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Background: Patient safety is a primary concern within the NHS. It has been reported that anatomical side marker (ASM) use in radiography does not meet the 'best practice' standard. Case reports suggest this may be a contributing factor to adverse events in healthcare. Purpose: This study aimed to investigate the latent conditions contributing to poor ASM practice; communities of practice, time of image acquisition and competing priorities with collimation practice. Method: Proxy variables of projection and laterality were used to measure communities of practice. ASM practice on 330 examinations (170 lumbar spine, 160 finger) was retrospectively observed using a data collection tool. Aggregate scores were calculated from the two images in each examination. Data was analysed using descriptive statistics, chi-square tests (projection) and Mann-Whitney U tests (laterality, time of acquisition and collimation practice). Results: 'Best practice' ASM use was met on one examination. Correct ASM were observed within the primary collimation in 32.0% images. Projection, laterality and collimation practice were associated with ASM use. Time of acquisition was not found to be associated. Discussion: Communities of practice and competing priorities impact on ASM use. Logistic regression to determine a primary latent condition was not possible. However, comparison with previous research suggests this is likely to be specific to each radiography department. Conclusion: Latent conditions are associated with poor ASM practice. These must be identified and addressed in each individual radiography department, to improve patient safety and uphold NHS Constitutional standards.