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.

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

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Index	Procedure List	File Size
A	A Additional Student Consent **	2.7MB
	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	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
	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 transfusion consent and refusal forms are now located under Blood specialty.
	Bone Biopsy	135 KB
	Breast Aspiration *	669 KB
	Breast Biopsy *	112 KB

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 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	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 This form is now superseded by Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic	6.5 MB
	CO2 Angiogram	72 KB
	Coiling - Cerebral Aneurysm	140 KB
	Conduitogram	24 KB
	Contrast Enema *	483 KB
	Contrast Injection - Iodinated	48 KB
	Contrast Injection - Iodinated (Renal Impaired Patient ONLY)	116 KB
	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
	CT Scan *	378 KB
	Cystogram *	284 KB

Index	Procedure List	File Size
D	Dacrocystogram	40 KB
	Defaecogram *	278 KB
	Discogram	85 KB
	Dobutamine Stress Study MRI	148 KB
	Drainage	148 KB

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
	Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic Stroke	6.5 MB
	Enteroclysis	33 KB
	Enema	40 KB
	Epidural Injection	131 KB

Index	Procedure List	File Size
F	Facet Joint Injection	131 KB
	Fetal Ultrasound - Nuchal Translucency	76 KB
	Fetal Ultrasound - Obstetric	73 KB
	Fine Needle Aspiration (FNA)	149 KB
	Fistulogram (AV)	103 KB
	Fistulogram / Sinogram *	356 KB

Index	Procedure List	File Size
G	Gastrostomy	40 KB
	Gastrostomy Check	127 KB
	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 *	112 KB

Index	Procedure List	File Size
H	Hickman Catheter Insertion	119 KB
	Hickman Catheter Check	64 KB
	HyCoSy *	101 KB
	Hydrodilatation	141 KB
	Hysterosalpingogram (HSG) *	556 KB

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
	Intravenous Pyelogram (IVP)	66 KB
	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

Index	Procedure List	File Size
J	Joint Injections - Other	141 KB

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 for Intrathecal Chemotherapy	109 KB
	Lung Biopsy	152 KB

Index	Procedure List	File Size
M	Mammary Ductogram *	603 KB
	Medical Imaging Generic Consent	72 KB
	Micturating CystoUrethrogram (MCU)	40 KB
	MRI Cardiac Stress Perfusion	114 KB
	MRI Contrast Injection	41 KB
	MRI Contrast Injection (Renal Impaired Patients ONLY)	83 KB
	MRI Dobutamine Stress Study	148 KB
	MRI Scan	57 KB
	Myelogram	146 KB
	Myocardial Perfusion Scan	86 KB

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 *	438 KB
	Nuclear Medicine Generic Consent	75 KB

Index	Procedure List	File Size
O
	Obstetric Ultrasound *	488 KB

Index	Procedure List	File Size
P	Pain Block	131 KB
	Parathyroid Sampling	151 KB
	PEG	127 KB
	PEG Check	41 KB
	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

Index	Procedure List	File Size
R
	Radiation and Medical Imaging	33 KB
	Radio Frequency Ablation (RFA)	186 KB
	Renal Biopsy	149 KB
	Renal Renin Sampling	130 KB

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	402 KB
	Swallow / Meal	46 KB

Index	Procedure List	File Size
T	Thoracentesis (Pleural Tap)	162 KB
	Thrombolysis - Cerebral This form is now superseded by Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic	6.5 MB
	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	3.6 MB
	Trans Rectal Ultrasound (TRUS) Biopsy	108 KB
	T Tube Cholangiogram	41 KB

Index	Procedure List	File Size
U
	Ultrasound Scan *	496 KB
	Ultrasound Scan - Nuchal Translucency	76 KB
	Ultrasound Scan - Obstetric	73 KB
	Ureteric Stent	168 KB
	Urethrogram *	335 KB

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

Index	Procedure List	File Size
Y	Yttrium-90 Colloid Therapy for Joint Pain and Swelling	89 KB

Last updated: 11 November 2021

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Informed Consent - Medical Imaging