Register - Complete Registration Form

 
 
 




     
* Institution (or referring institution, if different)  
     
* Office Phone:  
  Alternate Phone:  
* Email Address  
 
* Primary specialty  


     
* Are you board certified in your primary specialty?  
     
* Are you board certified in cardiac CT?  
     
* Years of experience reading coronary CTAs?   [one or two digits]
     
* Number of cardiac CTA cases read in your lifetime?  

     
* Number of cardiac CTA cases read in the past 12 months?  





     
* What is your level of training?  

     
* Training primarily aquired during?  






     
* Have you published as first author or senior author in cardiac CT?  
     
* Have you taught a CT course, either hands-on or lecture?  
     
* Gender  
     
* Age   [two digits]

   
* User Name   [6 to 12 characters]
* Password:   [6 to 20 characters]
* Retype Password:   [Must match Password]
     
Select your training dates  
* Please carefully consider the timeframe in which you wish to complete the case review, as your account will only be activated for the week you select here.
 
* Contact information may be released to third-party professional organizations.  
 

* E-mail reminders will be sent one week prior to account activation. If you need to change this date after registration has been completed, please contact us at stathelp@partners.org

* Background CTA reading experience will be kept strictly confidential. Aggregate and anonymized data may be used in post-trial publications; participants in the PROMISE CTA Case Review will be acknowledged.

Copyright © 2010 Massachusetts General Hospital