Magnetic Resonance Imaging Research Core Pilot Scan Time Application

OPEN ACCEPTANCE OF PROPOSALS

Proposals for MR scan time for pilot studies are currently accepted on a rolling basis, will be reviewed at the end of each month, and decisions will be announced in the first week of the following month. Please submit completed applications via e-mail attachment to Core Management at [email protected].

ELIGIBILITY – Geisinger Investigators and Physicians are permitted to apply for pilot scan time. Post-Doctoral Fellows, Residents and Fellows may serve as Co-Investigators, but must be sponsored by a Geisinger Investigator or Physician.

REVIEW – Proposals will be reviewed by the MRI Research Core committee. Each proposal will be evaluated on the basis of scientific merit, demonstration of need, and potential for successful extramural research support.

AWARD –  Awarded scan time must be used within 1 year and scan time must be scheduled in advance  An account under project name will be created at the MRI Research Core for the purpose of scheduling  In general no more than 25 pilot scans will be collected under this mechanism.

REPORTING – Following award of pilot scan time, investigators will be asked to provide the information included in the “reporting” section of this application. Current and historical recipients of pilot scans will be contacted annually to update their reported data.

QUESTIONS – All questions regarding the pilot scan time application process, award process, review criteria, or reporting requirements may be directed to MRI Research Core management at [email protected].

updated 12/23/15 by Page 1 of 4 Magnetic Resonance Imaging Research Core Pilot Scan Time Application

Proposals for MRI Research Core pilot scans are accepted throughout the year on a rolling basis. Applications must be complete and must be submitted via e-mail attachment to [email protected].

Date:

Section 1: Contact Information

Principal Investigator Name: PI Title:

Department:

Phone: Email:

Co-Investigator(s):

To be collected post award:

Research Assistant/Coordinator:

Phone: Email:

Grant Administrator/Billing Contact:

Phone: Email:

*All email addresses, except for grant administrator, will be added to Research MRI users email group unless otherwise requested.

Section 2: Project Information

IRB Approval No: IRB Approval Date: IRB Expiration Date:

IRB Approved Title:

Expected Number of Scans Requested: Length of Time for Each Scan:

Are you a first time user of our facility?

Do you have any other special requirements for your project (e.g., Technical or Logistical)?

Page 2 of 4 Magnetic Resonance Imaging Research Core Pilot Scan Time Application

Section 3: Other Information

Describe other resources requested to be provided by the Research MRI Core (i.e. computing, RF coils, special pulse sequences, statistical consultation, image analysis, fMRI paradigm design etc.)

Describe source of funds for other expenses (e.g., subject recruitment, subject payment, other equipment/materials etc.)

Please describe plans for securing extramural funding based on pilot data and planned submission dates:

Section 4: Proposal Section 4A: Research Plan (limit 2 pages) Describe the proposed research project. This protocol should describe the background and significance, specific aims, methodology and expected results. This protocol should have enough detail to allow a scientific review of the project.

Section 4B: References/Literature Cited (limit 1 page) Attach references cited in the proposal.

Section 5: Biosketches Attach a biosketch for each investigator cited in “Section 1”. Use the standard NIH 4 page format.

Section 6: IRB Approval & Consent Form Studies involving human subjects must include their IRB approval letter and consent form. (If pending, please note date of submission and provide copy)

Section 8: Reporting (post award) Investigators will be asked to report on whether the data gathered from awarded pilot hours resulted in any of the following: 1) conference presentation/abstract, 2) publication, including title, journal, and date; 3) submitted internal or external grant, including sponsor and date of submission; 4) awarded internal or external grant, including sponsor, PI, and date of award. Current and historical recipients of pilot grants will be contacted annually to update their reported data.

Section 9: (Use single name/code for each protocol) MRI TECHNOLOGIST USE ONLY

Page 3 of 4 Magnetic Resonance Imaging Research Core Pilot Scan Time Application

Protocol Name______

Page 4 of 4