Image quality and radiation dose were evaluated in 8radiography rooms in 5 several hospitals in Sudan as part of an International Atomic Energy Agency (IAEA) project RAF/9/033. Entrance Skin Air Kerma (ESAK) was measured in 452 patients in five Sudanese hospitals. The six most common X-ray examinations were selected: Chest posterioranterior (PA), abdomen, lumbar spine anterior-posterior (AP), lumbar spine lateral (LAT), pelvis AP and skull. Exposure factors such as kVp, mAs and focal to skin distance (FSD) were recorded. Output measurements were conducted under standardized protocols prepared by IAEA experts and they were used together with corresponding technical data to calculate each patient ESAK. Patient effective doses (E) were also obtained from ESAK values. Reject analysis was conducted in 959 films in 8 X-ray rooms for 12 days. Corrective actions were applied and a second analysis was again performed in 1803 films. The results of the ESAKs revealed large variations not only between hospitals but also within the same hospital. The kVp settings applied in chest exams were almost half than kVp recommended by EC guidelines. ESAKs are within IAEA GL for all types of examinations except for chest. The reject analysis showed a repeat rate range of 4.5-24.27% at the radiographer level. The accepted films ranged between 51.4-90.4%. Corrective actions were taken. The reject analysis after these actions showed a reduction % of repeat in the range of 2.6-19.3% at the radiographer level. The accepted films ranged between 70.4-94.4%. Significant improvement in image quality was observed. The measurement of patient doses is continued in more hospitals in Khartoum, the capital of Sudan and other states in order to establish national dose reference levels.