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    • Science
    • QIDW Contributor Request Form

    • Quantitative Imaging Data Warehouse (QIDW) logo

      1) Upload of data set is requested by:

       
      * Full Name:
      * Affiliation:
      * Email Address:
      * Position/Role:

      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?
                            
      * Total File Upload Size:
      * Total Number of Images:
      * Total Number of Image Series:  
      * Does this data currently exist in another database?
       
                              
      If yes, is it publicly available?  
                              
      * 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:  

      3) The data set will be publicly available unless specified below. Do you wish to restrict access to the data set?

      *4) Does the data set contain Clinical Scans?

                   

      If you answered yes:

      * Has IRB approval or waiver been obtained?
                              

      * Have the clinical scans been de-identified?
                              

       * 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


      * Required