Ultrasound Location: UWMC ROOSEVELT HMC SCCA Specific Anatomical areas of interest (please select all apply): Radiologic Diagnostic Location: UWMC ROOSEVELT HMC SCCA Specific Anatomical areas of interest (please specify): Number of proposed subjects/years of study/scan per subject. Number of Subjects: Number of Number of Scans per Subject: Is the proposed procedure identical to a standard clinical protocol? If "No", please indicate the specific sequencing. (Feasibility review process will determine if identical to a standard protocol.) NO Please specify: YES Is the supplying pharmaceuticals or devices for this proposal? NO Please specify: YES Quality Control, Site Qualifications, or Image Data Management. Initial site evaluation form? No Yes Frequency Describe the specific procedures required. Who will perform this work? Are specific QC measures that must be done? No Yes Frequency How often must the QC be repeated? Does the QC need to be sent to another site? No Yes Frequency Will the images be collected and sent for review to a central imaging facility? No Yes If imaging data collected, what transmission media will be used? (e.g., CD, Flash drive, secure internet, etc.). Have you arranged for transfer of the imaging data? (Shipping, data transmission, etc.). Please specify: Are measurements of tumors, such as RECIST reads, required? Yes No (If yes, please contact Diane Guay at 206-598-9322 or for pricing and billing procedure)
Ultrasound Location: UWMC ROOSEVELT HMC SCCA Specific Anatomical areas of interest (please select all apply): Radiologic Diagnostic Location: UWMC ROOSEVELT HMC SCCA Specific Anatomical areas of interest (please specify): Number of proposed subjects/years of study/scan per subject. Number of Subjects: Number of Number of Scans per Subject: Is the proposed procedure identical to a standard clinical protocol? If "No", please indicate the specific sequencing. (Feasibility review process will determine if identical to a standard protocol.) NO YES Please specify: Is the supplying pharmaceuticals or devices for this proposal? NO YES Please specify: Quality Control, Site Qualifications, or Image Data Management. Initial site evaluation form? No Yes Frequency Describe the specific procedures required. Who will perform this work? Are specific QC measures that must be done? No Yes Frequency How often must the QC be repeated? Does the QC need to be sent to another site? No Yes Frequency Will the images be collected and sent for review to a central imaging facility? No Yes If imaging data collected, what transmission media will be used? (e.g., CD, Flash drive, secure internet, etc.). Have you arranged for transfer of the imaging data? (Shipping, data transmission, etc.). Please specify: Are measurements of tumors, such as RECIST reads, required? Yes No (If yes, please contact Diane Guay at 206-598-9322 or for pricing and billing procedure)
RRR-FORM-RV-03-03-16.docx