Therapy TLD Order Form

This service is used to independently verify the output of a clinical linear accelerator. Patient TLDs are placed on the patient at the site of interest under bolus to provide charged particle equilibrium.Dose-response TLDs are irradiated under reference conditions to a known dose using the same energy as the patient TLDs.

All TLDs in a set must be returned at the same time. TLDs from different sets will have different sensitivities and should not be used interchangeably.

Each order is shipped via FedEx Priority to arrive by 10:30AM. A $15 shipping fee is included with all orders.

Physicist Name(Required)

First Last

Institution(Required)

Shipping Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physicist Phone(Required)

Physicist Email(Required)

PO Number

Billing Contact(Required)

First Last

Billing Institution(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Billing Phone(Required)

Billing Email(Required)

Therapy Patient Monitoring Service: Sets of 3 Patient TLDs ($100.00/set)

Therapy Patient Monitoring Service: Sets of 3 TLD's ($100.00 each)

Please enter a number from 1 to 100.

Therapy Patient Monitoring Service: Sets of 5 Patient TLDs ($125.00/set)

Therapy Patient Monitoring Service: Sets of 5 TLD's ($125.00 each)

Please enter a number from 1 to 100.

Therapy Patient Monitoring Service-Custom Sets: > 5 Patient TLDs ($25.00/Patient TLD)

If you would like a set of TLDs with more than 5 patient TLDs, please enter the total number of patient TLDs in each set, and number of sets you would like below.

Number of TLDs

Please enter a number from 6 to 100.

Number of Sets

Please enter a number from 1 to 100.

Number of TLDs

Please enter a number from 6 to 100.

Number of Sets

Please enter a number from 1 to 100.

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If you have any questions or if you do not see the Therapy TLD Service you are looking for, please contact us directly at rmm@uwmrrc.wisc.edu or 608/265-9579.

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Therapy TLD Order Form

Therapy TLD Order Form

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