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CIDUR Project Intake Questionnaire

Returning?

A A A

CIDUR is a web-based medical imaging data management system for the collection, secure storage, governance, and use of clinical imaging data for IRB-approved research.

This form is designed to get an initial overview of your study and evaluate how CIDUR can support your study's data storage, management, and governance needs.

In this form, 'prospective study' refers to an IRB-approved study that is collecting new data from consented subjects using clinical imaging modalities.

'Retrospective study' is a study using hostorical data from an imaging archive (such as PACS) that was part of a standard of care exam. Bulk data requests from an imaging archive for large retrospective studies must be initiated thorugh the Informatics Consultation service of CTSI and cannot be requested through this form directly.

Please fill out this questionnaire with as much detail as possible. If you have questions, email CIDUR_Support@urmc.rochester.edu directly.

XNAT Project ID

IRB Study ID

* must provide value

Full Protocol Name

Short Protocol Name (24 Characters)

Please upload the IRB-approved study protocol

* must provide value

Upload file

Type of project

* must provide value

Prospective

Retrospective (PACS bulk request)

reset

Please enter your email address

* must provide value

What is the CTSI Informatics Service Request [REDCap] request number:

Enter the email address of the person who submitted the request (to identify request in conversation with the PACS team)?

Upload the Excel file with Accession numbers that was attached to the ServiceNow ticket.

Upload file

Expected Project Start Date

M-D-Y

Expected Project End Date

M-D-Y

The primary principal investigator will receive an invitation to acknowledge our terms of service, create a list of study personnel to add to the project, and confirm de-identification needs.

Primary Principal Investigator Email:

* must provide value

Principal Investigator Email:

What type(s) of Image Modality (check all that apply)

Computed Tomography

Echocardiography

Magnetic Resonance

Positron emission tomography (PET)

Ultrasound

Digital Radiography

Computed Radiography

X-Ray Angiography

Radio Fluoroscopy

Other

Other Modality type:

Do you need to keep other administrative data modalities (e.g. KO, SR, PR, DOC modalities)?

Yes

Unsure

reset

Please provide relevant details on your data acquisition workflow: from where the data will be sent (PACS, Station Names and Locations), is data collected during standard of care exams, etc.

* must provide value

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.