PET or PET/CT


The case information submitted will be used in posting of clincial cases on the GE website, use in clinical trials and/or for softcopy and hardcopy prints to be used by the GE sales force.

Any data or images received from the site must have any associated patient information and identifiers stripped from the files prior to processing.

Reference will be made to the site supplying the case information, unless specifically asked not to by the case provider. An optional release form can be filled out, and should be sent with the case images to:

GE Healthcare
Attn: Jodi Young
3000 N. Grandview Blvd.
Mail Code W-1390
Waukesha, WI 53188

In the event that we need to contact you, please confirm (or change if necessary) your contact information below. If you would like to provide any additional information about yourself (i.e. best time to contact) or your case, fell free to do so, in the note field. Or just click submit.

You must be logged in to see pre-filled form. To pull the data from your member profile, please click here to login.

Your Name:   (Firstname Lastname)
Site Name: 
Telephone: 
Equipment Used:
Date of Exam:  mm/dd/yyyy
Physician Name:
Site Address:
Case Title:
Clinical Case Overview:

Patient History:

Prior Exam Results:
CT Results:
MR Results:
X-Ray Results:
Ultrasound Results:
Lab Results:
Histology Reports:
PET Findings:
Imaging Protocol:
Dose:
Emission Time:
Transmission Time:
Testimonial: How did it change patient management?
PET:
PET CT:
References:
Instructions:    For Discovery LS sites: Send Transaxial Volume Dataset transferred to CD (4 patients per CD) or EOD from eNTEGRA Workstation. Please also send a printed sample that shows the critical clinical images.

For Advance Sites: Send Transaxial Volume Dataset, Coronal and Sagittal Datasets transferred to a MOD or DAT tape. No raw sharc data. Please also send a printed image sample that shows the critical clinical images.

Please include arrrows to highlight the area of focus whenever possible.
Your Email: 
Notes (Optional):