Scheduling protocol for a PET/CT with 68Ga-PSMA examination

IZOTOPCENTRUM, s.r.o., Rázusova 24, 949 01 NITRA

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Patient information:

Referring organization:

Diagnosis and detailed health information on the patient:

Radiotherapy focused on prostate, event. prostatic capsule.:
Prostatic surgery (what type):

preparation as in a CT examination with the administration of contrast agent is necessary for the PET/CT examination with a fully diagnostic CT. See the patient’s preparation.

It is necessary to submit written findings from previous examinations or images (CT, MRI, USG…), ideally on a digital medium (CD, DVD, USB key…)

Does the patient use METFORMIN?:

Physician information:

Original application:
After pressing the button the protocol will be sent to us by e-mail and you will see the option to view the completed form in print format.
Mens sana in corpore sano A healthy mind in a healthy body.
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