Radiology & Imaging Consent

The Radiology and Imaging Consent form documents informed consent for diagnostic and interventional imaging procedures that carry specific risks requiring patient acknowledgment. While routine X-rays typically fall under general treatment consent, procedures involving contrast agents, significant radiation exposure, sedation, or invasive techniques require dedicated informed consent. This form addresses the unique risk profile of imaging procedures in clear, accessible language.

The form captures the specific imaging study ordered, the reason for the exam, and whether contrast media will be administered. A contrast agent section screens for prior contrast reactions, kidney function concerns, metformin use, and allergies to iodine or gadolinium. The radiation exposure section explains the risks in context, using comparisons to background radiation levels. A mandatory pregnancy screening question is included for patients of childbearing potential, as many imaging studies are contraindicated during pregnancy. For MRI studies, the form includes a ferromagnetic implant and device screening checklist.

Essential for radiology departments, outpatient imaging centers, interventional radiology suites, and any facility performing contrast-enhanced studies. The form meets ACR (American College of Radiology) practice guidelines for informed consent and helps protect against liability by documenting that patients were screened for contraindications and informed of risks before the procedure.