Radiography is the use of electromagnetic radiation (that is not light), to view hard tissue (e.g. bone).

• X-ray
• CT
• MRI
• PET
• Bone scan

Paperwork for Radiology request:

• Affix Pt label
• MO/GP name (medical officer)
• Tick for Film, Disc (conditions apply), General x-ray, Theater, Mobile, CT#, Ultrasound, Angiography #%, Intervention #%, Fluoroscopy, Mammography, MRI$. # IV contrast requires questionnaire/consent. % Angio/intervention requires procedure consent. $ MRO requires safety questionnaire. Telephone bookings are required for special procedures
• Examination required
• Clinical information
• Previous iaging (last 12 months) - ask Pt to bring old films
• Tick of Yes/No for Pregnancy, Infection risk (with Details ___), Allergies (with Details ___), renal disease (with eGFR or (creatinine) for all contrast exams ___). INR/Platelets: For angio/intervention ___
• Referring specialist name, Contact, Provider No
• Requesting MO name, signature, pager/phone, date __/__/___
• Radiographer coments, ticks for Correct Pt, Correct site, Correct procedure/examination. Radiographer signature. Date __/__/___
• Ionizing radiation (x-rays) should be used with caution, particualrly in children and women of child bearing age. Most x-ray exams are equivalent to days-weeks background radiation. Most CT exams are equivalent to months-years background radiation

The questionnaire/consent for imaging/CT with IV contrast, includes a Pt information sheet. The form itself includes:

• Affix Pt label
• eGFR: ___ and/or creatinine ___
• Date
• (This form must be completed, and accompany request for Imaging/CT with IV contrast, or exam cannot be booked)
• Requesting medical officer to complete: I have discussed the nature and purpose of the proposed Imaging/CT + IV contrast (dye) with this Pt. Requesting MO, sign, contact No (page/phone)
• Pt (or guardian) to complete: Your Dr has requested Imaging/CT with IV contrast (dye) examination. Please answer the following questions, with the columsn Answer (YES/NO), and Details ___. Questionnaire includes:
  • Do you have a Hx of asthma?
  • Do you have a Hx of kidney disease?
  • Do you have myeloma or other blood disorders?
  • Do you have thyroid disease?
  • Do you have diabetes?
  • Do you take any oral diabetes medication, especially Metformin (Diabex, Glucophage, Diaformin)?
  • Do you have any significant allergies?
  • Have you ever had an x-ray examination involving IV injection where Iodine-based contrast (dye) caused a reaction?
  • Is there any chance you could be pregnant (or breast-feeding)?
• It is hospital policy that you will have to complete this consent form prior to the imaging/CT study (unless exceptional/emergency situation). If you have any reservations or are uncertain please do not sign the following form. I have read Imaging/CT + IV contrast (dye) Information sheet (over page). I understand the nature and purpose of the scan, and I have understood the above screning questions. I commit to the procedure, and understand it carries small risk (as outlined in the information sheet). I have had the opportunity to ask questions, and I may withdraw consent at anytime
• Authentication, including Patient (or guardian) sign, Date

• Radiocontrast agent