It is well recognized in projection radiography that low-contrast detectability suffers in heavily attenuating regions due to excessively low x-ray fluence to the image receptor and higher noise levels. Exposure equalization can improve image quality by increasing the x-ray exposure to heavily attenuating regions, resulting in a more uniform distribution of exposure to the detector. Image quality is also expected to be improved by using the slot-scan geometry to reject scattered radiation effectively without degrading primary x-rays. This paper describes the design of a prototype scan equalization digital radiography (SEDR) system implemented with an amorphous silicon (a-Si) thin-film transistor (TFT) array-based flat-panel detector. With this system, slot-scan geometry with alternate line erasure and readout (ALER) technique was used to achieve scatter rejection. A seven-segment beam height modulator assembly was mounted onto the fore collimator to regulate exposure regionally for chest radiography. The beam modulator assembly, consisting of micro linear motors, lead screw cartridge with lead (Pb) beam blockers attached, position feedback sensors and motor driver circuitry, has been tested and found to have an acceptable response for exposure equalization in chest radiography. An anthropomorphic chest phantom was imaged in the posterior–anterior (PA) view under clinical conditions. Scatter component, primary x-rays, scatter-to-primary ratios (SPRs) and primary signal-to-noise ratios (PSNRs) were measured in the SEDR images to evaluate the rejection and redistribution of scattered radiation, and compared with those for conventional full-field imaging with and without anti-scatter grid methods. SPR reduction ratios (SPRRRs, defined as the differences between the non-grid full-field SPRs and the reduced SPRs divided by the former) yielded approximately 59% for the full-field imaging with grid and 82% for the SEDR technique in the lungs, and 77% for the full-field imaging with grid and 95% for the SEDR technique in the subdiaphragm. The SEDR technique demonstrated a substantial improvement in PSNRs over the anti-scatter grid technique. The improvements of PSNRs varied with the regions and are more pronounced in heavily attenuating regions.