages sequentially
+/// and sends them over a channel. The response body is a stream that yields
+/// each page as NDJSON immediately after it's extracted.
+///
+/// Cache status is always "skipped" for streaming since we bypass the cache
+/// to provide true incremental output.
 async fn extract_stream_handler(
     State(state): State<ServeState>,
     mut multipart: Multipart,
 ) -> Result<impl IntoResponse, AxumError> {
+    use tokio_stream::wrappers::ReceiverStream;
+    use tokio_stream::StreamExt;
+
     let (pdf_file, params) = receive_pdf(&mut multipart).await?;
     let options = build_options(&params)?;
 
-    // Get cache configuration
+    // Get cache configuration (for logging only - streaming bypasses cache)
     let cache_state = state.cache.lock().await;
-    let cache_dir = cache_state.cache_dir.clone();
-    let cache_size_bytes = cache_state.cache_size_bytes;
-    let cache_disabled = params.no_cache || cache_state.cache_disabled || cache_dir.is_none();
+    let _cache_dir = cache_state.cache_dir.clone();
     drop(cache_state);
 
-    let (result, _cache_status, _cache_age) = tokio::task::spawn_blocking(move || {
-        let cache_dir_ref = cache_dir.as_deref();
-        cache::extract_with_cache(
-            &pdf_file,
-            &options,
-            cache_dir_ref,
-            cache_disabled,
-            Some(cache_size_bytes),
-        )
-        .map_err(|e| AxumError::Extraction(format!("{:?}", e)))
-    })
-    .await
-    .map_err(|e| {
-        // Distinguish between cancellation (task dropped) and panic
-        if e.is_cancelled() {
-            AxumError::Internal(format!("Task cancelled: {}", e))
-        } else {
-            // is_panic() true means the task panicked - indicates a bug
-            AxumError::InternalPanic(format!("Extraction task panicked: {}", e))
-        }
-    })?
-    .map_err(|e| e)?;
+    // Create a channel for streaming pages
+    let (tx, rx) = tokio::sync::mpsc::channel::<Vec<u8>>(16);
 
-    // Build NDJSON output
-    let mut ndjson = String::new();
-    for page in &result.pages {
-        let page_json = serde_json::json!({
-            "index": page.index,
-            "spans": page.spans,
-            "blocks": page.blocks,
-        });
-        ndjson.push_str(&serde_json::to_string(&page_json).unwrap());
-        ndjson.push('\n');
-    }
+    // Spawn extraction task in background
+    tokio::task::spawn_blocking(move || {
+        use pdftract_core::extract::extract_pdf_ndjson;
+
+        // Clone sender for error handling
+        let tx_for_error = tx.clone();
+
+        // Write to a custom writer that sends to the channel
+        struct ChannelWriter {
+            tx: tokio::sync::mpsc::Sender<Vec<u8>>,
+        };
+
+        impl std::io::Write for ChannelWriter {
+            fn write(&mut self, buf: &[u8]) -> std::io::Result<usize> {
+                // Clone the buffer since we need to send it
+                self.tx
+                    .blocking_send(buf.to_vec())
+                    .map_err(|e| std::io::Error::new(std::io::ErrorKind::Other, e))?;
+                Ok(buf.len())
+            }
+
+            fn flush(&mut self) -> std::io::Result<()> {
+                Ok(())
+            }
+        }
+
+        let writer = ChannelWriter { tx };
+
+        // Extract to NDJSON, streaming each page as it's extracted
+        if let Err(e) = extract_pdf_ndjson(&pdf_file, &options, writer) {
+            // Send error as a JSON line
+            let error_json = serde_json::json!({
+                "error": format!("{:?}", e)
+            });
+            if let Ok(json_bytes) = serde_json::to_vec(&error_json) {
+                let _ = tx_for_error.blocking_send(json_bytes);
+                let _ = tx_for_error.blocking_send(b"\n".to_vec());
+            }
+        }
+
+        Ok::<(), AxumError>(())
+    });
+
+    // Create a stream from the receiver
+    let stream = ReceiverStream::new(rx).map(|item| Ok::<_, axum::Error>(bytes::Bytes::from(item)));
+
+    // Return a streaming body
+    let body = Body::from_stream(stream);
 
     let response = AxumResponse::builder()
         .status(StatusCode::OK)
         .header("X-Pdftract-Cache", CacheStatus::Skipped.header_value())
         .header("Content-Type", "application/x-ndjson")
-        .body(Body::from(ndjson))
+        .body(body)
         .map_err(|e| AxumError::Internal(format!("{:?}", e)))?;
 
     Ok(response)
diff --git a/crates/pdftract-core/build.rs b/crates/pdftract-core/build.rs
index a5251b0..808b902 100644
--- a/crates/pdftract-core/build.rs
+++ b/crates/pdftract-core/build.rs
@@ -496,12 +496,13 @@ pub fn cid_to_unicode(cid: u32) -> Option<&'static [char]> {{
             collection = module_name.to_uppercase(),
             json_name = json_name,
         );
-        fs::write(&out_path, rust_code).unwrap_or_else(|_| panic!("Failed to write {}", out_path.display()));
+        fs::write(&out_path, rust_code)
+            .unwrap_or_else(|_| panic!("Failed to write {}", out_path.display()));
         return;
     }
 
-    let json_content =
-        fs::read_to_string(&json_path).unwrap_or_else(|_| panic!("Failed to read {}", json_path.display()));
+    let json_content = fs::read_to_string(&json_path)
+        .unwrap_or_else(|_| panic!("Failed to read {}", json_path.display()));
 
     let data: serde_json::Value = serde_json::from_str(&json_content)
         .unwrap_or_else(|_| panic!("Failed to parse {}", json_path.display()));
@@ -572,7 +573,8 @@ pub fn cid_to_unicode(cid: u32) -> Option<&'static [char]> {{
         map = map_builder.build(),
     );
 
-    fs::write(&out_path, rust_code).unwrap_or_else(|_| panic!("Failed to write {}", out_path.display()));
+    fs::write(&out_path, rust_code)
+        .unwrap_or_else(|_| panic!("Failed to write {}", out_path.display()));
 }
 
 /// Parse a Unicode value from JSON to a Vec<char>.