MRI Acquisition Strategy Request Form

Lane Neuroimaging Lab MRI Acquisition Strategy Request Form

Study Information
Principal Investigator*
First Last
Contact Person (if other than PI):
First Last
Primary Contact Email*
IRB # and Study Title:*
Study Nickname*
(limited to 8 characters or less)
Number of proposed scan subjects*
Proposed start date:*
MM slash DD slash YYYY
Please limit your answers below to one or two short paragraphs:
Please describe the hypotheses that drive your experiment, i.e. what data are you hoping to collect and why.*
What statistical tests are you planning to use to analyze your data?*
Please describe your experimental paradigm (block, event-related) and your rationale for your particular paradigm timing.*
If you have questions, please contact us at researchmri@psychiatry.wisc.edu
Please describe the type of scans you plan to collect (T1, T2, DTI, DPI, ASL, etc.)*
If you are not sure, please contact us at researchmri@psychiatry.wisc.edu
Please describe your acquisition parameters (BOLD reps, Echo time, Flip Angle, etc.)*
If you are not sure, please contact us at researchmri@psychiatry.wisc.edu
What are your stimulus presentation plans?*
What peripheral measures do you plan to collect and what specific set-up requirements do you anticipate (Button Box, Eye Tracker, Skin Conductance, Respiration Data)?*
If you are not sure, please contact us at researchmri@psychiatry.wisc.edu

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Study Information