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Human MRI Research Project Application Form
Human MRI application
Before submitting a new project, please read the respective infrastructure usage fees and access policies at
this link.
Thank you for your interest in contributing to the CIBM community.
Agreement
*
I have read the infrastructure access policy and guidelines and I understand the fee structure associated to this project application.
I have read the 7T collaboration policy.
Principal Investigator information
Principal Investigator first name
*
Principal Investigator last name
*
Principal Investigator's e-mail
*
PrincipaI Investigator's phone number
*
PI's Institution
*
CHUV
UNIL
EPFL
UNIGE
HUG
Other
PI's Institution
PI's Laboratory/Unit
*
If Applicant is not PI
Applicant first name
Applicant last name
Applicant's E-mail
Applicant's phone number
Resource information
Please select resources requested
*
0.55T MRI, CHUV
3T MRI, CHUV
3T MRI, HUG
3T MRI, UNIGE
7T MRI, Campus Biotech Geneva
Number of hours (0.55T MRI, CHUV RAD)
Number of hours (7T MRI, Campus Biotech HNP)
Number of hours (3T MRI, CHUV RAD)
Number of hours (3T MRI, HUG RAD)
Number of hours (3T MRI, UNIGE BBL)
Project Information
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Project Title
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Project Tag name (max 20 char)
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Project expected start date
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Project expected end date
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Funding source
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Funding start date
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Funding end date
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Number of extra persons needing booking access (calpendo)
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1
2
3
4
5
Number of extra persons needing booking access (calpendo)
Extra person 1
Extra person 1's email
Extra person 2
Extra person 2's email
Extra person 3
Extra person 3's email
Extra person 4
Extra person 4's email
Extra person 5
Extra person 5's email
Type of population
*
Patients
Healthy subjects
Other
Other
Population age range
*
Project type
*
Application
Development (CIBM Equipments)
Development (Section scientific objectives)
Pilot hours
Education
To be defined
Section scientific objectives :
Topics
Ethics information
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Ethics committee approval
*
Approved
Submitted
Not applicable
Name of ethics committee
Ethics committee document
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Project description
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minus4
Keywords that describe your project (separate with ,)
*
Background and significance
*
0
of 250 max words
Research plan
*
0
of 250 max words
Imaging protocol
*
0
of 250 max words
Approach to image data analysis
0
of 250 max words
Other comments
0
of 250 max words
Number of subjects to be studied (volunteers, patients)
Special requirements and services
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minus4
3T MRI, CHUV RAD
Training for operating scanner independently
Assistance with data acquisition
Assistance with data analysis
MR expert needed
Visual stimulation
Auditory stimulation
Tesla high end reconstruction server
Eye-tracker
Response buttons or trackball
Physiological measurements
Other requirements
Other requirements
0.55T MRI, CHUV RAD
Training for operating scanner independently
Assistance with data acquisition
Assistance with data analysis
MR expert needed
Visual stimulation
Auditory stimulation
Tesla high end reconstruction server
Eye-tracker
Response buttons or trackball
Physiological measurements
Other requirements
Other requirements
3T MRI, HUG RAD
Training for operating scanner independently
Assistance with data acquisition
Assistance with data analysis
MR expert needed
Visual stimulation
Auditory stimulation
Olfactory stimulation
Tactile/ Thermal/ Electrical stimulation
Eye-tracker
Physiological measurements Biopac
Other requirements
Other requirements
3T MRI, UNIGE BBL
Training for operating scanner independently
Assistance with data acquisition
Assistance with data analysis
MR expert needed
Visual stimulation
Auditory stimulation
Olfactory stimulation
Tactile/ Thermal/ Electrical stimulation
Eye-tracker
Physiological measurements biopac
Other requirements
Other requirements
7T MRI, Campus Biotech HNP
Training for data acquisition
Training for data analysis
CIBM Equipment (coils, EEG setup, etc..)
Other requirements
Other requirements
Billing
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minus4
Account number (if known)
Billing address of the PI
*
Billing address of the PI
Billing address of the PI
Billing address of the PI
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