Guide · checked October 2026

Image quality audit and reject analysis in radiography

Image quality audit checks that images are adequate for diagnosis and that exposures were not wasted; the Quality Standard for Imaging 2026 expects services to show improvement through image quality and dose audits, to monitor reject analysis, and to audit local diagnostic reference levels regularly.

What the standards expect

QSI 2026 item XR-604 says services should demonstrate image quality improvements through image quality and dose audits, and that assessors should check the service monitors reject analysis, diagnostic acceptability and interpretation, with regular local DRL audits.

IR(ME)R 2017 regulation 7 requires the employer's procedures to provide for clinical audit and, since October 2024, for acting on the results. Regulation 12(9) requires a recorded clinical evaluation of the outcome of each exposure. For breast screening, the gov.uk guidance on implementing IR(ME)R lists calculating reject and repeat rates against programme standards and reviewing technical recalls and repeats. We found no general-radiography reject-rate target on an official page.

What to check

Anatomical markers present and correct.
Exposure adequate, neither under- nor over-exposed.
Collimation appropriate, with the area of interest fully included.
Positioning and rotation acceptable for the projection.
No burned-in identifiers or text where it should not be.
Rejected and repeated images counted with a reason.

Running the audit

Agree the criteria with radiographers and reporters first, sample across rooms, shifts and staff groups, and report by cause so the actions are practical: equipment, technique, patient factors or training. Repeat with the same method to show whether things changed.

What it does not mean

A low reject rate is not automatically good if rejects are not being recorded.
Image quality audit is not a review of radiographers' performance for discipline.
Staying below national DRLs does not by itself show optimisation, as DHSC's IR(ME)R guidance notes.

Where RadQA fits

RadQA's image QA checks cover markers, exposure, collimation, clipped anatomy, rotation and burned-in identifiers, combining deterministic rules with model-backed checks, and overlays findings as regions on the image. Protocol QA flags missing series, contrast and slice-thickness mismatches. Every finding is reviewed by a person.

Model-backed checks send only the image or text needed for that check to the model provider your department configures. RadQA is a pilot. It is a quality-assurance assistant, not a diagnostic device, and it does not replace radiologist reporting or clinical judgement.

Questions

Is reject analysis required?

The Quality Standard for Imaging 2026 expects services to monitor it as part of image quality and dose audits.

Is there a national reject-rate target for general radiography?

We did not find one on an official page. Breast screening guidance refers to programme standards for reject and repeat rates.

Sources

Official pages, checked October 2026. Guidance changes, so check the current version before you rely on it.

General information for healthcare managers and clinical teams, checked October 2026. It is not legal, regulatory or clinical advice; follow the current official guidance and your organisation's own policies. No patient data is used in these examples. RadQA is a quality-assurance assistant for imaging departments. It is not a diagnostic device and does not replace radiologist reporting or clinical judgement. Validate against your own systems and local governance before production use.