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Informed Consent - Medical Imaging

Adult |  Child/Young Person

Please note: The Medical Board of Australia recently 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.

Medical Imaging Informed Consent Directory

The Medical Imaging Informed Consent Directory is a guideline that specifies what consents and/or patient information sheets are required for medical imaging procedures. Click here to download the latest version of the Adult Medical Informed Consent Directory.


Available in Other Languages = Available in other languages

Medical Imaging Posters > Radiation and medical imaging - understanding the risks
> X-rays and scans - understanding the risks

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

A

A Additional Student Consent ** 2.4MB
 

Adenosine - MRI Cardiac Stress Perfusion Study

114 KB
 Adrenal Vein Sampling  

127 KB

 Amniocentesis/Chorionic Villus Sampling

1.70 MB

 Anaesthetic

66 KB

 Anorectal Physiology and Endoanal Ultrasound 3 MB
 Angiogram

149 KB

 Angiogram &/-Plasty / Stenting

209 KB

 Angioplasty

209 KB

 Antenatal Ultrasound Guided Procedure   37 KB
 Arterial Stent 209 KB
 Arteriogram 149 KB
 Arthrogram 165 KB
 Aspiration 148 KB
 Aspiration - Breast 80 KB
 Aspiration - Chest 162 KB


Index

Procedure List

File Size

B

  

Available in Other Languages

Barium Enema   40 KB
 

Biliary Drain Insertion

86 KB

 

Biliary Stent Insertion

86 KB

 Biliscopin

100 KB

 Biopsy - Chest

152 KB

 Biopsy - Other

149 KB

 Biopsy - Superficial

137 KB

 Biopsy - TRUS 108 KB
 Blood & Blood Products Transfusion - Consent Form & Patient Information 914 KB
 Blood & Blood Products Transfusion - Patient Information   31 KB
 Bone Biopsy 135 KB
 Breast Aspiration   80 KB
 Breast Biopsy 112 KB

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Index

Procedure List

File Size

C

Cardiac CT

80 KB

 

Cardiac MRI - Adenosine

114 KB

 Cardiac MRI - Dobutamine

148 KB

 Carotid Stent

157 KB

 Catheter Check with IV Contrast

64 KB

 Catheter Check without IV Contrast   41 KB
 Celiac Plexus Block

72 KB

 Central Line Check   64 KB
 Central Line Insertion 119 KB
 Central Vascular Access Device Insertion 119 KB
 Cerebral Vasospasm Treatment 135 KB
 Cerebral Thrombolysis / Clot Retrieval 125 KB
 Cerebrospinal Fluid (CSF) Shunt Patency Scan Consent 2.52MB
 Chemoemobolisation 113 KB
 Chest Aspiration 162 KB
 Chest Biopsy 152 KB
 Chest Drain 143 KB
 Cholangiogram - CT 100 KB
 Cholangiogram - Percutaneous   86 KB
 Chorionic Villus Sampling (CVS) 160 KB
 Clot Retrieval - Cerebral 125 KB
 CO2 Angiogram   72 KB
 Coiling - Cerebral Aneurysm 140 KB
 Conduitogram   24 KB

Available in Other Languages

Contrast Enema   40 KB

Available in Other Languages

Contrast Injection - Iodinated   48 KB
 Contrast Injection - Iodinated (Renal Impaired Patient ONLY) 116 KB

Available in Other Languages

Contrast Injection - MRI   41 KB
 Contrast Injection - MRI (Renal Impaired Patient ONLY)   83 KB
 CSF Flow Study 110 KB
 CT Cardiac   80 KB
 CT Cholangiogram 100 KB
 CT Colonoscopy   40 KB

Available in Other Languages

CT Scan   82 KB
 Cystogram   40 KB

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Index

Procedure List

File Size

D

Dacrocystogram

40 KB

 

Defaecogram

40 KB

 Discogram

85 KB

 Dobutamine Stress Study MRI

148 KB

 Drainage

148 KB


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Index

Procedure List

File Size

E

Embolisation - Cerebral Coiling

140 KB

 

Embolisation - CNS

102 KB

 Embolisation - Other

146 KB

 Embolisation Uterine Artery (EUA)

112 KB

 Enteroclysis   33 KB

Available in Other Languages

Enema   40 KB
 Epidural Injection

131 KB


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Index

Procedure List

File Size

F

Facet Joint Injection

131 KB

 

Fetal Ultrasound - Nuchal Translucency

76 KB

Available in Other Languages

Fetal Ultrasound - Obstetric

73 KB

 Fine Needle Aspiration (FNA)

149 KB

 Fistulogram (AV) 103 KB
 Fistulogram / Sinogram   32 KB

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Index

Procedure List

File Size

G

Gastrostomy

40 KB

 Gastrostomy Check 127 KB

Available in Other Languages

Gastrografin Enema   41 KB
 Generic Medical Imaging Consent    224 KB
 Generic Nuclear Medicine Consent   75 KB
 

Generic Ultrasound Guided Anenatal Procedure

37 KB

 Groin Biopsy 112 KB

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Index

Procedure List

File Size

H

Hickman Catheter Insertion

119 KB

 Hickman Catheter Check   64 KB
 

HyCoSy

101 KB

 Hydrodilatation

141 KB

 Hysterosalpingogram (HSG)

85 KB


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Index

Procedure List

File Size

I

InterCostal Catheter (ICC) Insertion

143 KB

 Interventional Procedure - Any Interventional Procedure Requiring Consent

72 KB

 Intrathecal Chemotherapy Lumbar Puncture

109 KB

 Intrauterine Blood Transfusion   37 KB

Available in Other Languages

Intravenous Pyelogram (IVP)   66 KB

Available in Other Languages

Iodinated Contrast   48 KB
 Iodinated Contrast (Renal Impaired Patients ONLY) 116 KB
 Iodine-131 Therapy for Hyperthyroidism   101 KB
 IVC Filter Removal

109 KB

 IVC Filter Insertion 128 KB

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Index

Procedure List

File Size

J

Joint Injections - Other

141 KB


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Index

Procedure List

File Size

L

Liver Biopsy 102 KB
 Liver Biopsy Under Imaging 149 KB
 Liver Biopsy - Transjugular 111 KB
 Lumbar Puncture (LP) 131 KB
 Lumbar Puncture (Intrathecal Chemotherapy) 109 KB
 

Lung Biopsy

152 KB


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Index

Procedure List

File Size

M

Mammary Ductogram   44 KB
 Medical Imaging Generic Consent   72 KB
 Micturating CystoUrethrogram (MCU)   40 KB
 MRI Cardiac Stress Perfusion 114 KB

Available in Other Languages

MRI Contrast Injection   41 KB
 MRI Contrast Injection (Renal Impaired Patients ONLY)   83 KB
 MRI Dobutamine Stress Study 148 KB

Available in Other Languages

MRI Scan   57 KB
 

Myelogram

146 KB

 Myocardial Perfusion Scan

86 KB


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Index

Procedure List

File Size

N

Nasogastric Tube Check   41 KB
 Nephrostogram   65 KB
 Nephrostomy 168 KB
 Nerve Root Injection 131 KB
 Nuchal Translucency Ultrasound   76 KB
 Nuclear Medicine Generic Consent   75 KB

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Index

Procedure List

File Size

O

  

Available in Other Languages

Obstetric Scan

73 KB


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Index

Procedure List

File Size

P

Pain Block 131 KB
 Parathyroid Sampling 151 KB
 PEG 127 KB
 PEG Check   41 KB

Available in Other Languages

Pelvic Ultrasound - Transvaginal   38 KB
 Percutaneous Transhepatic Cholangiogram (PTC)   86 KB
 Percutaneous Transluminal Angioplasty (PTA) 209 KB
 Peripherally Inserted Central Catheter (PICC) 119 KB
 Peripheral Thrombolysis 126 KB
 Permacath Insertion 119 KB
 Petrosal Sinus Sampling 151 KB
 Phosphorus-32 Therapy  82 KB
 Pleural Tap 162 KB
 Portacath Insertion 119 KB
 Portacathogram   64 KB
 

Prostate Biopsy

108 KB


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Index

Procedure List

File Size

R

  

Available in Other Languages

Radiation and Medical Imaging   33 KB
 Radio Frequency Ablation (RFA) 186 KB
 Renal Biopsy 149 KB
 

Renal Renin Sampling

130 KB


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Index

Procedure List

File Size

S

Saline Sonogram 101 KB
 Samarium-153 EDTMP Bone Therapy   81 KB
 Selective Internal radiation Therapy (SIRT) 112 KB
 Selective Termination   37 KB
 Sialogram   45 KB
 Sinogram / Fistulogram   32 KB
 Small Bowel Series / Follow Through   46 KB
 Small Bowel Enema   33 KB
 Spinal Injection 131 KB
 Stontium-89 Bone Therapy   81 KB
 Superficial Biopsy 137 KB

Available in Other Languages

Swallow / Meal

46 KB


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Index

Procedure List

File Size

T

Thoracentesis (Pleural Tap) 162 KB
 Thrombolysis - Cerebral 125 KB
 Thrombolysis - Peripheral (Catheter Directed) 126 KB
 Thyroid Biopsy 112 KB
 Transcatheter Arterial ChemoEmbolisation (TACE) 113 KB
 Transjugular Intrahepatic Portcaval Shunt (TIPS) 112 KB
 Transjugular Liver Biopsy 111 KB
 Transvaginal Ultrasound Consent            1.03 MB
 Trans Rectal Ultrasound (TRUS) Biopsy 108 KB
 T Tube Cholangiogram   41 KB

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Index

Procedure List

File Size

U

  

Available in Other Languages

Ultrasound Scan   38 KB
 Ultrasound Scan - Nuchal Translucency   76 KB

Available in Other Languages

Ultrasound Scan - Obstetric   73 KB
 Ureteric Stent 168 KB
 Urethrogram   46 KB

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Index

Procedure List

File Size

V

Vascath Insertion 119 KB
 Vasospasm (Cerebral) Treatment 135 KB
 Venogram 103 KB
 Vertebroplasty   86 KB
 V/Q Scan in Pregnancy   82 KB

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Index

Procedure List

File Size

Y

Yttrium-90 Colloid Therapy for Joint Pain and Swelling  89 KB

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Last updated: 2 June 2014