Introduction: Radiography is evolving, and education must evolve with it. Radiography training mainly consists of theory-centred classes and clinical practice; however, this varies from country to country. Image quality assessment is a critical part of radiography. This study examines how aspects of training influence student radiographers’ decision making. Aim: To investigate whether training (academic study, clinical experience and country of education) received by undergraduate radiography students in four European countries influences their assessment of image acceptability/quality. Materials and Methods: 23 radiography students from four European countries completed the task of accepting or rejecting 30 chest radiographs on the basis of image quality. Each participant gave reasons for any rejections. The total time taken, reject rate and reasons for rejection were compared between students in earlier/later stages of their degrees, those with more/less clinical experience, and those from different countries. Results: Clinical experience, academic experience or country of education did not influence time taken by participants to view images. Participants with more clinical experience rejected more images than those with less. Clinical experience and country of education also influenced reasons for image rejection; participants with more clinical experience rejected significantly more images for absence of a lead marker, while Irish and Norwegian students rejected more images based on exposure than Swiss students. Conclusion: Clinical experience had an influence on student radiographers’ assessment of chest x-ray image quality in terms of both rejection rates and reasons for rejecting images. Country of education also influenced reasons for rejection.