diff --git a/app/assets/sass/components/_reading.scss b/app/assets/sass/components/_reading.scss
index 660fbc95..f2cefacd 100644
--- a/app/assets/sass/components/_reading.scss
+++ b/app/assets/sass/components/_reading.scss
@@ -11,8 +11,133 @@
   padding: 10px;
 }
 
+// Mammogram thumbnail grid for reading pages
+.app-mammogram-thumbnails {
+  display: inline-grid;
+  grid-template-columns: auto auto;
+  gap: 8px;
+}
+
+.app-mammogram-thumbnail--right {
+  display: flex;
+  flex-direction: column;
+  align-items: flex-end;
+  gap: 8px;
+}
+
+.app-mammogram-thumbnail--left {
+  display: flex;
+  flex-direction: column;
+  align-items: flex-start;
+  gap: 8px;
+}
+
+// Individual image wrapper (contains image + label)
+.app-mammogram-thumbnail__image-wrapper {
+  position: relative;
+  // Fixed dimensions for consistent sizing
+  width: 120px;
+  height: 150px;
+  background-color: #000;
+  overflow: hidden;
+  // Use flexbox for image alignment
+  display: flex;
+  align-items: flex-start;
+}
+
+// Right breast images align right (inwards), left breast align left (inwards)
+.app-mammogram-thumbnail--right .app-mammogram-thumbnail__image-wrapper {
+  justify-content: flex-end;
+}
+
+.app-mammogram-thumbnail--left .app-mammogram-thumbnail__image-wrapper {
+  justify-content: flex-start;
+}
+
+.app-mammogram-thumbnail__image {
+  max-width: 100%;
+  max-height: 100%;
+  display: block;
+  cursor: default;
+}
+
+// Slight smoothing for diagram thumbnails to reduce moiré
+.app-mammogram-thumbnail__image--diagram {
+  filter: blur(0.5px);
+}
+
+.app-mammogram-thumbnail__label {
+  position: absolute;
+  top: 4px;
+  background-color: nhsuk-colour("blue");
+  color: #fff;
+  padding: 2px 6px;
+  font-size: 11px;
+  font-weight: 600;
+  z-index: 1;
+}
+
+// Labels align to outer edge - right breast labels on left, left breast labels on right
+.app-mammogram-thumbnail--right .app-mammogram-thumbnail__label {
+  left: 4px;
+}
+
+.app-mammogram-thumbnail--left .app-mammogram-thumbnail__label {
+  right: 4px;
+}
+
+// Missing image placeholder
+.app-mammogram-thumbnail__missing {
+  width: 100%;
+  height: 100%;
+  border: 2px dashed nhsuk-colour("grey-2");
+  background-color: nhsuk-colour("grey-5");
+  display: flex;
+  align-items: center;
+  justify-content: center;
+  box-sizing: border-box;
+}
+
+.app-mammogram-thumbnail__missing-text {
+  font-size: 12px;
+  color: nhsuk-colour("grey-2");
+}
+
+// Zoom overlay for thumbnails
+.app-mammogram-zoom {
+  position: fixed;
+  top: 0;
+  left: 0;
+  right: 0;
+  bottom: 0;
+  background-color: rgba(0, 0, 0, 0.95);
+  z-index: 9999;
+  display: flex;
+  align-items: center;
+  justify-content: center;
+  cursor: default;
+}
+
+.app-mammogram-zoom__image {
+  max-width: 95%;
+  max-height: 95%;
+  object-fit: contain;
+}
+
+.app-mammogram-zoom__label {
+  position: absolute;
+  top: 16px;
+  left: 16px;
+  background-color: nhsuk-colour("blue");
+  color: #fff;
+  padding: 8px 16px;
+  font-size: 14px;
+  font-weight: 600;
+}
+
 // Todo: should this be merged with app-status-bar.scss?
 // Todo: otherwise refctor so classes aren't created with &
+
 .app-reading-status {
   background-color: nhsuk-shade(nhsuk-colour("blue"), 40%);
   color: $nhsuk-reverse-text-colour;
diff --git a/app/config.js b/app/config.js
index 4f7bbc59..09bafec7 100644
--- a/app/config.js
+++ b/app/config.js
@@ -45,6 +45,9 @@ module.exports = {
     urgentThreshold: 10, // 10 days and over
     priorityThreshold: 7, // 7 days and over
     mammogramImageSource: 'diagrams', // 'diagrams' or 'real'
+    // View order for mammogram display: 'cc-first' or 'mlo-first'
+    // Right breast views always on left, left breast views on right
+    mammogramViewOrder: 'cc-first',
     // Distribution of image set tags (must sum to 1.0)
     // These are the base weights - they get adjusted based on event context
     // (symptoms, imperfect images, etc.)
diff --git a/app/lib/utils/reading.js b/app/lib/utils/reading.js
index 6ca77880..2d4401c3 100644
--- a/app/lib/utils/reading.js
+++ b/app/lib/utils/reading.js
@@ -1096,6 +1096,42 @@ const createReadingBatch = (data, options) => {
           event?.medicalInformation.symptoms?.length > 0
       )
     }
+
+    // 4. Apply complex case filter if specified
+    if (filters.complexOnly) {
+      const isComplexCase = (event) => {
+        const hasSymptoms =
+          event?.medicalInformation?.symptoms &&
+          event?.medicalInformation.symptoms?.length > 0
+
+        const hasAdditionalImages =
+          event?.mammogramData?.metadata?.hasAdditionalImages
+
+        const isImperfect =
+          event?.mammogramData?.isImperfectButBestPossible?.includes &&
+          event.mammogramData.isImperfectButBestPossible.includes('yes')
+
+        const isIncomplete =
+          event?.mammogramData?.isIncompleteMammography?.includes &&
+          event.mammogramData.isIncompleteMammography.includes('yes')
+
+        const hasImplants =
+          event?.medicalInformation?.medicalHistory
+            ?.breastImplantsAugmentation &&
+          event.medicalInformation.medicalHistory.breastImplantsAugmentation
+            .length > 0
+
+        return (
+          hasSymptoms ||
+          hasAdditionalImages ||
+          isImperfect ||
+          isIncomplete ||
+          hasImplants
+        )
+      }
+
+      events = events.filter((event) => isComplexCase(event))
+    }
   }
 
   // Apply read type filters
diff --git a/app/lib/utils/summary-list.js b/app/lib/utils/summary-list.js
index 71c9fceb..5ad55484 100644
--- a/app/lib/utils/summary-list.js
+++ b/app/lib/utils/summary-list.js
@@ -96,6 +96,60 @@ const handleSummaryListMissingInformation = (
   return processRow(input)
 }
 
+/**
+ * Add no-border class to the last summary list row
+ *
+ * Usefule where the summary list is within a card and you want to remove the bottom border
+ *
+ * @param {object|array} input - Summary list object or rows array
+ * @returns {object|array} Updated summary list or rows array
+ */
+const removeLastRowBorder = (input) => {
+  if (!input) return input
+
+  const isArrayInput = Array.isArray(input)
+  const rows = isArrayInput ? input : input.rows
+
+  if (!Array.isArray(rows) || rows.length === 0) return input
+
+  let lastRowIndex = -1
+
+  for (let index = rows.length - 1; index >= 0; index -= 1) {
+    const row = rows[index]
+
+    if (row && typeof row === 'object' && row.key) {
+      lastRowIndex = index
+      break
+    }
+  }
+
+  if (lastRowIndex === -1) return input
+
+  const updatedRows = rows.map((row, index) => {
+    if (index !== lastRowIndex) return row
+
+    const className = 'nhsuk-summary-list__row--no-border'
+    const existingClasses = row.classes || ''
+    const hasClass = existingClasses.split(' ').includes(className)
+    const classes = hasClass
+      ? existingClasses
+      : `${existingClasses} ${className}`.trim()
+
+    return {
+      ...row,
+      classes
+    }
+  })
+
+  if (isArrayInput) return updatedRows
+
+  return {
+    ...input,
+    rows: updatedRows
+  }
+}
+
 module.exports = {
-  handleSummaryListMissingInformation
+  handleSummaryListMissingInformation,
+  removeLastRowBorder
 }
diff --git a/app/routes/reading.js b/app/routes/reading.js
index eea793ac..795f57ce 100644
--- a/app/routes/reading.js
+++ b/app/routes/reading.js
@@ -149,6 +149,10 @@ module.exports = (router) => {
       filters.includeAwaitingPriors = true
     }
 
+    if (queryFilters.includes('complexOnly')) {
+      filters.complexOnly = true
+    }
+
     // Create the batch
     try {
       const batch = createReadingBatch(data, {
diff --git a/app/views/_includes/additional-image-details.njk b/app/views/_includes/additional-image-details.njk
index f94bd114..55d94cb9 100644
--- a/app/views/_includes/additional-image-details.njk
+++ b/app/views/_includes/additional-image-details.njk
@@ -53,9 +53,6 @@
         value: "Technical issues",
         text: "Technical issues"
       },
-      {
-        divider: "or"
-      },
       {
         value: "Other",
         text: "Other"
diff --git a/app/views/_includes/reading/image-warnings.njk b/app/views/_includes/reading/image-warnings.njk
index c03e831b..132f74f1 100644
--- a/app/views/_includes/reading/image-warnings.njk
+++ b/app/views/_includes/reading/image-warnings.njk
@@ -91,7 +91,7 @@
     <div class="nhsuk-grid-column-two-thirds">
       {{ insetText({
         html: warningsHtml,
-        classes: "nhsuk-u-margin-top-6"
+        classes: ""
       }) }}
     </div>
   </div>
diff --git a/app/views/_includes/summary-lists/medical-info-summary.njk b/app/views/_includes/summary-lists/medical-info-summary.njk
index bbd2408f..27193b84 100644
--- a/app/views/_includes/summary-lists/medical-info-summary.njk
+++ b/app/views/_includes/summary-lists/medical-info-summary.njk
@@ -214,26 +214,10 @@
   }) %}
 {% endif %}
 
-{# Final summary list rows #}
-{# Rebuild rows so we can add a no-border class to the final row #}
-{% set rowsForSummaryList = [] %}
-{% for row in rows %}
-  {% if loop.last %}
-    {% set rowsForSummaryList = rowsForSummaryList | push({
-      key: row.key,
-      value: row.value,
-      actions: row.actions,
-      classes: "nhsuk-summary-list__row--no-border"
-    }) %}
-  {% else %}
-    {% set rowsForSummaryList = rowsForSummaryList | push(row) %}
-  {% endif %}
-{% endfor %}
-
-{% if rowsForSummaryList | length == 0 %}
+{% if rows | length == 0 %}
   <p class="nhsuk-body">No medical information recorded.</p>
 {% else %}
   {{ summaryList({
-    rows: rowsForSummaryList
+    rows: rows | removeLastRowBorder
   }) }}
 {% endif %}
diff --git a/app/views/_includes/summary-lists/read-summary.njk b/app/views/_includes/summary-lists/read-summary.njk
index 9584c259..3593f52e 100644
--- a/app/views/_includes/summary-lists/read-summary.njk
+++ b/app/views/_includes/summary-lists/read-summary.njk
@@ -215,5 +215,5 @@
 {% endif %}
 
 {{ summaryList({
-  rows: rows
+  rows: rows | removeLastRowBorder
 }) }}
diff --git a/app/views/_includes/symptomsWarningCard.njk b/app/views/_includes/symptomsWarningCard.njk
index 156bf683..1acd90d5 100644
--- a/app/views/_includes/symptomsWarningCard.njk
+++ b/app/views/_includes/symptomsWarningCard.njk
@@ -8,6 +8,7 @@
 
   {{ warningCallout({
     heading: 'Significant symptoms reported',
-    html: warningCalloutHtml
+    html: warningCalloutHtml,
+    classes: "nhsuk-u-margin-top-3 nhsuk-u-margin-bottom-5"
   }) }}
 {% endif %}
diff --git a/app/views/events/images-manual-details.html b/app/views/events/images-manual-details.html
index b09135eb..c5751c2f 100644
--- a/app/views/events/images-manual-details.html
+++ b/app/views/events/images-manual-details.html
@@ -58,33 +58,63 @@ <h2 aria-hidden="true">{{ viewsQuestionText }}?</h2>
             {{ (viewsQuestionText + " for the") | asVisuallyHiddenText }} Right breast
           </legend>
           
-          {{ appStepperInput({
-            label: {
-              text: "RMLO"
-            },
-            _hint: {
-              text: "Mediolateral oblique view"
-            },
-            name: "event[mammogramDataTemp][viewsRightBreastMLOCount]",
-            value: viewsRightBreastMLOCount | default("1"),
-            id: "views-right-breast-mlo-count",
-            min: 0,
-            max: 9
-          }) }}
-          
-          {{ appStepperInput({
-            label: {
-              text: "RCC"
-            },
-            _hint: {
-              text: "Craniocaudal view"
-            },
-            name: "event[mammogramDataTemp][viewsRightBreastCCCount]",
-            value: viewsRightBreastCCCount | default("1"),
-            id: "views-right-breast-cc-count",
-            min: 0,
-            max: 9
-          }) }}
+          {% if data.config.reading.mammogramViewOrder == 'mlo-first' %}
+            {{ appStepperInput({
+              label: {
+                text: "RMLO"
+              },
+              _hint: {
+                text: "Mediolateral oblique view"
+              },
+              name: "event[mammogramDataTemp][viewsRightBreastMLOCount]",
+              value: viewsRightBreastMLOCount | default("1"),
+              id: "views-right-breast-mlo-count",
+              min: 0,
+              max: 9
+            }) }}
+            
+            {{ appStepperInput({
+              label: {
+                text: "RCC"
+              },
+              _hint: {
+                text: "Craniocaudal view"
+              },
+              name: "event[mammogramDataTemp][viewsRightBreastCCCount]",
+              value: viewsRightBreastCCCount | default("1"),
+              id: "views-right-breast-cc-count",
+              min: 0,
+              max: 9
+            }) }}
+          {% else %}
+            {{ appStepperInput({
+              label: {
+                text: "RCC"
+              },
+              _hint: {
+                text: "Craniocaudal view"
+              },
+              name: "event[mammogramDataTemp][viewsRightBreastCCCount]",
+              value: viewsRightBreastCCCount | default("1"),
+              id: "views-right-breast-cc-count",
+              min: 0,
+              max: 9
+            }) }}
+            
+            {{ appStepperInput({
+              label: {
+                text: "RMLO"
+              },
+              _hint: {
+                text: "Mediolateral oblique view"
+              },
+              name: "event[mammogramDataTemp][viewsRightBreastMLOCount]",
+              value: viewsRightBreastMLOCount | default("1"),
+              id: "views-right-breast-mlo-count",
+              min: 0,
+              max: 9
+            }) }}
+          {% endif %}
           
           {{ appStepperInput({
             label: {
@@ -108,33 +138,63 @@ <h2 aria-hidden="true">{{ viewsQuestionText }}?</h2>
             {{ (viewsQuestionText + " for the") | asVisuallyHiddenText }} Left breast
           </legend>
           
-          {{ appStepperInput({
-            label: {
-              text: "LMLO"
-            },
-            _hint: {
-              text: "Mediolateral oblique view"
-            },
-            name: "event[mammogramDataTemp][viewsLeftBreastMLOCount]",
-            value: viewsLeftBreastMLOCount | default("1"),
-            id: "views-left-breast-mlo-count",
-            min: 0,
-            max: 9
-          }) }}
-          
-          {{ appStepperInput({
-            label: {
-              text: "LCC"
-            },
-            _hint: {
-              text: "Craniocaudal view"
-            },
-            name: "event[mammogramDataTemp][viewsLeftBreastCCCount]",
-            value: viewsLeftBreastCCCount | default("1"),
-            id: "views-left-breast-cc-count",
-            min: 0,
-            max: 9
-          }) }}
+          {% if data.config.reading.mammogramViewOrder == 'mlo-first' %}
+            {{ appStepperInput({
+              label: {
+                text: "LMLO"
+              },
+              _hint: {
+                text: "Mediolateral oblique view"
+              },
+              name: "event[mammogramDataTemp][viewsLeftBreastMLOCount]",
+              value: viewsLeftBreastMLOCount | default("1"),
+              id: "views-left-breast-mlo-count",
+              min: 0,
+              max: 9
+            }) }}
+            
+            {{ appStepperInput({
+              label: {
+                text: "LCC"
+              },
+              _hint: {
+                text: "Craniocaudal view"
+              },
+              name: "event[mammogramDataTemp][viewsLeftBreastCCCount]",
+              value: viewsLeftBreastCCCount | default("1"),
+              id: "views-left-breast-cc-count",
+              min: 0,
+              max: 9
+            }) }}
+          {% else %}
+            {{ appStepperInput({
+              label: {
+                text: "LCC"
+              },
+              _hint: {
+                text: "Craniocaudal view"
+              },
+              name: "event[mammogramDataTemp][viewsLeftBreastCCCount]",
+              value: viewsLeftBreastCCCount | default("1"),
+              id: "views-left-breast-cc-count",
+              min: 0,
+              max: 9
+            }) }}
+            
+            {{ appStepperInput({
+              label: {
+                text: "LMLO"
+              },
+              _hint: {
+                text: "Mediolateral oblique view"
+              },
+              name: "event[mammogramDataTemp][viewsLeftBreastMLOCount]",
+              value: viewsLeftBreastMLOCount | default("1"),
+              id: "views-left-breast-mlo-count",
+              min: 0,
+              max: 9
+            }) }}
+          {% endif %}
           
           {{ appStepperInput({
             label: {
diff --git a/app/views/reading/create-custom-batch.html b/app/views/reading/create-custom-batch.html
index 817e3fcc..b24af7c4 100644
--- a/app/views/reading/create-custom-batch.html
+++ b/app/views/reading/create-custom-batch.html
@@ -89,13 +89,12 @@ <h1>{{ pageHeading }}</h1>
       },
       items: [
         {
-          value: "hasSymptoms",
-          text: "Only cases with symptoms"
-        },
-        {
-          value: "includeAwaitingPriors",
-          text: "Include awaiting priors cases"
-        } if false
+          value: "complexOnly",
+          text: "Only complex cases",
+          hint: {
+            text: "Symptoms, additional images, incomplete or imperfect images, or implants"
+          }
+        }
       ]
     }) }}
   {% endif %}
diff --git a/app/views/reading/workflow/opinion.html b/app/views/reading/workflow/opinion.html
index 9b0637fd..834472a5 100644
--- a/app/views/reading/workflow/opinion.html
+++ b/app/views/reading/workflow/opinion.html
@@ -3,7 +3,7 @@
 
 {% extends 'layout-reading.html' %}
 
-{% set pageHeading = "Review images" %}
+{% set pageHeading = participant | getFullName %}
 {% set gridColumn = "none" %}
 {% set showWorkflowNav = true %}
 
@@ -28,14 +28,36 @@
     {% set opinionHeading = "Update review" %}
   {% endif %}
 
+  {# Get mammogram images for thumbnails #}
+  {% set mammogramImageSource = data.config.reading.mammogramImageSource or "diagrams" %}
+  {% set mammogramImages = getImagesForEvent(eventId, mammogramImageSource, { event: event }) %}
+
+  {# View order from config - determines if CC or MLO comes first #}
+  {# Right breast views on left, left breast views on right #}
+  {% if data.config.reading.mammogramViewOrder == 'mlo-first' %}
+    {% set viewOrder = [
+      { key: 'rmlo', label: 'RMLO', side: 'right' },
+      { key: 'lmlo', label: 'LMLO', side: 'left' },
+      { key: 'rcc', label: 'RCC', side: 'right' },
+      { key: 'lcc', label: 'LCC', side: 'left' }
+    ] %}
+  {% else %}
+    {% set viewOrder = [
+      { key: 'rcc', label: 'RCC', side: 'right' },
+      { key: 'lcc', label: 'LCC', side: 'left' },
+      { key: 'rmlo', label: 'RMLO', side: 'right' },
+      { key: 'lmlo', label: 'LMLO', side: 'left' }
+    ] %}
+  {% endif %}
+
   {# Page header with status tags #}
   <div class="nhsuk-grid-row app-header-with-status">
     <div class="nhsuk-grid-column-two-thirds">
       <span class="nhsuk-caption-l">
-        {{ participant | getFullName }}
+        {{ opinionHeading }}
       </span>
       <h1 class="nhsuk-heading-l js-image-count">
-        {{ opinionHeading }}
+        {{ participant | getFullName }}
       </h1>
     </div>
     <div class="nhsuk-grid-column-one-third app-header-with-status__status-tag">
@@ -99,20 +121,87 @@ <h1 class="nhsuk-heading-l js-image-count">
     </div>
   </div>
 
-  {# Opinion form #}
+
+
+  {# Opinion form with thumbnails #}
   {% set questionText = "What is your opinion of these images?" %}
 
+  {# Count total images #}
+  {% set imageCount = 0 %}
+  {% for view in viewOrder %}
+    {% set allPaths = mammogramImages.allPaths[view.key] if mammogramImages and mammogramImages.allPaths else null %}
+    {% if allPaths %}
+      {% if allPaths is string %}
+        {% set imageCount = imageCount + 1 %}
+      {% else %}
+        {% set imageCount = imageCount + allPaths | length %}
+      {% endif %}
+    {% endif %}
+  {% endfor %}
+
+  <form action="./opinion-answer" method="POST">
+    
   {# Opinion form data attributes are used to manage the first-load lockout #}
   {# Todo: do we need a form here? is the parent layout's form not enough? #}
   <form action="./opinion-answer" method="POST" class="app-reading-opinion" data-reading-opinion-form="true" data-reading-opinion-locked="{{ 'false' if hasExistingOpinion else 'true' }}" data-event-id="{{ event.id }}" data-batch-id="{{ batch.id if batch }}">
 
-    {# Hidden field to track previous result for change detection #}
+    {# Hidden field to track previous result for opinion change detection #}
     <input type="hidden" name="imageReadingTemp[previousResult]" value="{{ currentResult }}">
 
-    {% if hasExistingOpinion %}
-      {# Show radios when updating an existing or in-progress result #}
-      <div class="nhsuk-grid-row">
-        <div class="nhsuk-grid-column-two-thirds">
+    <div class="nhsuk-grid-row">
+
+      {# Left column: Mammogram thumbnails #}
+      <div class="nhsuk-grid-column-one-third nhsuk-u-margin-bottom-4">
+        <h2 class="nhsuk-heading-s">Image thumbnails ({{ imageCount }})</h2>
+        <div class="app-mammogram-thumbnails">
+          {% for view in viewOrder %}
+            <div class="app-mammogram-thumbnail app-mammogram-thumbnail--{{ view.side }}">
+              {% set allPaths = mammogramImages.allPaths[view.key] if mammogramImages and mammogramImages.allPaths else null %}
+              
+              {% if allPaths %}
+                {# Handle both single path (string) and multiple paths (array) #}
+                {% if allPaths is string %}
+                  <div class="app-mammogram-thumbnail__image-wrapper">
+                    <span class="app-mammogram-thumbnail__label">{{ view.label }}</span>
+                    <img 
+                      class="app-mammogram-thumbnail__image{% if mammogramImageSource == 'diagrams' %} app-mammogram-thumbnail__image--diagram{% endif %}" 
+                      src="{{ allPaths }}" 
+                      alt="{{ view.label }} view"
+                      data-view="{{ view.label }}"
+                    >
+                  </div>
+                {% else %}
+                  {# Multiple images - each with its own wrapper and label #}
+                  {% for imagePath in allPaths %}
+                    <div class="app-mammogram-thumbnail__image-wrapper">
+                      <span class="app-mammogram-thumbnail__label">{{ view.label }}</span>
+                      <img 
+                        class="app-mammogram-thumbnail__image{% if mammogramImageSource == 'diagrams' %} app-mammogram-thumbnail__image--diagram{% endif %}" 
+                        src="{{ imagePath }}" 
+                        alt="{{ view.label }} view ({{ loop.index }} of {{ loop.length }})"
+                        data-view="{{ view.label }}"
+                      >
+                    </div>
+                  {% endfor %}
+                {% endif %}
+              {% else %}
+                {# Missing image placeholder #}
+                <div class="app-mammogram-thumbnail__image-wrapper">
+                  <span class="app-mammogram-thumbnail__label">{{ view.label }}</span>
+                  <div class="app-mammogram-thumbnail__missing">
+                    <span class="app-mammogram-thumbnail__missing-text">No image</span>
+                  </div>
+                </div>
+              {% endif %}
+            </div>
+          {% endfor %}
+        </div>
+      </div>
+
+      {# Right column: Opinion buttons/radios #}
+      <div class="nhsuk-grid-column-two-thirds">
+        {% if hasExistingOpinion %}
+          {# Show radios when updating an existing or in-progress result #}
           {{ radios({
             name: "imageReadingTemp[result]",
             fieldset: {
@@ -148,20 +237,12 @@ <h1 class="nhsuk-heading-l js-image-count">
           {{ button({
             text: "Update opinion"
           }) }}
-        </div>
-      </div>
 
-    {% else %}
-      {# Show buttons for initial assessment #}
-      <div class="nhsuk-grid-row">
-        <div class="nhsuk-grid-column-two-thirds">
-          <h2>{{ questionText }}</h2>
-        </div>
-      </div>
+        {% else %}
+          {# Show buttons for initial assessment - vertically stacked #}
+          <h2 class="nhsuk-heading-m">{{ questionText }}</h2>
 
-      <div class="nhsuk-grid-row">
-        <div class="nhsuk-grid-column-one-third">
-          <div class="form-group">
+          <div class="nhsuk-u-margin-bottom-4">
             {% if hasSymptoms %}
               {{ button({
                 text: "Normal, and add details",
@@ -177,26 +258,24 @@ <h2>{{ questionText }}</h2>
                 classes: "app-button-full-width nhsuk-u-margin-bottom-3"
               }) }}
 
-              <p class="nhsuk-u-margin-bottom-0">
+              <p class="nhsuk-u-margin-bottom-4">
                 <button type="submit" name="imageReadingTemp[result]" value="normal_with_details" class="app-button-link">
                   Normal, but add details
                 </button>
               </p>
             {% endif %}
           </div>
-        </div>
-        <div class="nhsuk-grid-column-one-third">
-          <div class="form-group">
+
+          <div class="nhsuk-u-margin-bottom-4">
             {{ button({
               text: "Technical recall",
               value: "technical_recall",
               name: "imageReadingTemp[result]",
-              classes: "nhsuk-button--secondary app-button-full-width"
+              classes: "nhsuk-button--secondary app-button-full-width nhsuk-u-margin-bottom-3"
             }) }}
           </div>
-        </div>
-        <div class="nhsuk-grid-column-one-third">
-          <div class="form-group">
+
+          <div class="nhsuk-u-margin-bottom-4">
             {{ button({
               text: "Recall for assessment",
               value: "recall_for_assessment",
@@ -204,19 +283,23 @@ <h2>{{ questionText }}</h2>
               classes: "nhsuk-button--warning app-button-full-width"
             }) }}
           </div>
-        </div>
+
+        {% endif %}
       </div>
+    </div>
 
-    {% endif %}
+  </form>
 
-    {% include "_includes/reading/image-warnings.njk" %}
 
-  </form>
+  {# Image notes - moved above opinion section #}
+  {% include "_includes/reading/image-warnings.njk" %}
+
 
   {# Medical summary #}
   {# Only show rows that have data #}
   {% set showOnlyPopulated = true %}
   {# No edits allowed in image reading #}
+
   {% set allowEdits = false %}
 
   {% set medicalSummaryHtml %}
@@ -231,3 +314,45 @@ <h2>{{ questionText }}</h2>
   }) }}
 
 {% endblock %}
+
+{% block pageScripts %}
+<script>
+// Thumbnail zoom functionality
+document.addEventListener('DOMContentLoaded', () => {
+  const enableThumbnailZoom = false
+
+  if (!enableThumbnailZoom)
+  {
+    return
+  }
+
+  const thumbnails = document.querySelectorAll('.app-mammogram-thumbnail__image')
+  
+  thumbnails.forEach(img => {
+    img.addEventListener('click', (e) => {
+      const src = e.target.src
+      const view = e.target.dataset.view || ''
+      
+      // Create zoom overlay
+      const overlay = document.createElement('div')
+      overlay.className = 'app-mammogram-zoom'
+      overlay.innerHTML = `
+        <span class="app-mammogram-zoom__label">${view}</span>
+        <img class="app-mammogram-zoom__image" src="${src}" alt="${view} view">
+      `
+      
+      // Close on click or escape
+      overlay.addEventListener('click', () => overlay.remove())
+      document.addEventListener('keydown', function escHandler(e) {
+        if (e.key === 'Escape') {
+          overlay.remove()
+          document.removeEventListener('keydown', escHandler)
+        }
+      })
+      
+      document.body.appendChild(overlay)
+    })
+  })
+})
+</script>
+{% endblock %}
diff --git a/app/views/reading/workflow/technical-recall.html b/app/views/reading/workflow/technical-recall.html
index ab18c9c6..db3e892f 100644
--- a/app/views/reading/workflow/technical-recall.html
+++ b/app/views/reading/workflow/technical-recall.html
@@ -26,8 +26,12 @@ <h1 class="nhsuk-heading-l js-image-count">
     {{ pageHeading }}
   </h1>
 
-  {# Standard views - could be dynamic based on participant/event in future #}
-  {% set views = ['RMLO', 'LMLO', 'RCC', 'LCC'] %}
+  {# Standard views - order matches config setting #}
+  {% if data.config.reading.mammogramViewOrder == 'mlo-first' %}
+    {% set views = ['RMLO', 'LMLO', 'RCC', 'LCC'] %}
+  {% else %}
+    {% set views = ['RCC', 'LCC', 'RMLO', 'LMLO'] %}
+  {% endif %}
 
   {% set recallReasons = [
     'Breast positioning',