Objectives This study was designed to assess the importance of communication between surgeons and radiographers in the operation of image intensifiers during orthopaedic surgery. Methods This study was designed and conducted as single-centre, observational study. Fifteen medical officers and 15 radiographers were involved in this study. Each of the 15 radiographers was assigned to a medical officer. The 15 pairs were then each given a task to simulate achieving 'perfect circles' on fluoroscopy for distal locking of an intramedullary nail. The time taken for the surgeon to verbally instruct the radiographer how to position the image intensifier in order to achieve 'perfect circles' was recorded. The overall time taken to perform the task, and total number of images taken was recorded before and after a terminology system to manoeuvre image intensifier was introduced to the pairs. Results The mean time taken for the pairs to achieve perfect circles after the introduction of the manoeuvre terminology showed statistically significant reduction from 212 to 97?s (t = 4.212, df = 88, P < 0.05) after the introduction of the terminology. The mean number of fluoroscopy exposures taken also showed a statistically significant reduction from 12 to 6 (t = 6.791, df = 88, P < 0.05). Conclusion The implementation of a clear and unambiguous set of commands to control the image intensifier, which are common to both surgeon and radiographer, can reduce the time to acquire the desired images, and requires less radiation exposure in the process.