PET/MRI Logbook Form
Record PET/MRI scan sessions, procedure details, observations, and follow-up actions.
Session Identification
Study/Patient/PET Identifier
*
Date of Scan
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of Scan
*
Hour Minutes
AM
PM
AM/PM Option
Operator/Technologist Name
*
Referring Department or Clinician
Imaging Procedure Details
Scan purpose / indication
*
Staging
Diagnosis
Treatment response
Follow-up
Research
Other
Tracer / radiotracer used
*
Administered dose (MBq)
*
Imaging protocol / sequence details
*
Scanner / model used
*
Scan duration (minutes)
*
Preparation, Observations, and Follow-up
Preparation Notes
Observations / Findings
Session Status
*
Completed
Partial
Aborted
Deferred
Issues / Incidents During Session
Follow-up Actions / Recommendations
Submit Logbook Entry
Should be Empty: