Medical imaging revised forms

Medical Imaging Informed Consent forms and Patient Information sheets have undergone a clinical, consumer and legal review.

As a result of this review, 76 new forms will be uploaded and the below listed will be superseded and removed in batches from the Informed Consent website by the end of July 2023. For Queensland Health staff, these forms will remain active in the Queensland Health ieMR for a further 12mths to ensure existing paper consent forms can be scanned into Queensland Health patient records.

Key

- Consent Form Only   - Patient Information Sheet Only   - Consent form and Patient Information Sheet

Superseded list

Adult

• Radiation and Medical Imaging is superseded by Medical Imaging and Radiation
• Radiation and Medical Imaging Information Sheet is superseded by Medical Imaging and Radiation
• Generic Medical Imaging Consent is superseded by  Medical Imaging Generic Consent
• Vertebroplasty is superseded by Vertebroplasty Consent
• Adrenal Vein Sampling is superseded by Venous Sampling Consent
• Parathyroid Sampling is superseded by Venous Sampling Consent
• Petrosal Sinus Sampling is superseded by Venous Sampling Consent
• Renal Renin Sampling is superseded by Venous Sampling Consent
• Embolisation - Cerebral Coiling is superseded by Embolisation of an Intra-Cranial Aneurysm Consent
• Coiling - Cerebral Aneurysm is superseded by Embolisation of an Intra-Cranial Aneurysm Consent
• Embolisation - CNS is superseded by Embolisation in the Central Nervous System (CNS) Consent
• Discogram is superseded by Discogram Consent
• Vasospasm (Cerebral) Treatment is superseded by Cerebral Vasospasm Treatment Consent
• Cerebral Vasospasm Treatment is superseded by Cerebral Vasospasm Treatment Consent
• Carotid Stent is superseded by Carotid Artery Angioplasty and Stenting Consent
• Adenosine - MRI Cardiac Stress Perfusion Study is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent
• Cardiac MRI - Adenosine is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent
• MRI Cardiac Stress Perfusion is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent
• MRI Dobutamine Stress Study is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent
• Dobutamine Stress Study MRI is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent
• Cardiac MRI - Dobutamine is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent
• Yttrium-90 Colloid Therapy for Joint Pain and Swelling is superseded by Yttrium-90 Colloid Therapy Consent *
• V/Q Scan in Pregnancy is superseded by Ventilation-Perfusion (VQ) Scan During Pregnancy Consent*
• Nuclear Medicine Generic Consent is superseded by Nuclear Medicine Scan Generic Consent
• Generic Nuclear Medicine Consent is superseded by Nuclear Medicine Scan Generic Consent
• Myocardial Perfusion Scan is superseded by Myocardial Perfusion Scan Consent*
• Iodine-131 Therapy for Hyperthryoidism  is superseded by Iodine-131 Therapy Consent
• CSF Flow Study is superseded by Cerebrospinal Fluid (CSF) Flow Study Consent
• Selective Internal Radiation Therapy (SIRT) is superseded by Selective Internal Radiation Therapy (SIRT) Consent
• Transjugular Liver Biopsy is superseded by Transjugular Liver Biopsy Consent
• Liver Biopsy - Transjugular is superseded by Transjugular Liver Biopsy Consent
• Transjugular Intrahepatic Portcaval Shunt (TIPS) is superseded by Transjugular Intrahepatic Portosystemic Shunt (TIPS) Consent
• PEG is superseded by Gastrostomy Insertion Consent
• Gastrostomy is superseded by Gastrostomy Insertion Consent
• Biliary Stent Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent
• Biliary Drain Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent
• Percutaneous Transhepatic Cholangiogram (PTC) is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent
• Cholangiogram - Percutaneous is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent
• Radio Frequency Ablation (RFA) is superseded by Thermal Ablation Consent
• Celiac Plexus Block is superseded by  Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent
• Spinal Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent
• Nerve Root Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent
• Epidural Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent
• Facet Joint Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent
• Pain Block is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent
• Hydrodilatation is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent
• Joint Injections - Other is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent
• Liver Biopsy is superseded by Biopsy (Image-Guided) Consent*
• Prostate Biopsy is superseded by Biopsy (Image-Guided) Consent*

• Trans Rectal Ultrasound (TRUS) Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Fine Needle Aspiration (FNA) is superseded by Biopsy (Image-Guided) Consent *
• Renal Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Lung Biopsy  is superseded by Biopsy (Image-Guided) Consent *
• Thyroid Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Bone Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Superficial Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Groin Biopsy * is superseded by Biopsy (Image-Guided) Consent *
• Breast Biopsy * is superseded by Biopsy (Image-Guided) Consent *
• Biopsy - Superficial * is superseded by Biopsy (Image-Guided) Consent *
• Liver Biopsy Under Imaging superseded by Biopsy (Image-Guided) Consent *
• Biopsy - TRUS is superseded by Biopsy (Image-Guided) Consent *
• Biopsy - Other is superseded by Biopsy (Image-Guided) Consent *
• Chest Biopsy is superseded by Biopsy (Image-Guided) Consent*
• Biopsy - Chest is superseded by Biopsy (Image-Guided) Consent *
• Breast Aspiration * is superseded by Aspiration/Drainage (Image-Guided) Consent *
• Aspiration - Breast * is superseded by Aspiration/Drainage (Image-Guided) Consent *
• Aspiration is superseded by Aspiration/Drainage (Image-Guided) Consent *
• Drainage is superseded by Aspiration/Drainage (Image-Guided) Consent *
• Arthrogram is superseded by Arthrogram (Image-Guided) Consent
• Embolisation - other is superseded by Embolisation Consent*
• Embolisation - Uterine Artery (EUA) is superseded by Embolisation of the Uterine Artery (EUA) Consent *
• Peripherally Inserted Central Catheter (PICC) is superseded by Peripherally Inserted Central Catheter (PICC) Consent
• Thrombolysis- Peripheral (Catheter Directed) is superseded by Thrombolysis (Catheter Directed) Consent*
• Peripheral Thrombolysis is superseded by Thrombolysis (Catheter Directed) Consent*
• Transcatheter Arterial ChemoEmbolisation (TACE) is superseded by Trans-Arterial Chemo-Embolisation (TACE) Consent*
• Chemoembolisation is superseded by Trans-Arterial Chemo-Embolisation (TACE) Consent*
• Venogram is superseded by Venogram Consent*
• Fistulogram (AV) is superseded by Venogram Consent*
• IVC Filter Insertion is superseded by Inferior Vena Cava (IVC) Filter Insertion Consent
• IVC Filter Removal is superseded by Inferior Vena Cava (IVC) Filter Removal Consent
• Central Vascular Access Device Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Portacath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Hickman Catheter Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Central Line Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Permacath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Vascath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Angiogram is superseded by Angiogram Consent*
• Angiogram &/-Plasty / Stenting is superseded by Angiogram Consent*
• CO2 Angiogram is superseded by Angiogram Consent*
• Arteriogram is superseded by Angiogram Consent*
• Arterial Stent is superseded by Angiogram Consent*
• Angioplasty is superseded by Angiogram Consent*
• Percutaneous Transluminal Angioplasty (PTA) is superseded by Angiogram Consent*
• Ureteric Stent is superseded by Nephrostomy with or without Ureteric Stent Insertion Consent
• T Tube Cholangiogram is superseded by Catheter Check with Iodinated Contrast
• Portacathogram is superseded by Catheter Check with Iodinated Contrast
• PEG Check is superseded by Catheter Check with Iodinated Contrast
• Nasogastric Tube Check is superseded by Catheter Check with Iodinated Contrast
• Gastrostomy Check is superseded by Catheter Check with Iodinated Contrast
• Central Line Check is superseded by Catheter Check with Iodinated Contrast
• Catheter Check with (IV) Iodinated Contrast is superseded by Catheter Check with Iodinated Contrast
• Catheter Check without (IV) Iodinated Contrast is superseded by Catheter Check with Iodinated Contrast
• Hickman Catheter Check is superseded by Catheter Check with Iodinated Contrast
• Aspiration - Chest is superseded by Thoracentesis Consent

• Pleural Tap is superseded by Thoracentesis Consent
• Chest Drain is superseded by Intercostal Catheter (ICC) Insertion Consent
• Intrathecal Chemotherapy Lumbar Puncture is superseded by Lumbar Puncture  (Intrathecal Chemotherapy) Consent
• Nephrostomy is superseded by Nephrostomy with or without Ureteric Stent Insertion Consent
• Pleural Tap is superseded by Thoracentesis Consent
• Thoracentesis (Pleural Tap) is superseded by Thoracentesis Consent
• InterCostal Catheter (ICC) Insertion is superseded by Intercostal Catheter (ICC) Insertion Consent
• Nephrostogram is superseded by Nephrostogram
• Conduitogram is superseded by Conduitogram
• Cystogram is superseded by Cystogram / Urethrogram / Micturating Cysto-Urethrogram (MCU)
• Dacrocystogram is superseded by Dacrocystogram
• Enteroclysis/Small Bowel Enema is superseded by Enteroclysis / Small Bowel Study
• Small Bowel Enema is superseded by Enteroclysis / Small Bowel Study
• Fistulogram/Sinogram is superseded by Fistulogram / Sinogram
• Sinogram/Fistulogram is superseded by Sinogram / Fistulogram
• Swallow/Meal under Imaging is superseded by Fluoroscopy Swallow / Meal
• Lumbar Puncture for Intrathecal Chemotherapy is superseded by Lumbar Puncture (Intrathecal Chemotherapy) Consent
• Lumbar Puncture (LP) is superseded by Lumbar Puncture (Image-Guided) Consent
• Sialogram is superseded by Sialogram
• Small Bowel Series/Follow Through is superseded by Small Bowel Series/Follow Through
• Contrast Injection - Iodinated is superseded by Computed Tomography (CT) Scan
• Contrast Injection - Iodinated (Renal Impaired Patients ONLY) is superseded by Computed Tomography (CT) Scan Consent
• Contrast Injection - MRI is superseded by Magnetic Resonance Imaging (MRI) Scan
• Contrast Injection - MRI (Renal Impaired Patients ONLY) is superseded by Magnetic Resonance Imaging (MRI) Scan Consent
• CT Scan is superseded by Computed Tomography (CT) Scan
• Iodinated Contrast is superseded by Computed Tomography (CT) Scan
• Iodinated Contrast (Renal Impaired Patients ONLY) is superseded by Computed Tomography (CT) Scan Consent
• MRI Scan is superseded by Magnetic Resonance Imaging (MRI) Scan
• MRI Contrast Injection is superseded by Magnetic Resonance Imaging (MRI) Scan
• MRI Contrast Injection (Renal Impaired Patients ONLY) is superseded by Magnetic Resonance Imaging (MRI) Scan Consent
• CT Cardiac is superseded by - Computed Tomography (CT) Cardiac Scan Consent
• CT Cholangiogram is superseded by - Computed Tomography (CT) Cholangiogram with Biliscopin Consent
• CT Colonoscopy is superseded by - Computed Tomography (CT) Colonography
• Myelogram is superseded by - Computed Tomography (CT) Myelogram Consent

Child/Young Person

• Generic Medical Imaging Procedure - Child/Young Person is superseded by  Medical Imaging Generic Consent *
• Radiation and Medical Imaging is superseded by Medical Imaging and Radiation
• Radiation and Medical Imaging Information Sheet is superseded by Medical Imaging and Radiation
• Gastrostomy is superseded by Gastrostomy Insertion Consent
• Biliary Stent Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent
• Biliary Drain Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent
• Percutaneous Transhepatic Cholangiogram (PTC) is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent
• Cholangiogram - Percutaneous is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent
• Fine Needle Aspiration (FNA) is superseded by Biopsy (Image-Guided) Consent *
• Renal Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Lung Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Superficial Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Thyroid Biopsy  is superseded by Biopsy (Image-Guided) Consent *
• Groin Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Breast Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Biopsy - Superficial is superseded by Biopsy (Image-Guided) Consent *
• Liver Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Bone Biopsy is superseded by Biopsy (Image-Guided) Consent *
• Biopsy - Other is superseded by Biopsy (Image-Guided) Consent *
• Chest Biopsy is superseded by Biopsy (Image-Guided) Consent*
• Biopsy - Chest is superseded by Biopsy (Image-Guided) Consent*
• Aspiration is superseded by Aspiration/Drainage (Image-Guided) Consent *
• Drainage is superseded by Aspiration/Drainage (Image-Guided) Consent *
• Peripherally Inserted Central Catheter (PICC) is superseded by Peripherally Inserted Central Catheter (PICC) Consent
• Venogram is superseded by Venogram Consent*
• Fistulogram (AV) is superseded by Venogram Consent*
• Sclerotherapy is superseded by Sclerotherapy Consent*
• Central Vascular Access Device Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Portacath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Hickman Catheter Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Central Line Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Permacath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Vascath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent*
• Chest Drain is superseded by Intercostal Catheter (ICC) Insertion Consent
• Hickman Catheter Check is superseded by Catheter Check with Iodinated Contrast
• T Tube Cholangiogram is superseded by Catheter Check with Iodinated Contrast
• Nasogastric Tube Check is superseded by Catheter Check with Iodinated Contrast
• Gastrostomy Check is superseded by Catheter Check with Iodinated Contrast
• Central Line Check is superseded by Catheter Check with Iodinated Contrast
• Hickman Catheter Check is superseded by Catheter Check with Iodinated Contrast
• Catheter Check with (IV) Iodinated Contrast is superseded by Catheter Check with Iodinated Contrast
• Catheter Check without (IV) Iodinated Contrast is superseded by Catheter Check with Iodinated Contrast
• Portacathogram is superseded by Catheter Check with Iodinated Contrast
• Aspiration - Chest is superseded by Thoracentesis Consent
• Pleural Tap is superseded by Thoracentesis Consent
• PEG Check is superseded by Catheter Check with Iodinated Contrast
• Thoracentesis (Pleural Tap) is superseded by Thoracentesis Consent
• InterCostal Catheter (ICC) is superseded by Intercostal Catheter (ICC) Insertion Consent
• Nephrostogram is superseded by Nephrostogram
• Ultrasound Scan is superseded by Ultrasound
• Conduitogram is superseded by Conduitogram
• Swallow/Meal under Imaging is superseded by Fluoroscopy Swallow / Meal
• Small Bowel Series/Follow Through is superseded by Small Bowel Series/Follow Through
• Sialogram is superseded by Sialogram
• Lumbar Puncture for Intrathecal Chemotherapy is superseded by Lumbar Puncture (Intrathecal Chemotherapy) Consent
• Lumbar Puncture  (LP) is superseded by Lumbar Puncture (Image-Guided) Consent
• Intussusception Reduction Enema is superseded by  Intussusception Reduction Enema Consent
• Enema - Intussusception is superseded by Intussusception Reduction Enema Consent
• Small Bowel Enema is superseded by Enteroclysis / Small Bowel Study
• Enteroclysis/Small Bowel Enema is superseded by Enteroclysis / Small Bowel Study
• Cystogram/Urethrogram/ Micturating Cysto-Urethrogram is superseded by Cystogram / Urethrogram / Micturating Cysto-Urethrogram (MCU)
• Micturating Cysto-Urethrogram (MCU) is superseded by Cystogram / Urethrogram / Micturating Cysto-Urethrogram (MCU)
• Urethrogram is superseded by Cystogram / Urethrogram / Micturating Cysto-Urethrogram (MCU)
• Contrast Enema is superseded by Contrast Enema
• Barium Enema is superseded by Contrast Enema
• Enema is superseded by Contrast Enema
• Gastrograffin Enema is superseded by Contrast Enema
• Contrast Injection - Iodinated is superseded by Computed Tomography (CT) Scan
• Contrast Injection - Iodinated (Renal Impaired Patients ONLY) is superseded by Computed Tomography (CT) Scan Consent
• Contrast Injection - MRI is superseded by Magnetic Resonance Imaging (MRI) Scan
• Contrast Injection - MRI (Renal Impaired Patients ONLY) is superseded by Magnetic Resonance Imaging (MRI) Scan Consent
• CT Scan is superseded by Computed Tomography (CT) Scan
• Iodinated Contrast is superseded by Computed Tomography (CT) Scan
• Iodinated Contrast (Renal Impaired Patients ONLY) is superseded by Computed Tomography (CT) Scan Consent
• MRI Scan is superseded by Magnetic Resonance Imaging (MRI) Scan
• MRI Contrast Injection is superseded by Magnetic Resonance Imaging (MRI) Scan
• MRI Contrast Injection (Renal Impaired Patients ONLY) is superseded by Magnetic Resonance Imaging (MRI) Scan Consent