ISP Request form

Acerca del clínico peticionario

Esta sección recopila la información necesaria para identificar al profesional solicitante y garantizar la correcta trazabilidad y envío de los dispositivos médicos y representaciones generadas. Los datos aportados permitirán asegurar la comunicación directa y el cumplimiento de los requisitos de calidad del servicio.

Nombre y apellidosNúmero de colegiadoCorreo electrónico personalTeléfono de contactoPaísInstitución / HospitalServicio / Departamento

Clinical Data

To guarantee the accuracy and effectiveness of the surgical planning, we require essential clinical information about the case. This data allows us to adapt the modeling and planning to the specific anatomical and pathological context of each patient, complying with safety, traceability, and confidentiality standards.

Please complete the fields with the highest possible level of detail and accuracy.

PatologíaNúmero de Historia ClínicaSexo del pacienteFecha de nacimiento del paciente

Surgery Date

Surgical ProcedurePathology

Prioridad Urgente implica un priorización en el desarrollo de su caso en nuestra orden de trabajo, aunque también implica un aumento en el precio final. Revise tarifas.

Medical Imaging

The quality of surgical planning depends directly on the diagnostic information we receive. Therefore, we request the necessary medical imaging studies to generate the anatomical model and design the personalized planning according to ISP-XR protocols.

‍Important: Please ensure you upload complete studies, preferably in DICOM format, and with the highest available quality.

Modality

CT MROther

Study Date

Study NameCalidad del DICOM

Debe especificar si el estudio es de hace menos de 30 días, si tiene una resolución espacial menor de 1mm y si tiene algun tipo de contraste.

File Upload

Only ZIP or RAR compressed files will be accepted to ensure that all medical information is received completely and without loss

Subir un fichero

Upload Widget English Version

Segmentation

Indicate the anatomical structures relevant to this clinical case.
Our team will use this information to accurately segment the CT or MRI data and generate a customized 3D model. You may include bones, soft tissues, tumors, or any other surgically relevant regions.

Segmentación

Indique las estructuras anatómicas que considera relevantes para este caso clínico.
Nuestro equipo utilizará esta información para segmentar con precisión la imagen tomográfica (TAC o RM) y generar el modelo 3D personalizado.

Define the Device

Please indicate the devices or solutions required for this case. You may select one or more options depending on your clinical needs and the procedural requirements.All devices are custom-designed based on the medical imaging data and in compliance with ISP-XR standards.

Select the required device types:DesignProposed Surgical Approach:

Surgical Review Modality

To guarantee the validation of personalized surgical planning, we offer different review modalities adapted to your availability and technological resources.
Please select how you wish to review the anatomical segmentation and the generated surgical proposal:

How would you like to review the proposed surgical segmentation?

Standard 3D Videoconference

Virtual Environment with NavigatorPro XR

I already have a Meta Quest 3 device

I would like information on how to acquire a Meta Quest 3 device

Meeting Date

Comercial responsable

I Agree to the Terms and Conditions

Planning Request