University of Wisconsin-Madison
The Waisman Laboratory for Brain Imaging and Behavior

Acquisition Strategy Request Form for 3.0T MR Imaging Projects

Principal Investigator:

Person to contact with questions (if other than PI):

Email address:

IRB # and title (if approved):

Study title:

Study Nickname (8 letters or less):

Number of proposed scan subjects:

Proposed start date:

Please limit your answers below to one or two short paragraphs.

Please describe the hypotheses that drive your experiment (what data are you hoping to collect and why?)

Statistical tests (what statistical tests are you planning to use to analyze your data?):

Paradigm design: please describe your experimental paradigm (block, event-related, rationale for your particular paradigm timing).:

Types of scans to collect (T1, T2, DTI, EPI, ASL, etc.)

Acquisition parameters (BOLD reps, echo time, flip angle, etc.):

What are your stimulus presentation plans?:

What peripheral measures do you plan to collect and what specific set-up requirements do
you anticipate (i.e., button box, goggles for stimulus presentation, skin conductance, respiration, eye tracking etc.)?:

Last updated: July 26, 2010