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

Index Procedure List File Size
AA Additional Student Consent ** 2.7 MB
 Adenosine - MRI Cardiac Stress Perfusion Study is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent 
 Adrenal Vein Sampling is superseded by Venous Sampling Consent 
 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  Angiogram is superseded by Angiogram Consent*  
  Angiogram &/-Plasty / Stenting is superseded by Angiogram Consent*  
  Angioplasty is superseded by Angiogram Consent*  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  Arterial Stent is superseded by Angiogram Consent*  
  Arteriogram is superseded by Angiogram Consent*  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  Arthrogram is superseded by Arthrogram (Image-Guided) Consent 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  Aspiration is superseded by Aspiration/Drainage (Image-Guided) Consent *  
  Aspiration - Breast * is superseded by Aspiration/Drainage (Image-Guided) Consent *  
 Aspiration - Chest is superseded by Thoracentesis Consent  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 Biliary Drain Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent 
 Biliary Stent Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent 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 is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent 
 Cardiac MRI - Dobutamine is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent 
 Carotid Artery Angioplasty and Stenting Consent542 KB
 Carotid Stent is superseded by Carotid Artery Angioplasty and Stenting Consent 
 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 Consent749 KB
 Cerebral Vasospasm Treatment is superseded by Cerebral Vasospasm Treatment Consent 
  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 is superseded by Embolisation of an Intra-Cranial Aneurysm Consent 
 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
 Computed Tomography (CT) Scan During Pregnancy Consent635 KB
 Computed Tomography (CT) Scan with Rectal Contrast619 KB
 Conduitogram 410 KB
 Contrast Enema * 48 KB
 Cerebrospinal Fluid (CSF) Flow Study Consent648 KB
 CSF Flow Study is superseded by Cerebrospinal Fluid (CSF) Flow Study Consent 
 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 Consent718 KB
 Discogram is superseded by Discogram Consent 
 Dobutamine Stress Study MRI is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent                                                                                   
 Drainage is superseded by Aspiration/Drainage (Image-Guided) Consent * 

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Index Procedure List File Size
EEmbolisation - Cerebral Coiling is superseded by Embolisation of an Intra-Cranial Aneurysm Consent 
 Embolisation - CNS is superseded by Embolisation in the Central Nervous System (CNS) Consent 
 Embolisation Consent*642 KB
 Embolisation in the Central Nervous System (CNS) Consent850 KB
 Embolisation of an Intra-Cranial Aneurysm Consent815 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 is superseded by Medical Imaging Generic Consent * 
 Generic Nuclear Medicine Consent is superseded by Nuclear Medicine Scan Generic Consent 
 Generic Ultrasound Guided Antenatal Procedure Consent * 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 Consent 558 KB
  Iodine-131 Therapy for Hyperthyroidism is superseded by Iodine-131 Therapy Consent 
 Ionising Radiation During Pregnancy Consent532 KB
 Ionising Radiation During Pregnancy357 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 Enterography (MRE) (Small Bowel Study) 614 KB
 Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent 604 KB
 Magnetic Resonance Imaging (MRI) Scan Consent 634 KB
 Magnetic Resonance Imaging (MRI) Scan 473 KB
 Magnetic Resonance Imaging (MRI) Scan of Liver with Primovist® 446 KB
 Magnetic Resonance Imaging (MRI) Scan with a MRI-Conditional Pacemaker/Implantable Cardioverter Defibrillator (ICD) Consent * 814 KB
 Mammary Ductogram * 603 KB
 Medical Imaging and Radiation734 KB
 Medical Imaging Generic Consent *613 KB
  Micturating CystoUrethrogram (MCU) is now superseded  Cystogram / Urethrogram / Micturating Cysto-Urethrogram *  
  MRI Cardiac Stress Perfusion is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent 
  MRI Dobutamine Stress Study is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent 
 Myocardial Perfusion Scan Consent * 637 KB
  Myocardial Perfusion Scan is superseded by Myocardial Perfusion Scan Consent *  

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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 Scan Generic Consent 707 KB
  Nuclear Medicine Generic Consent is superseded by Nuclear Medicine Scan Generic Consent 
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 is superseded by Venous Sampling Consent 
  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 is superseded by Venous Sampling Consent 
  Pleural Tap is superseded by Thoracentesis Consent 
 Positron Emission Tomography (PET) Scan 415 KB
 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 is superseded by Medical Imaging and Radiation 
  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 is superseded by Venous Sampling Consent 
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 is superseded by Cerebral Vasospasm Treatment Consent 
 Venogram Consent 645 KB
  Venogram is superseded by Venogram Consent 
 Venous Sampling Consent 642 KB
 Vertebroplasty Consent 475 KB
 Vertebroplasty is superseded by Vertebroplasty Consent 
 Ventilation-Perfusion (VQ) Scan During Pregnancy Consent * 519 KB
  V/Q Scan in Pregnancy is superseded by Ventilation-Perfusion (VQ) Scan During Pregnancy Consent*  
YYttrium-90 Colloid Therapy Consent * 589 KB
  Yttrium-90 Colloid Therapy for Joint Pain and Swelling is superseded by Yttrium-90 Colloid Therapy Consent *

Last updated: 5 April 2024