Home | Information for Radiology Centres | MRI Scanner Details Form MRI Scanner Details Form Contact Name (include title) * Invalid Input Email Address * Please let us know your email address. Position * Invalid Input Organisation * Invalid Input Department * Invalid Input Street Address * Invalid Input Suburb/Area * Invalid Input Post/Zip Code * Invalid Input City * Invalid Input Country * Invalid Input Telephone Number (include area code) * Invalid Input Fax Number (include area code) Invalid Input Will this person be the Primary Technical Contact? Primary Technical Contact? * YesNoInvalid Input (The Primary Technical contact will be responsible for technical communications with Resonance Health and if applicable scanning the FerriScan Phantom Pack or a test patient to verify the correct acquisition protocol has been set up) If not, please enter contact details of an appropriate Primary Technical Contact. Contact Name (include title) Invalid Input Email Address Invalid Input Position Invalid Input Which analyses are you interested in? Service * FerriScan Liver Iron Concentration onlyFerriScan plus Cardiac T2*HepaFat-ScanI want to participate in the AI beta testingInvalid Input What field strength is your scanner? Please confirm your scanner has a field strength of 1.5T? * YesInvalid Input Manufacturer * SiemensPhilipsGEOtherInvalid Input Who is the manufacturer? Specify manufacturer if other Invalid Input Scanner Model * Invalid Input Can your scanner achieve a minimum TE of 6.0ms (single spin echo)? (for FerriScan) TE of 6.0ms with a T2-weighted single spin echo (SE) sequence? * YesNoUnsureInvalid Input Software Level * Invalid Input Is your scanner equipped with a torso/chest/abdomen surface receiver coil? Receiver Coil: YesNoInvalid Input Can you transfer images to a networked computer with an internet connection? Transfer images * YesNoInvalid Input Do you have a current Service Contract with your MRI manufacturer for regular maintenance? Service Contract YesNoInvalid Input Do you have access to an Application Specialist from the MRI manufacturer to assist you with setting up the FerriScan imaging protocol (if required)? Application Specialist: YesNoInvalid Input Cardiac T2* only Is your scanner equipped with an ECG facility and a cardiac package with a multi-echo T2* sequence? YesNoInvalid Input Is your scanner able to achieve a minimum TE between 2 & 3ms and a maximum TE between 16 & 23 ms? YesNoInvalid Input Data Transfer and Access to Patient Results FAST is the Resonance Health web based system you will use to upload patient image data for analysis and to access patient results. It is important that we only provide access to FAST to approved staff in your organisation. Please nominate the person in your organisation who has the authority to approve FAST access. Contact Name (include title) * Invalid Input Email Address * Invalid Input Position * Invalid Input The following questions will provide Resonance Health with a better understanding of how we can best assist you, should you proceed with our services. Did your enquiry about Resonance Health services arise from? Referring clinician requestConference attendancePublicationsPersonal researchOtherInvalid Input Please specify if other Invalid Input How would the cost of the service(s) be funded at your centre (tick any that apply)? Covered by the MRI DepartmentCovered by Government reimbursementCharged to department / referring clinicianCharged to a Pharmaceutical companyCharged directly to patientOtherInvalid Input Please specify if other Invalid Input Would you like Resonance Health to assist in marketing the service(s) to referring clinicians in your area? Provide assistance? YesNoInvalid Input Would you like to be provided with information for referring clinicians? Provide information? YesNoInvalid Input
