Clinical trial: NCT05671016
Section: Purpose of Research
Subsections: Title Of Project: Brain Imaging To Predict Toxicity In Elderly Patients After Radiotherapy (Briter Study) Trial Team: Dr C Lorimer, Dr J Brock, Dr L Welsh, Prof A Chalmers, Dr S Mills

Please initial all boxes 1. I confirm that I have read and understand the information sheet version…………….. Dated…………………
for the above study. I have had the opportunity to consider the information and ask questions if necessary and have had these answered satisfactorily.  
2. I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my medical care or legal rights being affected.  
3. I understand that relevant sections of my medical notes, my scans and data collected during the study may be looked at by the trial team. I give permission for these individuals to have access to these records.  
4. I understand that my involvement will involve completing simple paper questionnaires and may involve undergoing an MRI scan with administration of a contrast agent through a cannula 5. I undertand that my GP will be informed that I am taking part in this study 6. I agree to take part in the above study.  
Name of Participant Date Signature Name of Trial team member Date Signature