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The goal of the study is to determine the inter-rater agreement on multiple factors that were utilized to evaluate the quality of pediatric chest X-ray exams from different levels of healthcare provision in an African setting. The image quality of pediatric chest X-rays from 3 South African medical centers of varying level of healthcare service were retrospectively assessed by 3 raters for 12 quality factors including (1) absent body parts; (2) under inspiration; (3) patient rotation; (4) scapula in the way; (5) patient kyphosis/lordosi