In vivo radionuclide(s) use - animal imaging plan of work

This form must be completed before ordering radionuclide(s) for in vivo animal imaging using microPET/PET and SPECT units.

Fields with asterisks (*) are required.

First name *

Last name *

Email *

PI Last Name

IACUC Protocol Number *

Radioisotope(s) to be injected *

Confirmation number for this RAM to be used for this procedure. You should have requested and recieved the confirmation number prior to submitting this form. *

RAM Vendor *

Total maximum activity in microcuries *

Radioisotope(s) delivery date *

Radioisotope(s) animal injection date *

Name of the personnel injecting radioisotope(s) to the animal *

Name of the personnel preparing the syringe for injection. *

Name of the personnel imaging the animal *

Imaging date (post-injection) *

Animal housing location after radioisotope injection & imaging *

Name of the personnel taking care of radioisotope - injected animal *

Additional Comments