Version 4: Radiology Cost Estimate Request

Please select the type of cost estimate you would like to request.

Please note:

It is the study team's responsibility to obtain Radiology procedure costs if they are required, by submitting the cost estimate request.

Regarding De-Identification: If imaging data is to be shared outside of Columbia, any scans performed with PHI must be de-identified through the Department of Radiology's De-identification Service, Rad De-identification. The de-identified images will be placed in a folder to which the requesting CRCs have access; the CRC will be responsible for data transfer. 

If you require a full cost estimate, please select the type of cost estimate review you will need.

1: Standard Cost Estimate Review - The PI and study team are responsible for entering the correct procedures
2: Enhanced Cost Estimate Review Service - A valid chartstring will be needed for this service.

Please enter information to the best of your knowledge as this will help speed up the review process.

What is the Total number of subjects?

if there are different arms or cohorts, write this separated by commas

Please provide a valid chartstring for the Enhanced Review service.
An invoice will be sent to your Department along with the Finalized Cost Estimate.

If chartstring is not yet available:

By completing this section, you are confirming that the invoice for Enhanced review can be sent at a later date to the study team.

I acknowledge that I will provide the chartstring for the Enhanced Review service as soon as it becomes available.
Enter Name and uni:
Print your name, or the name of your manager who will provide the chartstring.

If you require ONLY de-identification costs, and no other Radiology procedures costs.

Please select the scenario that fits your situation:

If this protocol was previously under a different IRB number and/or PI, please provide the previous IRB number and/or PI name here.

The expectation is that all studies using Radiology procedures require or already have a finalized cost estimate.

Please provide justification for NOT needing a full finalized cost estimate.

Please upload documentation (PDF'ed email from sponsor, imaging manual, or protocol) to indicate de-identification requirement for the study in the file upload below.

Please indicate the page number these details appear on.

Where were the scans for which you are requesting Safety Reads performed?

If scans were performed at an External location, provide the name of the location where the scans were performed

For Diagnostic CT scan Safety Reads:

How many safety reads are you requesting?

Write total per subject, and number of subjects

For Interventional Radiology scan Safety Reads:

How many safety reads are you requesting?

For Mammogram Safety Reads:

How many safety reads are you requesting?

For MRI Safety Reads:

How many safety reads are you requesting?

Write (total per subject), (number of subjects)

For Nuclear Medicine Safety Reads:

How many safety reads are you requesting?

For PET/CT Safety Reads:

How many safety reads are you requesting?

For Ultrasound scan Safety Reads:

How many safety reads are you requesting?

For X-ray Safety Reads:

How many safety reads are you requesting?

Please describe any additional details of the safety reads that you are requesting

CT Location - By default, we will provide costs for CU 168th St. (PET Center).

Please select ALL that apply.

CT at Kreitchman PET Center:
What is the total number of subjects?

CT at Kreitchman PET Center:
What is the number of visits per subject?

CT at Kreitchman PET Center:
What is the expected time period?

Provide the start date and end date (month and year) 

CT at NYPH:
What is the total number of subjects?

CT at NYPH:
What is the expected time period?

Provide the start date and end date (month and year) 

CT at CHONY:
What is the expected time period?

Provide the start date and end date (month and year) 

MR Location - By default, we will provide costs for CU 168th St. (Neuro Institute Basement).

Please select ALL that apply.

MRI at Neurological Institute Basement, NIB
What is the total number of subjects?

MRI at Neurological Institute Basement, NIB:
What is the number of visits per subject?

MRI at Neurological Institute Basement, NIB:
What is the expected time period?

Provide the start date and end date (month and year) 

MR at NYPH:
What is the total number of subjects?

MR at NYPH:
What is the number of visits per subject?

MR at NYPH:
What is the expected time period?

Provide the start date and end date (month and year) 

MR at CHONY:
What is the total number of subjects?

MR at CHONY:
What is the number of visits per subject?

MR at CHONY:
What is the expected time period?

Provide the start date and end date (month and year) 

PET CT - By default, we will provide costs for CU 168th St. (PET Center).

Research scans cannot be performed at other locations

PET/CT at Kreitchman PET Center:
What is the total number of subjects?

PET/CT at Kreitchman PET Center:
What is the number of visits per subject?

PET/CT at Kreitchman PET Center:
What is the expected time period?

Provide the start date and end date (month and year) 

If study is Industry Sponsored:

For  CT scans at CU PET Center, please select all that apply.
Note the prices have been simplified.

• all CT scans without contrast will have the same price
• all CT scans with contrast will have the same price
• all  CT scans with and without contrast will have the same price.

Do you require Non-industry prices for CT scans at CU locations?

(non-Industry is NIH, Foundation, IIT, Other etc)
Please select Yes or No

Non-Industry studies: for CT scans at CU PET Center 
Please choose all required body parts for CT scans without contrast

Non-Industry studies: for CT scans at CU PET Center 
Please choose all required body parts for CT scans with contrast

Non-Industry studies: for CT scans at CU PET Center 
Please choose all required body parts for CT scans with and without contrast

CT at CU Kreitchman PET Center: If an assessment read is needed, please choose one

----------------------------------------------------------------------------

For scans at NYP and/ or CHONY

How many body parts are required to scan?

For MRIs at Columbia University Neurological Institute Basement (NIB):

Choose all that apply

For Standard imaging MRI Scans at Columbia University location

NIB, 168th street (MRI Center at Neurological Institute Basement)
Note the prices have been simplified.

• all MRI scans without contrast will have the same price.
• all MRI scans with and without contrast will have the same price

Please check all that apply

For MRI scans at NIB 

How many body parts require MRI scans without contrast

For MRI scans at NIB, please indicate

How many body parts require MRI scans with and without contrast

MRI at CU location: If an assessment read is needed, please choose one:

For Non- standard of care (non- SOC) imaging MRI scans at Neuro Institute Basement (NIB, 168th street)

(Also referred to as Acquisition of Time, AOT scans)

Choose all that apply:

For MRI scans at NYP, CHONY:

How many body parts are required to scan?