Medical image quality assessment is an important aspect of image acquisition, as poor-quality images may lead to misdiagnosis. Manual labelling of image quality is a tedious task for population studies and can lead to misleading results. While much research has been done on automated analysis of image quality to address this issue, relatively little work has been done to explain the methodologies. In this work, we propose an explainable image quality assessment system and validate our idea on two different objectives which are foreign object detection on Chest X-Rays (Object-CXR) and Left Ventricular Outflow Tract (LVOT) detection on Cardiac Magnetic Resonance (CMR) volumes. We apply a variety of techniques to measure the faithfulness of the saliency detectors, and our explainable pipeline relies on NormGrad, an algorithm which can efficiently localise image quality issues with saliency maps of the classifier. We compare NormGrad with a range of saliency detection methods and illustrate its superior performance as a result of applying these methodologies for measuring the faithfulness of the saliency detectors. We see that NormGrad has significant gains over other saliency detectors by reaching a repeated Pointing Game score of 0.853 for Object-CXR and 0.611 for LVOT datasets.