×
OSLD
OSLD Tracking
OSLD Output Checks
OSLD Irradiation Form
Phantoms
Phantom Tracking
Phantom Irradiation Form
Credentialing
Credentialing Tracking
Site Administration
Facility Questionnaire
User Management
IROC
Try Again
Comment
Search Address
Institution
Person
Search
RDS#
Name
Street
City
State
Country
ZIP
Search Address Results
Refresh
Action
RDS #
Name
LastName
Street
City
State
Country
ZipCode
Address Type
Search People
RDS#
People Name
Search
Search People Results
Refresh
Action
RDS #
FirstName
Position
Phone1
Email1
Contact Type
Phantom Request
To save time completing this request form, existing users can log in to the User Portal
here.
Request Type
--Select Type--
Clinical Trial
Recalculation for Clinical Trial
For Fee
Recalculation for Fee
Varian
RTOG Foundation
US Oncology
Phantom Requested
IMRT H and N
IMRT Spine
Liver Phantom WITH Motion Table
Liver Phantom WITHOUT Motion Table
Lung Phantom WITH Motion Table
Lung Phantom WITHOUT Motion Table
Proton Brain
Proton CT-RLSP Phantom
Proton H and N
Proton IGRT Phantom
Proton Liver WITH Motion Table
Proton Liver WITHOUT Motion Table
Proton Lung WITH Motion Table
Proton Lung WITHOUT Motion Table
Proton Output Check
Proton Prostate
Proton Spine
SRS Head
TBI Phantom
IMRT H and N
IMRT Spine
Liver Phantom WITH Motion Table
Liver Phantom WITHOUT Motion Table
Lung Phantom WITH Motion Table
Lung Phantom WITHOUT Motion Table
Proton Brain
Proton CT-RLSP Phantom
Proton H and N
Proton IGRT Phantom
Proton Liver WITH Motion Table
Proton Liver WITHOUT Motion Table
Proton Lung WITH Motion Table
Proton Lung WITHOUT Motion Table
Proton Output Check
Proton Prostate
Proton Spine
SRS Head
TBI Phantom
Using the control key while highlighting phantoms allows a request for more than one phantom type.
Voucher #
Demographics
Institution
RTF No
Physicist first name
Physicist last name
Physicist phone number
Physicist email
Shipping To
Address1
Address2
City
State/Province
Zip Code:
Country
Is the machine physically located at the address above? (y/n)
--Select Yes or No--
Yes
No
Address
Name of Facility
Is this repeat phantom? (y/n)
Yes
No
Method to account for respiratory motion (if applicable)
Protocol to be credentialed for
Has your IRB granted approval for this protocol? (y/n)
--Select Yes or No--
Yes
No
Machine
Machine
Machine Serial Number
Beam
IF this is a new machine please list all energies (photon and electron) for this machine
Treatment Planning System
Model
Software Version
Algorithm used for
heterogeneity corrections
Misc
Protons Only - Beam Delivery Method
How did you hear of our services
--Select One--
AAPM Summer Meeting
Word of Mouth
Presentation
Other
If Other please indicate
Billing
Payment Type
--Select Payment--
Purchase Order
Credit Card
Name
Title
Phone
Email
Address1
Address2
City
State
Zip code / postal code
Country
Submit
Change Password