Thyroid Intercomparison: Participant's Results Sheet

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Contact Person:

Name of Laboratory or Facility:

Address of Laboratory or Facility:

Phone Number and Area Code:

Date Measurement Taken:

Counting Time:	(sec)
Detector Type (NaI, HpGe):
Detector Dimensions	(cm X cm)
Distance from Phantom to Detector:	(cm)
Length of Collimator:	(cm)
MDA of counting system for 131 I:	(Bq)
MDA of counting system for 125I:	(Bq)

Email address (if applicable):

Do you have a Multi Channel Analyzer?

If yes, what energy region of interest (keV) are your peaks found in?

	WITHOUT FAT OVERLAY PLATE			WITH FAT OVERLAY PLATE
Thyroid phantom #	Gross Cnt Rate (cps)	Net Cnt Rate (cps)	Measured Activity (Bq)	Gross Cnt Rate (cps)	Net Cnt Rate (cps)	Measured Activity (Bq)

Analyst's Signature: ___________________________________________

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Please submit results to the Human Monitoring Laboratory no later than one month after the measurements took place.

Results can be sent by:

Fax: (613) 957-1089
E-mail: Linda_Burns@hc-sc.gc.ca