PROTOCOL SPECIFIC MATERIALS
6684 PROTOCOL ACTIVATION AND APPLICATION MATERIALS Minimize

For an overview of ACRIN application process, click here

Protocol Specific Application (PSA)
Each site interested in participating must complete the PSA. ACRIN 6684 PSA form [DOC]

Modality-specfic Quality Assurance (QA) Questionnaire

Sites that do not have ACR accreditation for the PET/CT scanner or the MRI scanner to be used for scanning trial participants must submit a QA questionnaires for both imaging modalities with the PSA. A site’s application will not be reviewed unless either ACR accreditation is documented in the PSA or the required PET/CT and MRI QA questionnaires are submitted. 

PET QA Questionnaire [DOC]

Other Forms
 
Forms Required Prior to Site Activation

FDA Form 1572 [DOC]

Case Reimbursement Schedule [PDF]

User Registration for Web-based Data Entry

All site study related personnel should request an individual Login Name and Password if they will be registering patients or entering accrued patient data on the ACRIN website.  A Reader ID should be obtained for all Radiologists that will participate and/or read study related images.  The ACRIN Login Name and Password should not be shared with other study site personnel.

An ACRIN Login Name and Password or Reader ID can be obtained using the link below:
User Registration for Web-based Data Entry [External Link]


Protocol Activation Checklist
 
This checklist is intended to inform site research personnel about all of the requirements necessary (applications, imaging requirements, training etc.) for a site to activate the ACRIN 6684 protocol.  Check List [DOC]
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