AbstractIntroductionImage reject analysis (RA) in direct digital radiography (DDR) is an important quality indicator tool. Analysis of rejected images is a component of quality assurance (QA) programmes, with the overall aim of reducing patient radiation dose. This study aimed to compare differences in image rejection rates (RR) and the reasons for rejection between two radiology departments.MethodsA retrospective quantitative descriptive study of images performed across the two radiology departments (RAD 1 and RAD 2) acquired with DDR systems between the beginning of February and the end of May 2021 was undertaken. Collected data included the medical imaging technologist (MIT) selection of image rejection reasons for different anatomic regions and compared between the two radiology departments.ResultsA total of 47,046 images and 29,279 images were acquired at RAD 1 and RAD 2, respectively, with an overall image rejection rate of 7.86% at RAD 1 and 5.91% at RAD 2. The primary reason for image rejections was positioning errors, 79.4% and 77.3% recorded at RAD 1 and RAD 2, respectively. Significant differences were demonstrated between the two radiology departments for image rejection rates and selected reasons for rejection for most anatomical body groups.ConclusionThe implementation of image RA remains a key part of QA in radiology departments utilising DDR systems. This study recommends interventions based on image RRs for examinations taking into consideration the department‐specific variations and imaging protocols used.