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Pre-Clinical Imaging Research Project Application Form
Preclinical 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 facility/infrastructure access policy and guidelines and I understand the fee structure associated to this project application.
Principal Investigator information
Principal Investigator first name
*
Principal Investigator last name
*
PI's E-mail
*
PI's phone number
*
Institution
*
CHUV
UNIL
EPFL
UNIGE
HUG
Other
Institution
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
*
9.4T MRI, EPFL AIT
14.1T MRI, EPFL AIT
PET, EPFL AIT
PET, HUG PIPPA
Read the access policies
Number of hours (9.4T MRI, EPFL AIT)
Number of hours (14.1T MRI, EPFL AIT)
Number of hours (PET, EPFL AIT)
Number of hours (PET, HUG PIPPA)
Project Information
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Project Title
*
Project Tag name (max 20 char)
*
Project expected start date
*
Project expected end date
*
Funding source
*
Funding start date
*
Funding end date
*
Number of extra persons needing booking access (calpendo)
*
0
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
Authorization number for animal experiments
*
Number of animals or ex vivo samples requested
*
Project type
*
Application: in-vivo
Application: ex-vivo (phantoms/solutions/organs)
Development: in-vivo
Development: ex-vivo (phantoms/solutions/organs)
Development (CIBM Equipment)
Development (Section scientific objectives)
Pilot hours
Education
To be defined
Section scientific objectives :
Topics
Ethics information
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minus4
Ethics committee/animal authorisation
*
Approved
Submitted
Not applicable
Name of ethics/authorisation committee
Ethics committee document/Forms A, AB
Drop file(s) here or click to upload
Choose File
Maximum file size: 20MB
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
Special requirements and services
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minus4
9.4T/14.1T MRI, EPFL AIT
MR expert needed
Operator service (upon agreement)
Assistance with data analysis
Preparation of phantoms or ex-vivo
Usage of the bench
Vet needed for animal monitoring
Vet needed for surgery before MRI scans
Specific surgeries or cares/follow-up/scoring before or after MRI experiments including the training from the veterinary team at CIBM.
Assistance during processing of the data or preparation of phantoms or ex-vivo samples for MRI/MRS.
Development of a new Acquisition Protocol based on a scientific question and requested by a PI.
Other
Other
PET, EPFL AIT
Assistance with data analysis
Vet needed for animal monitoring
Vet needed for surgery before MRI scans
Other requirements
Other requirements
PET, HUG PIPPA
Training for operating scanner independently
Assistance with data acquisition
Assistance with data analysis
MR expert needed
Vet needed for animal monitoring
Vet needed for surgery before MRI scans
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
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
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American Samoa
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Heard Island and McDonald Islands
Holy See
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Hungary
Iceland
India
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Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Poland
Portugal
Puerto Rico
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Reunion
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Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
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Samoa
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Saudi Arabia
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Slovakia
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Somalia
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South Georgia and the South Sandwich Islands
South Korea
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Vanuatu
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Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
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