UCI GCRC Neuroimaging-Radiologist Request Form

General Clinical Research Center, Neuroimaging Core
Neuroradiology Assessment of Research Images

The GCRC Neuroimaging Core provides UCI researchers who work with brain MRI scans the opportunity to consult with medical Neuroradiologists at the Medical Center to find out if an incidentally discovered concern warrants formal clinical follow up. To do so, images must be either DICOM format or ANALYZE format and uploaded to the Neuroimaging server with the proper requested information. If you have both, please upload only the DICOM format, as this is more preferable.

For DICOM images, ensure that all individuals images are zipped together. (Click here for zipping instructions.)
For ANALYZE images, ensure that both the *.img and *.hdr are uploaded.

Fill out the following information with the proper contact information and all of the top 6 fields regarding the nature of the request. Depending on the file format, choose the proper upload method to load the image file. Check the box verifying that this is not to be used as a contractual medical diagnosis and submit. Upon completion, an e-mail will be sent to the address supplied in the contact information that the upload was successful.

Upon approval by the Neuroimaging Core director, you will be notified by e-mail that the request has been accepted. This process usually takes between 1-2 business days. If approved, brain MRI images will be stripped of any confidential header information and sent to the UCI radiologist with the attached questions for examination. Please be aware at this point there may be delay in response depending on the radiologist's schedule. Once an answer has been received, you will be forwarded the comments.

Questionnaire and File Upload Form

UCI PI requesting neuroradiology opinion:

E-mail:

Name of study:

Study ID number for subject whose scan generated question (please do not include any identifying data such as subject name or medical record number):

Any background information you wish to share with the Neuroradiologist:

What is your question regarding the scan:


Zipped Dicoms :

or

ANALYZE *.hdr File
ANALYZE *.img File

Note that no contractural arrangement is generated here between the GCRC, the radiologist who will examine these films, the investigator, and the MRI subject. Opinions expressed as a result of the current request do not constitute a formal medical/clinical opinion.

I have read and understand the above statement and comply with the terms. I understand my IP address, 38.103.63.16, will be logged for security purposes.

Please click the button only ONCE. The upload process will take a while. Please be patient and wait for the confirmation screen.

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