Checks on radiographic quality and reasons for the rejection of chest X-rays taken in the Black Lung program are reviewed. Aspects of Public Law 92/303, the Federal Coal Mine Health and Safety Act, involving requirements for chest X-ray examinations of coal miners are discussed. Local certified facilities (with A-readers) produce and read the X-rays and then pass them on to the Appalachian Laboratory for Occupational Respiratory Diseases where the X-rays are interpreted by B-readers who, in the case of disagreement, pass the X-ray to a C-reader. It is noted that of the 67,000 radiographs which had been received, 2,098 (or about 3 percent) were rejected by a B-reader or C-reader for poor quality. Furthermore, of the 144 approved facilities, 37.5 percent had no rejects, while 44 percent had more than 10 percent of their X-rays rejected. X-rays were seldom rejected for bad equipment, but for poor processing, over exposure or under exposure, and mistakes in geometry. The authors conclude that the problem of poor quality lies in the willingness of the A-reader to accept a radiograph of poor quality. Training programs are recommended to make A-readers aware of the quality problems and reasons for rejection, and familiarize them with the quality of radiograph required.