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A referrer can also be defined as someone who makes a recommendation for an individual (i.e. patient) to consult the professional person (Radiologist) or group (Imaging team) for help or information in respect to the individual's circumstances and in this context medical situation which warrant an intervention (Bond, 2001, 483-88). Radiographic referrals for imaging can be made by medical and non-medical referrers. The term medical referrers will refer to group of people who are qualified junior Doctors and specialist Doctors. They are primarily in charge of patient management in the hospitals and clinics while non- medical referrers include Nurse practitioners, Physiotherapist Practitioners and all others associated with the care of patient who has undergone a formal training in the area of radiographic referrals. It is also mentioned that medical history, physical examination and standard x-rays are very important tools in a diagnostic process. This highlights the importance of medical history and physical examination to the referrer of musculoskeletal cases. He concluded that radiologist should be informed by the clinicians about the special reasons for the diagnostic demands in order to them choose the best imaging technique.

The term scaphoid derives from the Greek word skaphe meaning boat. The scaphoid is seated on the radial side of the wrist and is the only bone that bridges the two carpal rows creating a mechanical linkage between them. The scaphoid has a complex three-dimensional geometry, but overall it can be considered to have medial and volar concavities and dorsal and lateral convexities (Bond, 2001, 483-88). Conventionally the bone is divided into three basic regions - proximal pole, waist and distal pole. Three of the six surfaces of the scaphoid are articular. The distal surface articulates with the trapezoid and trapezium, its medial surface with both capitate and lunate and its proximal convexity articulates with a corresponding concave fossa on the distal radial surface, the scaphoid fossa (Barton, 1992, 289-310).

The waist of the scaphoid is best understood by considering the three non-articular surfaces, which lie dorsal, lateral and volar. As a unit they form a helix winding from the proximal end of the dorsal surface, around the lateral surface and terminating at the base of the tubercle volarly. The waist represents a non-articular strip, which is devoid of articular hyaline cartilage and macroscopically can be seen as a roughened ridge of bare bone (Figure 1). This bare area has consistently been shown to be the site of multiple vascular foramina, which serve as entry portals for feeding arteries. The study of nearly 300 cadaveric specimens showed that the largest foraminae occur in the distal half of the bone. In their study 13% of scaphoids had no perforations in the proximal half of the bone and a further 20% had only a single foramen at or proximal to the waist (Dias, 1989, 307-10). The major blood supply to the scaphoid arises variably from the radial artery and its superficial palmar branch, although additional anastomosis from the anterior interosseous artery is described.

The main feeding ...