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MRI Scanner Protocol Template
Home
/
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/ MRI Scanner Protocol Template
Please make sure to also submit your project to the BMC
database
and complete your
safety training
.
Study Name:
*
PI:
*
Personnel:
*
Scanner
*
3T Prisma
PET/MR
Equipment
Which modality are you using?
*
PET Only (with MRI attenuation correction)
PET and MRI
MRI Only
Which coil do you use?
*
16 channel
20 channel
32 channel
64 channel
1 channel Tx/Rx
Flex
Spine
Which headphones do you use?
*
Innerear
Optoacoustics
Res Tech
Siemens
None
Do you use the Optoacoustics microphone?
*
Yes
No
Do you use the Opto noise cancelling feature?
*
Yes
No
What visual equipment do you use?
Goggles
LCD BOLDscreen
Do you use a camera?
*
Yes
No
Sometimes
What camera do you use?
*
Res Tech with the goggles
MREyes with the LCD
Do you collect physiological data?
*
Yes
No
What type of physiological data do you collect?
(Check all that apply)
*
Siemens Respiration
Siemens Pulse
Siemens ECG
Biopac Pulse Ox
Biopac GSR
Biopac Respiration
Other:
Which emergency squeeze ball/button do you use?
*
Res Tech on headphones
Siemens handheld
Do you use the trigger?
*
Yes
No
Which button box do you use?
*
1x4L
2x2
Two 1x4 curved
Joystick
Trackball
None
What setting do you use on the button box?
*
HID KEY BYGRT
HID KEY 12345
HID KEY NAR BYGRT
HID KEY NAR 12345
HID KEY No 5
Which computer do you use for stimuli?
(Check all that apply)
*
BMC Laptop
BMC Desktop
Group Laptop
No Stimuli
Do you use any additional non-BMC equipment?
Subject Setup
Which Radiopharmaceutical(s) will you be using?
*
What type of uptake?
*
Uptake outside the scanner
Uptake while scanning
Uptake during MRI sequences
Do you want the subject to wear a face mask during the scan?
*
Yes
No
No Preference
Do you play movies or music?
*
Yes, movies
Yes, music
Yes, movies and music
No
Which earplugs do you prefer?
*
Green
Yellow
No preference
Do not use earplugs
Do you use the weighted blanket?
*
Yes
No
Sometimes
Do you know how to pick out corrective lenses if required for your subject?
*
Yes
No
Do you use a fiducial marker?
*
Right Temple
Left Temple
No
Scanning
Do you need tech assistance?
*
Yes
No
Sometimes
Do you ever need an MRI tech to be your safety second?
*
Yes
No
Sometimes
How long is your scanning protocol?
*
How much session time do you schedule?
(must include setup, scanning and cleanup)
*
What type of MRI sequences do you run?
(Check all that apply)
*
Localizer
Autoalign
Standard BOLD
Multiband BOLD
Fieldmaps
T1 Structural
T2 Structural
Diffusion
Spectroscopy
ASL
MRI attenuation correction
Other:
Do you need to save TWIX or .RDA files?
*
Yes
No
Do you use any HCP/CMRR sequences?
*
Yes
No
Misc
Do you take blood pressure readings?
*
Yes
No
Do you perform blood draws at BMC?
*
Yes
No
Do you need to draw blood while inside the scanner?
*
Yes
No
Do you schedule familiarization sessions?
*
Yes
No
Which scanner do you use for familiarization sessions?
*
Prisma
Sonata
Both
Do you use the prep room?
*
Yes, prescan
Yes, post scan
Yes, pre and post scan
No
Do you administer any study medications and/or foods in the prep room or Prisma suite?
*
Yes
No
Is this an RDRC protocol?
*
Yes
No
Any other special needs we should know about?
Submitted by:
*
Contact Email:
*