Objective evaluation, e.g., using the modulation transfer function (MTF) or the noise power spectrum (NPS) of an X-ray imaging system may not correctly correspond to the subject’s evaluation, e.g., when using the receiver operating characteristic (ROC). Moreover, it is difficult to measure MTF or NPS from clinical images. We therefore applied MTF fractal dimension to an X-ray imaging system. The MTF fractal dimension includes the frequency properties of the human eye in addition to quantitative complexity. In this study, we demonstrated a relationship between basic image quality and MTF fractal dimension using simulated and actual X-ray images.