Project request form
*
Medical Distributor
End-user
Other
Institution/Company:
Title:
Mr.
Ms.
Name*:
Phone:
Email*:
Name of the project:
Explanation/Goals of the project:
Viewing Stations
Type A
No. of Viewing Station type A:
1
2
3
4
5
6
7
8
9
Display quality:
finding
viewing
No. of Displays:
1
2
4
Display size:
15''/17''
19''
20''
21''
22''
23''
Types of images to make
findings:
CR
CT
MR
US
NM
others:
Video grabber:
yes
no
Scanner/CR Interface:
DICOM PRINT:
yes
no
Type B
No. of Viewing Station type B:
1
2
3
4
5
6
7
8
9
Display quality:
finding
viewing
No. of Displays:
1
2
4
Display size:
15''/17''
19''
20''
21''
22''
23''
Types of images to make
findings:
CR
CT
MR
US
NM
others:
Video grabber:
yes
no
Scanner/CR Interface:
DICOM PRINT:
yes
no
Type C
No. of Viewing Station type C:
1
2
3
4
5
6
7
8
9
Display quality:
finding
viewing
No. of Displays:
1
2
4
Display size:
15''/17''
19''
20''
21''
22''
23''
Types of images to make
findings:
CR
CT
MR
US
NM
others:
Video grabber:
yes
no
Scanner/CR Interface:
DICOM PRINT:
yes
no
Archive
ONLINE Long term archive (no.):
no selection
1 single archive
2 single archives
mirrored pair or servers
cluster
Volume in Terrabyte:
no selection
1 TB
1.5 TB
2 TB
3 TB
4 TB
5 TB
6 TB
7 TB
8 TB
9 TB
10 TB
Comments:
No. of studies to archive:
CT:
Matrix:
384x384
512x512
MRI:
Matrix:
128x128
192x192
256x256
512x512
CR:
Reader type(s):
Mammo:
Reader type(s):
US:
Image type:
b/w only
b/w & color images
single images & sequences
NM:
Matrix:
64x64
128x128
192x192
256x256
Image type:
b/w
b/w & color
Webserver
No. of webservers:
no
1
2
3
4
Storage volume:
no selection
1 TB
1.5 TB
2 TB
3 TB
4 TB
5 TB
6 TB
Total no. of users:
No. of estimated concurrent users:
No. of studies to store:
CT:
MRI:
CR:
Mammo:
US:
NM:
DICOM Paper Print
DICOM normal paper print server:
no
1
2
3
4
5
(1 server for each XEROX Printer)
Mobile Finding Stations
MORITS mobile finding stations:
no
1
2
3
4
Network
Modalities to connect to the system:
Name and type
DICOM STORE
DICOM Print
1.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
2.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
3.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
4.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
5.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
6.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
7.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
8.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
9.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
10.
no DICOM
?
DICOM STORE SCU
DICOM STORE SCP
DICOM STORE SCU/SCP
no
?
Print SCU
Print SCP
Print SCU/SCP
General comments: