Center for Imaging Research

Center for Imaging Research

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CIR Scanner Usage Form

NOTE:  IF THE PROTOCOL IS NOT LISTED, THE STUDY MAY NOT PROCEED.  INFORM THE RESEARCHER THAT THE INVESTIGATOR AGREEMENT AND STUDY INFORMATION FORMS MUST BE TURNED IN PRIOR TO SCANNER USAGE.
Select PI and Study
Researcher(s)
Study Type Human   Animal   Phantom
Consent Verified? Yes  No If no, explain:
Choose Scanner 3T Short Bore   3T Long Bore  
Scan  2 digit month  2 digit date  4 digit year     
Reservation Time Scheduled End Time Number of Hours Reserved
The reservation time and schedule end time are the same as the time blocked off on the calendar.
 
Actual Start Time Actual End Time Number of Hours Used
The actual start and end times include set-up and break down time.
 
Hours @ 100%
Hours @ 25% If 25% charge, explain:
Hours @ No Charge If no charge, explain:
Form Completed By:    
Notes:

 

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Page Updated 06/17/2013