The study aimed to evaluate the Commission of the European Communities (CEC) quality criteria for paediatric lateral spine radiographs, and to use these to assess and compare the quality of film-screen and digital images. 286 paediatric lateral spine radiographs (89 film-screen and 197 digital) were independently analysed by two observers according to the CEC criteria. Based on fulfilment of criteria, images were assigned two scores, an image criteria score and a visual grading analysis score. Sensitivity values (S) on digital radiographs were recorded and correlated with image quality. Variability for assignment of scores between observers was lower for the image criteria than the visual grading analysis technique. Analysis of variance for fulfilment of criteria between techniques, and (for digital images) age and sensitivity values was calculated. Film-screen did significantly better (p<0.05) than digital imaging for Criterion 6 (visually sharp reproduction of the cortex and trabecular markings consistent with age), but significantly worse for Criterion 7 (reproduction of the adjacent soft tissues). There was a significant difference in mean S values for each age group when Criterion 6 was or was not met. Results show that although interpretation between two observers was ambiguous, the CEC criteria were able to detect differences in quality of film-screen and digital images. It is also possible to use them when optimizing target S values.