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18
F PET/CT | PET/MR
Brain PET/CT
68
Ga PET/CT | PET/MR
89
Zr PET/CT | PET/MR
177
Lu SPECT/CT
PET/CT | PET/MR Accreditation enrollment form
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EARL
About EARL
Organisational Structure
Testimonials
Accreditation
About
Accreditation process / timelines
Accreditation specifications
Fees
18
F PET/CT | PET/MR
Brain PET/CT
68
Ga PET/CT | PET/MR
89
Zr PET/CT | PET/MR
177
Lu SPECT/CT
PET/CT | PET/MR Accreditation enrollment form
Online Box
Phantom Videos
Centres of Excellence network
CoE clinical studies
Webinars
Guidelines and publications
Theranostics
SASAI
About SASAI
Expert Auditors
Available Audit Reports
ABX
GE Healthcare
Upcoming Audits
Audit report order form
FAQ
EU Projects
SIMPLERAD
Consortium
Advisory Board
Work packages
Workshop Programme
Workshop Sessions review
Final Report
Contacts
EARL 177Lu SPECT/CT enrollment form - beta
Name
This field is for validation purposes and should be left unchanged.
Institution name in English
(Required)
Please ensure you write the name in English, it will be displayed on the accreditation certificate.
Department name in English
(Required)
Please ensure you write the name in English, it will be displayed on the accreditation certificate.
Address of institution in English:
(Required)
Street & number
City
City
Post code
Post code
Country
Country
EU VAT number (billing)
EU VAT number (billing)
Billing details (not applicable for the pilot study)
same as institution/department
different from institution/department
Billing details
(if different from institution/department)
Entity name in English:
Entity name in English:
EU VAT number (billing)
EU VAT number (billing)
Street & number (billing)
Street & number (billing)
City (billing)
City (billing)
Post code (billing)
Post code (billing)
Country (billing)
Country (billing)
Full name of billing contact
(Required)
Billing Email
(Required)
Email of person/team responsible for the billing
Contacts
Select the check box for each contact below if you wish this person to receive notifications for QC due
Full name of person completing this form
(Required)
Contact Email
(Required)
Email of person completing this form
Head of Department title & full name
(Required)
Receive QC requests
Email
(Required)
Email
Phone
Phone
Primary contact for EARL accreditation full name
(Required)
Receive QC requests
Email
(Required)
Email
Phone
Phone
Contact for scanner validation full name
(Required)
Receive QC requests
Email
(Required)
Email
Phone
Phone
Other contact(s) to receive QC requests (use semicolon to separate multiple names)
Name(s)
Email(s) (use semicolon to separate multiple emails)
Email(s) (use semicolon to separate multiple emails)
SPECT/CT scanner 1
Detector Type - select from the options
(Required)
NaI (3/8")
NaI (5/8")
CZT dual head
CZT full ring
Year of installation
(Required)
Manufacturer
(Required)
Model/Version
(Required)
SPECT Software Version
(Required)
Number of CT slices
(Required)
Station Name as set up on your network/PACS
(Required)
Device Serial Number (SPECT component)
(Required)
Reconstruction Software name used for 177Lu
(Required)
Reconstruction Software version number used for 177Lu
(Required)
Scanner Manufacturer Reconstruction Software Name (N/A if not applicable)
(Required)
Scanner Manufacturer Reconstruction Software Version Number (N/A if not applicable)
(Required)
Additional reconstruction software used for quantitative analysis
Yes
No
Additional reconstruction software details
Additional reconstruction software name
(Required)
Additional reconstruction software version number
(Required)
This field is hidden when viewing the form
Section Break
Add SPECT/CT 2
Add SPECT/CT 2
SPECT/CT scanner 2
Detector Type - select from the options
(Required)
NaI (3/8")
NaI (5/8")
CZT dual head
CZT full ring
Year of installation
(Required)
Manufacturer
(Required)
Model/Version
(Required)
SPECT Software Version
(Required)
Number of CT slices
(Required)
Station Name as set up on your network/PACS
(Required)
Device Serial Number (SPECT component)
(Required)
Scanner Manufacturer Reconstruction Software Name (N/A if not applicable)
(Required)
Scanner Manufacturer Reconstruction Software Version Number (N/A if not applicable)
(Required)
This field is hidden when viewing the form
Section Break
Add SPECT/CT 3
Add SPECT/CT 3
SPECT/CT scanner 3
Detector Type - select from the options
(Required)
NaI (3/8")
NaI (5/8")
CZT dual head
CZT full ring
Year of installation
(Required)
Manufacturer
(Required)
Model/Version
(Required)
SPECT Software Version
(Required)
Number of CT slices
(Required)
Station Name as set up on your network/PACS
(Required)
Device Serial Number (SPECT component)
(Required)
Scanner Manufacturer Reconstruction Software Name (N/A if not applicable)
(Required)
Scanner Manufacturer Reconstruction Software Version Number (N/A if not applicable)
(Required)
177Lu uniformity assessment
Yes
No
Provide frequency (177Lu uniformity)
Radionuclide Calibrator
Provide the following details of the radionuclide calibrator used for
177
Lu measurements
How many radionuclide calibrators do you use?
1
2
more than 2
How do you cross-calibrate the calibrators?
Radionuclide calibrator #1
#1 calibrator manufacturer
(Required)
#1 calibrator model
(Required)
#1 calibrator year of installation
Which radionuclide calibrator do you use to measure the activity administered to patients
#1
#2
both 1 & 2
All ( select if more than 2 are used)
Other
Please, explain what other methods do you use for measuring the activity administered to patients
Please upload the list of numerical dial/calibration factor used for 177Lu measurements for calibration #1?
Max. file size: 28 MB.
This field is hidden when viewing the form
2nd calibrator section
Add 2nd Rn Calibrator
Add Radionuclide Calibrator #2
#2 radionuclide calibrator
Provide the following details of the 2nd radionuclide calibrator used for
177
Lu measurements
#2 calibrator manufacturer
(Required)
#2 calibrator model
(Required)
#2 calibrator year of installation
(Required)
Please upload the list of numerical dial/calibration factor used for 177Lu measurements for calibration #2?
Max. file size: 28 MB.
Section Break
Do you perform the same QC for all radionuclide calibrators?
Yes
No
Explain differences between the QC of radionuclide calibrations:
Traceability of 177Lu activity measurements
Accreditation necessitates some form of traceability to ensure the accuracy of Lu-177 radionuclide calibrator activity measurements.
How do you calibrate your radionuclide calibrator for Lutetium-177?
(Required)
Calibration via a metrology laboratatory (eg. National Meaurement Institute, Designated Institute or other reference laboratory)
Via a metrology lab
Via a traceable reference source from a supplier
Via the factory calibration provided by the radionuclide calibrator manufacturer
Do not know
Do not calibrate it specifically for 177Lu
Other
Metrology Lab Calibration / Traceability
What metrology lab are you traceable to?
What approach did you use?
Purchase a calibrated source
Sent an aliquot of activity to the lab
Please upload the list of numerical dial/calibration factor used for 177Lu measurements for calibration:
Max. file size: 28 MB.
Can you provide a calibration certificate?
Yes
No
Calibration certificate (from metrology lab)
Max. file size: 28 MB.
Calibration via a 177Lu reference source from a supplier
e.g. radiopharmaceutical supplier
Who is the supplier of your traceable reference source?
Please upload the list of numerical dial/calibration factor used for 177Lu measurements for calibration:
Max. file size: 28 MB.
Can you provide a calibration certificate?
Yes
No
Calibration certificate (ref source from a supplier)
Max. file size: 28 MB.
Calibration via the calibrator factory manufacturer calibration
Please upload the list of numerical dial/calibration factor used for 177Lu measurements for calibration:
Max. file size: 28 MB.
Is the dial setting/calibration factor specific to 177Lu?
Yes
No
This field is hidden when viewing the form
Do not know how the radionuclide calibrator is calibrated
Please describe how do you ensure that 177Lu activity measurements are accurate?
(Required)
This field is hidden when viewing the form
Do not calibrate the radionuclide calibrator specifically for 177Lu
Please upload the list of numerical dial/calibration factor used for 177Lu measurements for calibration:
Max. file size: 28 MB.
Please describe how do you ensure 177Lu activity measurements are accurate?
This field is hidden when viewing the form
Other (How do you calibrate your radionuclide calibrator for 177Lu?)
Please describe
This field is hidden when viewing the form
General for all calibration methods
Do you estimate the measureament uncertainty of the dispensed activities?
Yes
No
Would you be willing to estimate uncertainties if support is provided?
Yes
No
General feedback
Provide feedback on this form, the user manual, the process, any unclear sections/questions.
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