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Rejecting, deleting and repeating of diagnostic radiographs are against the professional and ethical issues of the radiology departments. Repeated images of radiological examinations increase the risk of radiation exposure of the patients, wastes medical resource, and reduce the quality of services of radiology department. The aim of this study is to perform X-ray images reject analysis in radiology departments of different hospitals in Riyadh. Saudi Arabia. KSA. Materials and Methods: A prospective study was conducted in the radiology department of different hospitals in Riyadh, Saudi Arabi, KSA. A total of 100 radiographs were evaluated manually by examining all types of radiological images. The data were analyzed by using Microsoft Excel 2010 program. Results: Out of 100 random radiograph were analyzed, most frequent repeats were observed for chest (38%) chosen, it appears that chest was registered as the highest exams (37 %) while the lower extremities were (19 %), Abdomen (9%), Spine, pelvis and upper examination (8%) for each exam, Chest and abdomen (6%), Cranium and Paranasal sinuses registered as the lowest exams repeated as (4%). where the major factors contributing the causes of rejection were anatomical side marker, followed by collimation and positioning error. Conclusion: The study has shown that, the highest reject rate was for chest exams and the most frequent causes for reject are side marker and collimation and position error.