UNIVERSITY OF CALIFORNIA, IRVINE

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UNIVERSITY OF CALIFORNIA, IRVINE
BERKELEY  DAVIS  IRVINE  LOS ANGELES  MERCED  RIVERSIDE  SAN DIEGO  SAN FRANCISCO
SANTA BARBARA  SANTA CRUZ
NEUROSCIENCE IMAGING CENTER
Steven L. Small, Ph.D., M.D., Director
David B. Keator, Ph.D., Operations Director
Keith R. Burnett, M.D., Clinical Director
Ahmed (Duke) Shereen, Ph.D., Lead Physicist
Irvine Hall Room 181
Irvine, CA 92697-3960
Telephone: +1 (949) 824-7872
Email: [email protected]
UNFUNDED MRI DEVELOPMENT PROPOSAL
1) Title of project:
2) Principal Investigator(s):
a) Name:
b) Department:
c) Contact Information:
3) Description (NIH style: Specific Aims, Significance/Innovation, and Methods 2 pages max):
4) How does this MRI development project benefit the larger UCI imaging community (include
specific faculty, technological improvement, what scientific questions can be answered with
the success of this project that couldn't be answered before)?
5) Data collection requirements*
a) Operator certification (date of last safety exam):
b) Subject population (include medical conditions):
c) Number of Subjects/Phantoms:
d) Estimated Total Scanner Time:
e) Special data acquisition, storage, or processing requirements:
6) Plans for acquiring extramural funding (time table for submission after completion of pilot
data):
7) Projected utilization of NIC by grant if funded:
8)
IRB approval letter (if applicable, i.e. scanning humans participants)**
9)
IRB consent form (if applicable)
*Proposals requesting >15 hours of scanner time may not be approved unless a compelling reason
is given. Note, at time of scheduling unfunded scan, slots may not be booked more than 1 week in
advance to give priority to funded projects unless scan occurs outside regular business hours.
**If animals are to be used for any portion of the development project, please include the
appropriate IACUC approval information.
Version
3/21/16
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