Peak Skin Dose Estimate Information

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Please fill out the form below to have a West Physics representative contact you to arrange for a service or product quote for your facility.

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Our address and telephone numbers are:

West Physics
3825 Paces Walk SE
Suite 250
Atlanta, GA 30339

770-435-9186 • 1-866-275-9378 • FAX 770-599-2333

Office Hours: West Physics maintains liberal office hours for the convenience of our customers nationwide.

Monday-Friday:

9AM – 8PM Eastern Time
8AM – 7PM Central Time
7AM – 6PM Mountain Time
6AM – 5PM Pacific Time

Closed Weekends & U.S. National Holidays

DICOM images should be uploaded to the secure server or CD’s mailed to West Physics Remote Services at 3825 Paces Walk SE, Suite 250 Atlanta, GA 30339. Most information needed for the calculation will be contained in the images. Please also provide the following:

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General Information:

Facility Name:*

Contact Person and Title for Report:*

Department:

Date of Study:*

Exam ID or MRN:

Procedure Name:

Fluoroscopy Unit Make and Model:*

Average kVp:*

Cumulative Air Kerma (mGy):*

Cumulative Dose-Area Product – Fluoroscopy (mGy-cm2 ):*

Source to Image Receptor Distance (SID) (cm):*

Patient Thickness (cm):*

Total Fluoro Time (min):

Distance Between Patient and Image Receptor (cm):*

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