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CONSENT TO ACT A S SUBJECT FOR RESEARCH AND INVESTIGATIONS UNDER (Also Supported in Part by AEC) Pathological Conditions Studied : Paget ' s Disease,My elo fibrosis of other diseases of the bone marrow resulting in increased bone Patient ' s Name Date Name of person(s1 who will perform pro - ce dure s and investigations, and / or such assistants as may be selected by him to perform the following procedures and investigations : 1 . 18Fe52 whole body s can 4.Evaluate the effect on bone blood flow of drugs 1 - dep hos ph on ate (EHDP) in my elo fibrosis or other pharmaceuticals receiving FDA approval for a specific medical use within the pur vue of this 5. Repeat 1, 2,and3at the end of 12-week period 2.The procedures and Investigations listed in Paragraph1have been exD laine d to me b y in Paragraph1involve the following possible risks and d is - 3.I understand that the procedures and investigations described 1. The combined dose of irradiation to the bone marrow from the isotopes used.The latter is comparable to the radiation dose of x rays which would be re - ce i ved from an upper gastrointestinal series ; 2.It is possible there may be allergic reactions to the administration of calc eton in or of EH DP,though the incidence of such reactions is infrequent ; skin oreye testing for allergic reactions is done prior to the use of the above pharmaceuticals ;
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3. Discomfort : Procedure1involves the discomfort of an intravenous injection one day and2hours lying still during imaging the following day.Procedure ce dure4involves a dally injection(in the buttock) by another person ; and that the studies may result in information leading to a better understanding of m,v disease. 4.I understand that I may terminate my parti cio ation in the study following) : is a minor,or otherwise run able to sign,complete the Subject is a minor(age : 1, or is unable to sign because Other person and relations hio