Radiology Research Feasibility Assessment

To ensure that Radiology resources will be available for human research at Jefferson, protocols that requires imaging assistance must be submitted for review by the Department of Radiology. A formal request for review is initiated by completing the RadRequest webform that may be found on the Jefferson Office of Human Research Protection site. A complete log of all correspondences will be maintained by the Department of Radiology. 

ATTENTION – Study Team Must Read Before Proceeding
  1. All fields below should be thoroughly read, comprehended, and answered to the best of your knowledge. Failure to do so may result in extended reviewing time.
  2. Informal or verbal requests for Radiology resources will not be acceptable.
  3. Any updates to the imaging guidelines after this submission or Radiology approval will need to be resubmitted for evaluation.
  4. The PIs should review the imaging protocol and be mindful of patients’ implant status and imaging tolerance. 
  5. Please e-mail the latest protocol and/or imaging manual version to RadRequest@jefferson.eduRequests submitted without supporting document(s) will not be evaluated - no exceptions.

Form Completed by:

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Section I: General Information

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Is the PI the author of the protocol/study? required field">*
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Has this study has already been submitted to the IRB? required field">*
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Section II: Study Details

For this study, patients are: required field">*
What phase is the trial in? required field">*
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Section III: Imaging Details

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Is the TJUH standard clinical imaging protocol acceptable for this study? required field">*

If you answer “Yes”, this means there is no questionnaire, no training, and no phantom imaging required. If the protocol requires ANY of the above, please check “No”. 
 

Is there any phantom imaging or a volunteer imaging required? required field">*

*If yes, you may be required to supply a volunteer for imaging. 

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Is there specific online training required for imaging team? required field">*
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Is there a questionnaire to be completed? required field">*
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Is contrast required for study? *Please note, double dose contrast is not permitted required field">*
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Identify all Radiology modalities for which imaging is required for the study: required field">*
Identify all body parts for which imaging is required for the study (brain, abdomen, pelvis, spine, etc.) required field">*
Can you attest that you, as the Study Coordinator, have fully read the Imaging Trial requirements for this study? required field">*
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Section IV: Staff Resources

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Identify if additional Radiologist support for this study is required: required field">*
Has a radiologist with knowledge of the protocol been identified as a co-investigator? required field">*
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Section V: Additional Comments

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