Radiology Research Feasibility Assessment

In order to ensure that radiology imaging equipment/resources will be available for human research at Jefferson, research protocols that require radiology assistance with imaging should be submitted for review by the Department of Radiology. The request for review is initiated by completing a webform that may be found on the Jefferson Office of Human Research webpage. A complete log of all imaging research requests and responses will be maintained by the Department of Radiology to facilitate imaging research on campus.

Note: Radiology will provide a clinical report on every study (as per department policy) to the requesting physician or PI. Any standard imaging procedure, non-standard imaging, post-processing, measurements, case report form, data transfer request, or non-routine radiological interpretation required for the study must be specified on this form, or they will not be provided when patients are imaged for the study. 

Form Completed by:

(A copy of your responses will be emailed to the address you provided.)

IMPORTANT INFORMATION: Informal/verbal requests for equipment availability and study prices will NO LONGER be acceptable. 

A formal request for review MUST be submitted by the initiating investigator PRIOR to submission for IRB approval, or any time information is required about availability and/or cost of imaging for a specific study/proposal.  

Has this study has already been submitted to the IRB?

Section I: General Information

Indicate which of the following:
Is the PI the author of the protocol/study? *
Please enter grant number

Section II: Study Details

For this study, patients will be:
What phase is the trial in?
Does the study require any phantom imaging prior to approval?
Identify all Radiology modalities for which imaging is required for the study:
Identify all body parts for which imaging is required for the study (brain, abdomen, pelvis, spine, etc.)
Is contrast required for study? *Please note, double dose contrast is not permitted

Section III: Imaging Data

Identify if additional Radiologist support for this study is required:

Section IV: Staff Resources

Has a radiologist with knowledge of the protocol been identified as a co-investigator?

Section V: Additional Comments