Benefits of Computed Tomography (CT) Scans:

• Detailed Imaging - Provides highly detailed cross-sectional images of the body, helping doctors identify issues that might not be visible through regular x-rays.
• Fast and Non-invasive - CT scans are quick, making them especially useful for emergency situations where time is crucial.
• Accurate Diagnosis - Helps diagnose a wide range of conditions, including cancers, infections, and internal injuries, with high precision.
• Guiding Treatment - CT scans can guide doctors in planning and monitoring treatments, such as surgeries, biopsies, and radiation therapy.
• Detecting Small Abnormalities - Can detect very small tumors or other abnormalities that might be difficult to spot through physical exams or other imaging methods.
• Monitoring Disease Progression - Useful for monitoring the progression of diseases like cancer or evaluating how well treatments are working.

Risks:

• Your doctor has recommended a CT exam with Apex Radiology that may require contrast material (“x-ray dye”) administered through an intravenous line. The contrast media injection helps achieve better detailed imaging of certain structures inside your body. Contrast agents are safer than previously used media, but any injection carries some risk.
• Approximately 95% of all reactions to contrast media are mild to moderate, which may include - Itching, rash and swelling of lips and eyes. It is impossible to predict who will have a reaction to the contrast.
• Breathing and heart-related reactions are rare but serious and require medical treatment.
• Symptoms are usually recognized promptly and treated without difficulty.
• On rare occasions, the contrast media could leak out of the vessel, causing swelling and skin inflammation. This is called extravasation.
• Patients with conditions such as sickle cell disease, allergies, asthma, or previous reactions to contrast materials are more likely to have problems.
• The risk of death is about 1 out of every 100,000 exams, which is no greater than that from an injection of penicillin.
• CT scans use X-rays, which expose a fetus to radiation. While studies indicate that CT scans performed during the first, second, and third trimesters are generally considered safe when medically necessary, there is a potential risk of miscarriage in the first trimester. Additionally, radiation exposure may slightly increase the risk of birth defects, particularly affecting the brain and nervous system, as well as a small, elevated risk of childhood cancer later in life. However, during the third trimester, the fetus is more developed, and the risk of radiation-related birth defects is significantly lower.

To help us ensure your safety, we ask that you co-operate with us to complete this form as accurately and completely as possible. This form is TO BE COMPLETED BY PATIENT OR PARENT/GUARDIAN.

WAIVER & CONSENT

I acknowledge that I have been informed about the purpose, benefits, and potential risks of undergoing a CT scan, including exposure to low levels of radiation. I understand that while CT scans are generally considered safe, radiation exposure carries a small potential risk, particularly for pregnant individuals or those with underlying health conditions.

If applicable, I confirm that I have disclosed any known or suspected pregnancy to the medical provider.

I voluntarily consent to undergo the CT scan as recommended by my healthcare provider. I release Apex Radiology, its staff, and medical professionals from any liability related to unforeseen complications or outcomes associated with this procedure.

Witness Confirmation

By clicking the "Confirm" button, you acknowledge that Apex Radiology has electronically witnessed this consent form. The date and time of submission are recorded and securely stored as part of your medical record.