×
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
To save time completing this request form, existing users can log in to the User Portal
here.
If you don't have portal access but your insitution has an RTF number, click
here
(this will prepopulate much of the form data from your institution)
Phantom Request
RTF No
Prepopulate institution data from RTF
Find RTF
Request Type
--Select Type--
Clinical Trial
Recalculation for Clinical Trial
For Fee
Recalculation for Fee
Varian
RTOG Foundation
US Oncology
Phantom Requested
HU-RLSP Calibration Check (Proton)
IMRT H and N
IMRT Spine
Liver Phantom WITH Motion Table
Lung Phantom WITH Motion Table
Proton Brain
Proton H and N
Proton IGRT Phantom
Proton Liver WITH Motion Table
Proton Lung WITH Motion Table
Proton Output Check
Proton Spine
SRS Head
TBI Phantom
TMPRT H&N phantom
Using the control key while highlighting phantoms allows a request for more than one phantom type.
Typically, phantom results are available 5-6 weeks after the date of the phantom irradiation... Would you like to order expedited service for a fee of $500?
--Select Yes or No--
Yes
No
Voucher #
Demographics
Institution
Physicist first name
Physicist last name
Physicist phone number
Physicist email
Shipping To
Is this a new address
Department
Street Address
City
State/Province
Zip Code:
Country
Afganistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla (UK)
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda (UK)
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Virgin Islands (UK)
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
CANADA
Cambodia
Cameroon
Cape Verde
Cayman islands
Central African Republic
Chad
Chile
China
Christmas Island (Australia)
Cocos (Keeling) Islands (Australia)
Colombia
Comoros
Congo, D.R.
Congo, Rep.
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Rep.
Denmark
Djibouti
Dominica
Dominican Rep.
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands (Denmark)
Fiji
Finland
France
French Guiana
French Polynesia (France)
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar (UK)
Greece
Greenland
Grenada
Guadeloupe
Guam (USA)
Guatemala
Guernsey
Guinea
Guinea-B.
Guyana
Haiti
Holy See
Honduras
Hong Kong SAR (China)
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democ
Korea, Rep.
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall I.
Martinique
Mauritania
Mauritius
Mayotte (France)
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat (UK)
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles (Netherlands)
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island (Australia)
Northern Mariana Islands (USA)
Norway
Oman
Pakistan
Palau
Palestinian territories
Panama
Papua N.G.
Paraguay
Peru
Philippines
Pitcairn Islands (UK)
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion (France)
Saint Helena (UK)
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Vincent and the Grenadines
Saint-Pierre and Miquelon (France)
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and South Sandwich Islands (UK)
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands (Norway)
Swaziland
Sweden
Switzerland
Syria
Tadjikistan
Taiwan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau (NZ)
Tonga
Trinidad
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
UAE
UK
USA
Uganda
Ukraine
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands
W. Samoa
Wallis and Futuna (France)
Western Sahara
Yemen
Zambia
Zimbabwe
Is the machine physically located at the address above? (y/n)
--Select Yes or No--
Yes
No
Machine Address
Name of Facility
Method to account for respiratory motion
Protocol to be credentialed for
Machine
Machine
Machine Serial Number
Select 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
Billing
Name
Street Address
City
Zip code
Submit
Find RTF
"
Find RTF
Enter Search Criteria
Institution Name
RTF
City
State/Provence
Zip
Country
Search
Change Password