en Medical Physics Medical Physics Brief Communication Brief Communication Reject analysis is as a quality indicator and critical tool for dose and image quality optimization in radiology departments. By reducing image rejection rate (RR), radiation dose to patients can be reduced effectively, yielding increased total cost-effectiveness. The aims of this study were to assess the rate of image rejection at 2 direct digital radiography (DR) departments to find the sources of rejection and to observe how radiology students and radiographers deal with image rejection.<br> Two radiology departments were surveyed during a 3-month period for all imaging procedures. Type of examination, numbers, and reasons for digital image rejection were obtained by systems and questionnaire. A predefined questionnaire, including 13 causes for rejection, was filled by radiographers and students.<br> Out of the 14 022 acquired images, 1116 were rejected, yielding an overall RR of 8%. Highest RRs were found for examination of cervical spine and lumbosacral. Positioning errors and improper patient preparation were the main reasons for digital image rejection.<br> The image RR was small, but there is a need for optimizing radiographic practice, and enhancing radiographer&rsquo;s knowledge may enhance the performance.<br> &nbsp; Digital radiography, Image rejection, Quality assurance, Radiation safety 301 304 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-4479-2&slc_lang=en&sid=1 Sajjad Rastegar sajjadrastegar9810@gmail.com 200319475328460062664 200319475328460062664 No Student Research Committee, Paramedical Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Jalal Beigi jalal.beigi1375@gmail.com 200319475328460062665 200319475328460062665 No Student Research Committee, Paramedical Faculty, & Department of Radiology Technology, Paramedical Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Ehsan Saeidi احسان سعیدی ehsansaeedi26@gmail.com 200319475328460062666 200319475328460062666 No Student Research Committee, Paramedical Faculty, & Department of Radiology Technology, Paramedical Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran گروه تکنولوژی رادیولوژی، دانشکده پیراپزشکی، دانشگاه علوم پزشکی رفسنجان، رفسنجان، ایران Ali Dezhkam alidezhkam74@yahoo.com 200319475328460062667 200319475328460062667 No Student Research Committee, Paramedical Faculty, & Department of Radiology Technology, Paramedical Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Tofigh Mobaderi tofigh.state@gmail.com 200319475328460062668 200319475328460062668 No Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran Hamed Ghaffari hamedghaffari@yahoo.com 200319475328460062669 200319475328460062669 Yes Department of Medical Physics, School of Medicine, & Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran Ali Mehdipour a_mehdipour312@yahoo.com 200319475328460062670 200319475328460062670 No Department of Radiology Technology, Paramedical Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Hamid Abdollahi hamid_rbp@yahoo.com 200319475328460062671 200319475328460062671 No Department of Radiologic Sciences and Medical Physics, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran