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Purpose: To evaluate the perception and 5-year application of anatomic side markers (ASMs) by radiographers in Malta., Methods and Materials: Phase 1 involved a longitudinal, retrospective observation of a stratified sample of radiographs over 5 years, using a self-designed data record sheet to record features of the placement of ASMs. Phase 2 consisted of a cross-sectional, prospective self-designed questionnaire evaluating the radiographers' perception on the use of ASMs in professional practice., Results: In phase 1, radiographs (n = 500) were selected from 234,105 taken over the 5-year period (error: ±4.38%; 95% confidence level). Four hundred thirty radiographs (86%) had evidence of markers, of which 110 (25.6%) had a pre-exposure marker and 320 (74.4%) had a postprocessed marker. The remaining 14% had no evidence of any markers. Two hundred eighty two (56.4%) of the radiographs had ASMs placed according to recommended guidelines by Ballinger, Frank, and Merrill. In phase 2, most radiographers (84.6%) preferred using postprocessing markers, with 15.4% preferring pre-exposure markers (76.6% of radiographers found applying pre-exposure markers time consuming). Sixty percent (60.5%) of radiographers gave correct answers on use of markers as recommended in the guidelines., Conclusions: Radiographer preference in using postprocessing markers was evident, while the use of pre-exposure markers was seen to be influenced by time of examination, projection executed, and patient positioning. Radiographer awareness and continuous training are recommended., (Copyright © 2016 Canadian Association of Medical Radiation Technologists. Published by Elsevier Inc. All rights reserved.)