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Informed Consent - Medical Imaging

Adult |  Child/Young Person

Please note: The Medical Board of Australia has published Guidelines: Sexual boundaries in the doctor-patient relationship. These guidelines, which came into effect on 12 December 2018, provide guidance on establishing and maintaining sexual boundaries in the doctor-patient relationship. To support hospitals/individual health practitioners/patients to comply with these guidelines, our Informed Consent forms and Patient Information sheets for procedures requiring intimate examinations, have been updated in the relevant surgical areas, indicated below by an (*).

Two separate additional student consent forms (adult and child/young person), indicated below by an (**), are to be used for patients to complete if the procedure is yet to occur and prior consent has been undertaken on the previous version of informed consent forms, or if the procedure consent form does not have a student section included.

A |  C |  D |  E |   |  G |  H |   I |  J |  K  |   |  M |  N |  O |  P |  Q  |  R |  S |  T |  U |   |  W  |  Y |  Z

Index Procedure List File Size
AA Additional Student Consent ** 2.7 MB
 Adenosine - MRI Cardiac Stress Perfusion Study 114 KB
 Adrenal Vein Sampling 127 KB
 Amniocentesis/Chorionic Villus Sampling * 3.2 MB
 Anaesthetic 66 KB
 Anorectal Physiology and Endoanal Ultrasound *                                                          5.06 MB
 Angiogram Consent* 837 KB
  Angiogram is superseded by Angiogram Consent*  
  Angiogram &/-Plasty / Stenting is superseded by Angiogram Consent*  
  Angioplasty is superseded by Angiogram Consent*  
 Antenatal Ultrasound Guided Procedure 37 KB
  Arterial Stent is superseded by Angiogram Consent*  
  Arteriogram is superseded by Angiogram Consent*  
 Arthrogram (Image-Guided) Consent 636 KB
  Arthrogram is superseded by Arthrogram (Image-Guided) Consent 
 Aspiration/Drainage (Image-Guided) Consent * 1.6 MB
  Aspiration is superseded by Aspiration/Drainage (Image-Guided) Consent *  
  Aspiration - Breast * is superseded by Aspiration/Drainage (Image-Guided) Consent *  
 Aspiration - Chest is superseded by Thoracentesis Consent  
Index Procedure List File Size
BBarium Enema 40 KB
 Biliary Drain Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent 
 Biliary Stent Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent 
 Biopsy (Image-Guided) Consent * 580 KB
  Biopsy - Chest is superseded by Biopsy (Image-Guided) Consent *  
 Biopsy - Other is superseded by Biopsy (Image-Guided) Consent * 
 Biopsy - Superficial * is superseded by Biopsy (Image-Guided) Consent * 
 Biopsy - TRUS is superseded by Biopsy (Image-Guided) Consent * 
  Blood transfusion consent and refusal forms are now located under Blood specialty.             
 Bone Biopsy is superseded by Biopsy (Image-Guided) Consent * 
  Breast Aspiration * is superseded by Aspiration/Drainage (Image-Guided) Consent *  
 Breast Biopsy * is superseded by Biopsy (Image-Guided) Consent * 
 Breast Imaging * 788 KB

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Index Procedure List File Size
C  
 Cardiac MRI - Adenosine 114 KB
 Cardiac MRI - Dobutamine 148 KB
 Carotid Stent 157 KB
 Catheter Check with Iodinated Contrast 377 KB
  Catheter Check with IV Contrast is superseded by Catheter Check with Iodinated Contrast
  Catheter Check without IV Contrast is superseded by Catheter Check with Iodinated Contrast 
 Celiac Plexus Block is superseded by  Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent 
  Central Line Check is superseded by Catheter Check with Iodinated Contrast 
  Central Line Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*  
 Central Vascular Access Device (CVAD) Insertion Consent* 658 KB
  Central Vascular Access Device Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*  
 Cerebral Vasospasm Treatment 135 KB
  Cerebral Thrombolysis / Clot Retrieval
This form is now superseded by Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic
6.5 MB
 Cerebrospinal Fluid (CSF) Shunt Patency Scan Consent * 3.2 MB
  Chemoemobolisation is now superseded by Trans-Arterial Chemo-Embolisation (TACE) Consent *  
 Chest Biopsy is superseded by Biopsy (Image-Guided) Consent * 
  Chest Drain is superseded by Intercostal Catheter (ICC) Insertion Consent 
 Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent817 KB
 Cholangiogram - Percutaneous is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent 
 Chorionic Villus Sampling (CVS) 160 KB
  Clot Retrieval - Cerebral
This form is now superseded by Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic
6.5 MB
  CO2 Angiogram is superseded by Angiogram Consent*  
 Coiling - Cerebral Aneurysm 140 KB
 Computed Tomography (CT) Cardiac Scan Consent 597 KB
 Computed Tomography (CT) Cholangiogram with Biliscopin Consent 917 KB
 Computed Tomography (CT) Colonography 1.1 MB
 Computed Tomography (CT) Myelogram Consent 698 KB
 Computed Tomography (CT) Scan Consent 607 KB
 Computed Tomography (CT) Scan 456 KB
 Conduitogram 410 KB
 Contrast Enema * 48 KB
 CSF Flow Study 110 KB
 Cystogram / Urethrogram / Micturating Cysto-Urethrogram (MCU)* 510 KB

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Index Procedure List File Size
DDacrocystogram 488 KB
 Defaecogram * 278 KB
 Dental Imaging * 680  KB
 Discogram 85 KB
 Dobutamine Stress Study MRI                                                                                  148 KB
 Drainage is superseded by Aspiration/Drainage (Image-Guided) Consent * 

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Index Procedure List File Size
EEmbolisation - Cerebral Coiling 140 KB
 Embolisation - CNS 102 KB
 Embolisation Consent* 642 KB
  Embolisation - Other is now superseded by Embolisation Consent *  
 Embolisation of the Uterine Artery (EUA) Consent *608 KB
 Embolisation Uterine Artery (EUA) is now superseded by Embolisation of the Uterine Artery (EUA) Consent * 
 Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic Stroke 6.5 MB
 Enteroclysis / Small Bowel Study * 506 KB
  Enteroclysis is now superseded by Enteroclysis / Small Bowel Study 
 Enema 40 KB
 Epidural Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent 

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Index Procedure List File Size
FFacet Joint Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent 
 Fetal Ultrasound - Nuchal Translucency 76 KB
 Fetal Ultrasound - Obstetric 76 KB
 Fine Needle Aspiration (FNA) is superseded by Biopsy (Image-Guided) Consent * 
 Fistulogram (AV) is superseded by Venogram Consent 
 Fistulogram / Sinogram * 412 KB
 Fluoroscopy Swallow / Meal 531 KB
GGastrostomy Insertion Consent608 KB
 Gastrostomy is superseded by Gastrostomy Insertion Consent 
  Gastrostomy Check is superseded by Catheter Check with Iodinated Contrast 
 Gastrografin Enema * 41 KB
 Generic Medical Imaging Consent 224 KB
 Generic Nuclear Medicine Consent 75 KB
 Generic Ultrasound Guided Antenatal Procedure * 3.2 MB 
 Groin Biopsy * is superseded by Biopsy (Image-Guided) Consent * 

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Index Procedure List File Size
H Hickman Catheter Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*  
  Hickman Catheter Check is superseded by Catheter Check with Iodinated Contrast 
 Hydrodilatation is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent 
 Hysterosalpingogram (HSG) *                                                                           556 KB

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Index Procedure List File Size
IInferior Vena Cava (IVC) Filter Insertion Consent 1.2 MB
 Inferior Vena Cava (IVC) Filter Removal Consent 1.1 MB
 Intercostal Catheter (ICC) Insertion Consent 678 KB
  InterCostal Catheter (ICC) Insertion is superseded by Intercostal Catheter (ICC) Insertion Consent 
 Interventional Procedure - Any Interventional Procedure Requiring Consent 72 KB
  Intrathecal Chemotherapy Lumbar Puncture is superseded by Lumbar Puncture  (Intrathecal Chemotherapy) Consent 
 Intrauterine Blood Transfusion 37 KB
 Iodine-131 Therapy for Hyperthyroidism 101 KB
  IVC Filter Removal is superseded by Inferior Vena Cava (IVC) Filter Removal Consent 
  IVC Filter Insertion is superseded by Inferior Vena Cava (IVC) Filter Insertion Consent 

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Index Procedure List File Size
JJoint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent 852 KB
  Joint Injections - Other is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent                                                                                         
L Liver Biopsy is  superseded by Biopsy (Image-Guided) Consent*  
  Liver Biopsy Under Imaging superseded by Biopsy (Image-Guided) Consent *  
  Liver Biopsy - Transjugular is superseded by Transjugular Liver Biopsy Consent 
 Lumbar Puncture (Image-Guided) Consent 722 KB
  Lumbar Puncture (LP) is now superseded by Lumbar Puncture (Image-Guided) Consent 
 Lumbar Puncture  (Intrathecal Chemotherapy) Consent 788 KB
  Lung Biopsy is superseded by Biopsy (Image-Guided) Consent *  

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Index Procedure List File File
MMagnetic Resonance Imaging (MRI) Scan Consent 634 KB
 Magnetic Resonance Imaging (MRI) Scan 473 KB
 Mammary Ductogram * 603 KB
 Medical Imaging Generic Consent 72 KB
  Micturating CystoUrethrogram (MCU) is now superseded  Cystogram / Urethrogram / Micturating Cysto-Urethrogram *  
 MRI Cardiac Stress Perfusion 114 KB
 MRI Dobutamine Stress Study 148 KB
 Myocardial Perfusion Scan 86 KB

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Index Procedure List File Size
N Nasogastric Tube Check is superseded by Catheter Check with Iodinated Contrast 
 Nephrostogram 319 KB
 Nephrostomy with or without Ureteric Stent Insertion Consent 846 KB
  Nephrostomy is superseded by Nephrostomy with or without Ureteric Stent Insertion Consent 
  Nerve Root Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent 
 Nuchal Translucency Ultrasound *                                                                            438 KB
 Nuclear Medicine Generic Consent 75 KB
OObstetric Ultrasound * 488 KB

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Index Procedure List File Size
P Pain Block is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent                                                                                                                          
 Parathyroid Sampling 151 KB
  PEG is superseded by Gastrostomy Insertion Consent 
  PEG Check is superseded by Catheter Check with Iodinated Contrast 
 Pelvic Ultrasound - Transvaginal 38 KB
  Percutaneous Transhepatic Cholangiogram (PTC) is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent 
  Percutaneous Transluminal Angioplasty (PTA) is superseded by Angiogram Consent*  
 Peripherally Inserted Central Catheter (PICC) Consent 1.13 MB
  Peripherally Inserted Central Catheter (PICC) is now superseded by Peripherally Inserted Central Catheter (PICC) Consent 
  Peripheral Thrombolysis is superseded by Thrombolysis - Peripheral (Catheter Directed) Consent 
  Permacath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*  
 Petrosal Sinus Sampling 151 KB
  Pleural Tap is superseded by Thoracentesis Consent 
 Port Removal Consent* 522 KB
  Portacath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*  
  Portacathogram is superseded by Catheter Check with Iodinated Contrast 
  Prostate Biopsy is superseded by Biopsy (Image-Guided) Consent*  

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Index Procedure List File Size
RRadiation and Medical Imaging 33 KB
  Radio Frequency Ablation (RFA) is superseded by Thermal Ablation Consent 
 Radio-guided Occult Lesion Localisation using Iodine-125 Seeds (ROLLIS) Consent * 639 KB
  Renal Biopsy is superseded by Biopsy (Image-Guided) Consent *  
 Renal Renin Sampling 130 KB
SSaline Sonogram * 101 KB
 Sclerotherapy Consent* 638 KB
 Selective Internal Radiation Therapy (SIRT) Consent 580 KB
  Selective Internal Radiation Therapy (SIRT) is superseded by Selective Internal Radiation Therapy (SIRT) Consent 
 Sialogram * 392 KB
 Sinogram / Fistulogram *                                                                                                              412 KB
 Small Bowel Series / Follow Through 367 KB
  Small Bowel Enema is now superseded by Enteroclysis / Small Bowel Study 406 KB
  Spinal Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent 
  Superficial Biopsy is superseded by Biopsy (Image-Guided) Consent *  
  Swallow / Meal is now superseded by Fluoroscopy Swallow / Meal 

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Index Procedure List File Size
TThermal Ablation Consent 506 KB
 Thoracentesis Consent 755 KB
  Thoracentesis (Pleural Tap) is superseded by Thoracentesis Consent 
  Thrombolysis - Cerebral
This form is now superseded by Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic
6.5 MB
 Thrombolysis (Catheter Directed) Consent * 736 KB
  Thrombolysis - Peripheral (Catheter Directed) is now superseded by Thrombolysis (Catheter Directed) Consent *  
  Thyroid Biopsy is superseded by Biopsy (Image-Guided) Consent *  
 Trans-Arterial Chemo-Embolisation (TACE) Consent * 716 KB
  Transcatheter Arterial ChemoEmbolisation (TACE) is superseded by Trans-Arterial Chemo-Embolisation (TACE) Consent 
 Transjugular Intrahepatic Portosystemic Shunt (TIPS) Consent 1.2 MB
  Transjugular Intrahepatic Portcaval Shunt (TIPS) is superseded by Transjugular Intrahepatic Portosystemic Shunt (TIPS) Consent 
 Transjugular Liver Biopsy Consent 543 KB
  Transjugular Liver Biopsy is superseded by Transjugular Liver Biopsy Consent 
 Transvaginal Ultrasound 3.6 MB
  Trans Rectal Ultrasound (TRUS) Biopsy is superseded by Biopsy (Image-Guided) Consent *  
  T Tube Cholangiogram is superseded by Catheter Check with Iodinated Contrast 

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Index Procedure List File Size
UUltrasound Scan *                                                                                                                 496 KB
 Ultrasound Scan - Nuchal Translucency 76 KB
 Ultrasound Scan - Obstetric 73 KB
  Ureteric Stent is superseded by Nephrostomy with or without Ureteric Stent Insertion Consent 
  Urethrogram  is superseded by Cystogram / Urethrogram / Micturating Cysto-Urethrogram *                 
V Vascath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*  
 Vasospasm (Cerebral) Treatment 135 KB
 Venogram Consent 645 KB
  Venogram is superseded by Venogram Consent 
 Vertebroplasty 86 KB
 V/Q Scan in Pregnancy 82 KB
YYttrium-90 Colloid Therapy for Joint Pain and Swelling 89 KB
Last updated: 21 September 2023