Firma orientovaná na oblasť výroby rádiofarmák a nukleárnej medicíny

Application forms

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Inviting patients for examinations

We invite patients for examination based on delivered completed application form. Application form you may send online, by mail, by fax or by e-mail. Preliminary date reservation may be arranged by phone.

Contact data for ordering

Ambulance – Telephone: 02/20670187 (working hours 7:30 – 14:00 hod.)
Ambulance – fax: 02/20670127

Application form types

Application Form For PET-PET / CT Examination With 18FDG (Adobe Acrobat PDF)
Application Form For PET-PET / CT Examination With 18FDG (Microsoft Word DOC)
Application Form For Gamma-Radiography Examination (Adobe Acrobat PDF)
Application Form For Gamma-Radiography Examination (Microsoft Word DOC)

Ordering PET/CT examinations with 18FDG

-state time interval since chemotherapy, radiotherapy, surgery
-if indication is disease remission confirmation, 1 month time distance from CHT, 3 months from RAT, 1 month from surgery is needed
-in the case of indication of examination for immediate CHT effect confirmation, time distance of several days is sufficient
-send a patient also with relevant documentation (medical record, clinical data, oncomarkers, CT and MRI scans)
-for health-care insurance company it is necessary to present code of forwarding physician (oncologist)


-patient with empty stomach, last meal is light dinner one day before examination
-adequate hydratation (sugar-free liquids unlimited)
-do not exert demanding manual activity one day before examination
-prevention of stress reaction and brown fat imaging: 3 x Diazepam 10 mg in 8-hour intervals, optionally also Trimepranol 5mg (last dose 2 hours before examination)
-compensated diabetes (glycaemy below 10 mmol/L), in the case of increased glycaemy patient will not undergo examination, do not administer insulin in the morning before examination
-usual daily medicines take with a glass of water on the day of examination, do not administer chemotherapy in the morning before examination
-patient may bring a meal, liquids and drugs, a stay at PET centre is approximately for 4 hours

Ordering gamma-radiographic examinations

-individual procedure following examination type, relevant information will provide a nurse in ambulance, or PET centre physician