MRI Safety Forms

 

Download and complete the forms as needed. If you need to amend the study and have used a previous version of the forms, please complete a new form. If you need to amend the study and have used the new form, make the changes and re-submit the form.

MRI Research using Human Subjects (DOCX)

 

MRI Research using Animals (DOCX)

 

Screening form for Research Subjects (PDF)

 

Gadolinium Use for Research Screening form (PDF)

 

Frequently asked questions about which forms to use for research using MRI at the Medical College of Wisconsin (MCW) are listed below. If you need further assistance or have questions please contact us.

 

 

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  Which form do I use if submitting an application for research using MRI with human subjects?

Complete this form MRI Research Using Human Subjects (DOCX) if you propose to use magnetic resonance imaging (MRI) or spectroscopy (MRS) as a research procedure on human subjects.

  Which form do I use if submitting an application for research using MRI with animal subjects?

Complete this form MRI Research Using Animals (DOCX) if you propose to use magnetic resonance imaging (MRI) or spectroscopy (MRS) on animals.

  How do I amend a research study using MRI and human or animal subjects?

See instructions at the top of the page to  amend your human or animal study.

  Which form do I use to screen human subjects or others before they enter the scanner magnet room?

Use this form to Magnetic Resonance Imaging (MRI) Screening Form for Research Subjects (PDF) properly investigate the potential safety risk of your subjects and others BEFORE entering the magnetic environment.

  What is a quick list of safety concerns for someone who needs to briefly enter the scanner magnet room?

Note: this quick checklist (PDF) is used only for individuals visiting the area briefly. Screening of human subjects and others who will be entering the scanner room and the scanner magnet MUST complete the Magnetic Resonance Imaging (MRI) Screening Form (PDF) for Research Subjects.

  What is the Medical College of Wisconsin policy if I want to use Gadolinium based contrast for research purposes only?

The established Gadolinium Use Policy (PDF) must be followed when administering contrast for research purposes only.

  What is the proper form to use for screening the health of subjects who will be receiving Gadolinium based contrast for research purposes?

The Gadolinium Use Screening form (PDF) must be completed and reviewed prior to administration of contrast media.

Contact MRI Safety

MRI Safety Training: Julie Peay, BSM, RTR, (MR) FSMRT

Chair, MRI Safety Committee: Andrew Nencka, PhD, Assistant Professor

MRI Safety Committee

MRIsafety@mcw.edu

Research MRI Safety Site Map

Medical College of Wisconsin
8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
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Page Updated 02/02/2016
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