Bachelor of Science in Nuclear Medicine Imaging Sciences Program Radiation Dosimeter Monitoring Form | UAMS Department of Imaging and Radiation Sciences

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This field is for validation purposes and should be left unchanged.

Report Information

Student Name(Required)

Student Email(Required)

Today's Date(Required)

Report for Radiation Dosimeter Monitoring Period (Month)(Required)

Report for Radiation Dosimeter Monitoring Period (Year)(Required)

Radiation Information

Ring Finger Radiation Type/Radiation Quality(Required)

Ring Finger Dose Equivalent (mrem) – Shallow (SDE)(Required)

Use the drop downs below to report any others besides the ring finger.

Use #1(Required)

Use #1 Radiation Type/Radiation Quality(Required)

Use #1 Dose Equivalent (mrem) – Deep (DDE)(Required)

Use #1 Dose Equivalent (mrem) – Eye (LDE)(Required)

Use #1 Dose Equivalent (mrem) – Shallow (SDE)(Required)

Use #2(Required)

Use #2 Radiation Type/Radiation Quality(Required)

Use #2 Dose Equivalent (mrem) – Deep (DDE)(Required)

Use #2 Dose Equivalent (mrem) – Eye (LDE)(Required)

Use #2 Dose Equivalent (mrem) – Shallow (SDE)(Required)

Use #3(Required)

Use #3 Radiation Type/Radiation Quality(Required)

Use #3 Dose Equivalent (mrem) – Deep (DDE)(Required)

Use #3 Dose Equivalent (mrem) – Eye (LDE)(Required)

Use #3 Dose Equivalent (mrem) – Shallow (SDE)(Required)

Comments

Click the "Yes" button below to signify your acknowledgement and understanding of the radiation dosimetry report for the month specified above.(Required)

Yes

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