IMAGING RESEARCH CENTER (IRC) RADIOLOGY PROPOSAL FORM
This form must accompany your proposal to the IRC/Radiology Scientific Advisory Committee for approval of your
research project. Please follow the guidelines given for each portion of the proposal and be as brief as possible.
Consult the Business Manager, Donna Lyons, for current scanner fees. If human subjects or animals are to be used,
appropriate IRB or IACUC approval must be obtained before your project can begin. Please attach IRB with
consent or IACUC protocol and approval letter as well as a copy of a 4 page NIH format biosketch of the P.I. A
letter must also accompany proposals from your Department Head in support of the proposed project. Submit
completed proposals to Donna Lyons, Radiology/IRC, MLC-5033 or via e-mail to donna.lyons@cchmc.org. If you
have questions please call 636-2863. The IRC/Radiology Scientific Advisory Committee will review all proposals.
Project title:
Principal Investigator:
Division:
Address (MLC):
IRC Liaison:
Scanner:
IRC modalities:
Radiology Clinical Modalities:
Methods:
Subjects:
Which modalities are best suited for your project?
Philips 3T
Bruker 7T
MicroCT
1.5 T
3.0 T
CT
US
NM
MRI
MRS
Radiography
Ultrasound
Nuclear Medicine
Phantom
Animal*
Human*
CR
Animal Protocol #:
Human Protocol #:
Number of subjects/scans required:
Number of controls/scans required:
*Please attach relevant IACUC or IRB protocol with consent form and approval letter
Duration of project:
Costs: Estimate total cost for the project including:
a) Time and expense for development of hardware, software, and imaging protocols:
b) Scanner time charges for proposed number of scans based on hourly scanning costs:
Sources of funding:
a) List current funding source and budgeted amount:
b) Is external funding anticipated for this project?
Signature of Principal Investigator:
Signature of Department Head:
**See below for required documents for proposal packet
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IMAGING RESEARCH CENTER (IRC) RADIOLOGY PROPOSAL FORM
Attach a 3-5 page summary of the proposed project using the NIH-PHS-398 research plan format. If the work is
connected with a funded project, please attach a copy of the proposal if available.
Research Plan Format
Specific Aims - Concise statement of hypothesis to be tested and the specific aims of the proposed imaging
research.
Background and Significance - Brief description of work in related fields including a few key references and
appropriate journal articles. Mention any previous work you may have done on related problems. Attach your
relevant publications.
Preliminary Studies - If you have done preliminary experiments that are relevant to the imaging study you are
proposing, describe them briefly. If no previous work is relevant please discuss work by others which might be
relevant and rationale behind the proposed study. Attach relevant reprints of your related work.
Research Design and Methods - Describe what type of experiment you propose? Include details of the
number of subjects/animals, the methods to be used and how the methodology will be tested.
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