Referral forms and more information about the services offered by our MTIC practices
The Melbourne Theranostic Innovation Centre will offer access to PET scans using a wide range of radiopharmaceuticals for both clinical and research applications.
Prostate Specific Radiopharmaceutical
MTIC is also licenced to use additional investigational radioisotopes including:
Currently, Medicare will cover routine CT and general nuclear medicine scans. For PET imaging, only certain indications are covered by Medicare.
To be eligible for Medicare reimbursement the referral must be from a medical specialist and meet the criteria listed in the Medicare benefits schedule.
The full list of Medicare reimbursable indications is listed on the MTIC referral form and the referring clinic should specify which these indications is applicable. If the indication for the PET scan does not meet any of these criteria there may be an out-of-pocket cost for the PET scan. This should be discussed with the patient prior to referring them to MTIC for the scan.
Click the below link to download our patient information sheet to give to your patients having a PET scan. This information sheet explains the PET scan process and preparation as well as risks, side effects and fees.
Radionuclide Therapy - LuPSMA
Click the below link to download our patient information sheet to give to your patients for consideration of Radionuclide therapy with 177LuPSMA. This information sheet explains the therapy considerations, process, preparation as well as radiation safety, side effects and fees.
Imaging Request Form
Click the below link to download the MTIC imaging request form. Email through a completed and signed referral form to: firstname.lastname@example.org
Discover the Benefits of Advanced Medical Imaging
Unlock the full potential of medical imaging with the latest technology.