Technology Development Request Form

Center for Clinical Imaging Research

Technology Development Request Form The development of new imaging acquisition and processing technologies is a major goal of the Center for Clinical Imaging Research (CCIR). These activities require efforts that fall outside what is considered normal support of a research project. In some cases, the CCIR can cover both scanner costs and provide access to the staff for such “development” activities. Up to 8 hours of scanner access can be obtained at no cost, particularly when the development activities might benefit multiple research projects. The CCIR staff also can assist in development activities, which may or may not be a billable service depending on the task and the level of effort required.

To submit a development request, please complete the following form and send it back to Robin Link (747- 0380, [email protected]). In addition, if the development activity requires more than 8 hours on a CCIR scanner, please contact Glenn Foster (747-9346, [email protected]) to further discuss the activities.

Restrictions: “MRD requiring a technologist must take place between the hours of 8AM-4PM” - Pam

NOTE: THIS FORM DOES NOT CONTSTITUE A REQUEST FOR MIR PILOT FUNDS. TO REQUEST PILOT FUNDS PLEASE COMPLETE THE “MIR FUNDED SCANS REQUEST FORM”.

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Date: Fund: Department Number: Title: (Note: the Fund and Dept. Numbers will only be used for billable support. If no fund number is available, please enter “none”.)

Principal Investigator (Insert PI name and telephone number):

Person Responsible for Doing Work::

Brief Description of CCIR Development Activity: Insert one paragraph explicitly describing what you would like the CCIR to do. This paragraph SHOULD NOT be a cut-and-pasted description of the scientific question being addressed in a research study, but rather a description of the support needed by CCIR.

Tracking # Page 1 PI: Version 01-28-2016 Campus Box 8223, 510 South Kingshighway, Saint Louis, Missouri 63110-1076 (314) 747-2300 Fax: (314)-747-9366 Estimated Time (Briefly describe scanner needs and length of development activities):

If this request involves human subjects, what IRB number will be used?

How do these activities benefit other research projects that utilize the CCIR?

Will these data serve as pilot data? Yes No

As part of receiving this development time, I agree to write a one page synopsis of this research to be shared among other CCIR Researchers.

Campus Box 8223, 510 South Kingshighway, Saint Louis, Missouri 63110-1076 (314) 747-2300 Fax: (314)-747-9366