QIDW Contributor Request

2. Dataset information

Data Set Title

Brief Description (include # of studies, # of images/study, # of subjects available, modality, anatomical sites. Please note that secondary data capture of PHI are not acceptable.)

How does this have relevance to QIBA (e.g., does your data align with any QIBA Profiles, Biomarker Committee or Task Force efforts)?

Are the data in DICOM format?

Yes

Total File Upload Size

Total Number of Images

Total Number of Image Series

Does this data currently exist in another database?

Yes

If yes, is it publicly available?

Yes

Metadata Description (e.g., clinical data, pathology data, outcomes data, phantom and DRO image acquisition details, etc.)

Please describe restrictions or requirements for Data Analysis and/or Results Reporting Software (e.g., necessary DICOM fields for processing)

Funding Agency (if applicable)

Other Relevant Data or Supporting Information

4. Does the data set contain Clinical Scans?

Yes

If you answered yes:

Has IRB approval or waiver been obtained?

Yes

Have the clinical scans been de-identified?

Yes

De-identification format

If other than all, Please specify which data fields have been retained

Terms and Conditions

Contributor Agreement for Clinical Data

Contributor Agreement for Non-Clinical Data

I understand that in addition to this form, I must complete, print and sign the appropriate Contributor Agreement

The Quantitative Imaging Data Warehouse (QIDW) Contributor Request

1. Upload of data set is requested by:

2. Dataset information

3. The data set will be publicly available unless specified below.

4. Does the data set contain Clinical Scans?

Terms and Conditions