MRI Safety Forms

If you know which form you need, you may download as needed.

MRI Research using Human Subjects (PDF)

MRI Research using Animals (PDF)

Amendment to MRI Protocol (PDF)

Screening form for Research Subjects (PDF)

Gadolinium Use for Research Screening form (PDF)

Implant or Device MRI Safety Conditional Exemption Request 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.

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

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

 Which form do I use if amending a research study using MRI and human or animal subjects?

Use this form (PDF) to add an amendment 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 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.

 Which form do I use to request an exemption for an implant or device?

You should submit the Implant or Device MRI Safety Conditional Exemption Request form (PDF) to the subcommittee of the MRI Safety Committee for review. See instructions on the form or contact MRISafety@MCW.edu for assistance.

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
Directions & Maps
© 2014

Page Updated 11/07/2014
Top