Project feasibility - data requirements

Project feasibility - data requirements

If you would prefer not to submit via this form, you can instead email Sales@Segmed.ai with your project requirements to initiate a feasibility study.
Name*

First NameLast Name
Company Name
Email*
example@example.com
Please write a short (1-2 sentences) summary of your project, including the intended use of the data*
For example: We are creating an algorithm to detect lung nodules on CT scans in clinical practice. The data will be used for validation study of our algorithm for FDA submission.

Basic information
What imaging modality(ies) are required?*

X-rayCTMRMammographyUltrasoundEchocardiographyPET, PET/CT, or PET/MRFluorescenceOther
If you selected multiple imaging modalities above, do you require longitudinal view (e.g. X-ray followed by CT within the next 12 months)? If so, please describe your expectations.
Contrast?*

With oral contrastWithout oral contrastWith IV contrastWithout IV contrastOther

What manufacturer(s) are required?*

If you selected "required" for any manufacturers above, please describe any distribution requirements below.
For example: approximately equal distribution of GE Siemens
What body part(s) / anatomic coverage?*
How many studies do you need?*
Are there any requirements for Plane, Slice Thickness, Spatial Resolution, Reconstruction Kernel, or similar fields?*
Are there any requirements regarding the collection / data selection protocol?*
For example: cases must be sequentially selected, randomly selected, etc.

Inclusion and exclusion criteria
From which source geography(ies) will you accept data?*

AnywhereUnited StatesNorth America- otherEuropeSouth AmericaAsia / PacificAfricaOther
Do you require data from multiple regions within the geography(ies) selected, or is a single region acceptable? If multiple regions are required, how many regions and which ones?*

Patient demographics (inclusion criteria).

	No requirements	Yes, there are requirements (see below)
Patient Age
Patient Sex
Patient Race/Ethnicity

If you selected "Yes, there are requirements (see below)" for any of the patient demographics above, please describe.
For example: "Patient Age: Acceptable age range is 18-80"; "Patient Sex: Male only"; etc.
Please list your INCLUSION criteria, and whether each is required or 'nice to have'. This could include specific clinical and/or acquisition criteria, or any other details about what cases you want to include.*
Please list your EXCLUSION criteria, and whether each is required or 'nice to have'. This could include specific clinical and/or acquisition criteria, or any other details about what cases you want to exclude.*
Are there any Subgroups based on clinical criteria or need for having a Control group? If so, please describe.

Data format, contents, and delivery
What are the required deliverables?*

DICOM filesRadiology reportsPathology reportsNIfTI filesOther

Which of the following DICOM tags / headers / metadata do you need?*

	Required	Nice-to-have	Not needed
Patient Age
Patient Sex
Race/Ethnicity
Series Thickness
Series Description
Other (add details in the next question)

Are there any other specific DICOM tags / headers / metadata that are required? If so, please list the item and whether it is required, nice-to-have, or not needed.
Are there any other data requirements or details that would be helpful for us to know in order to assess feasibility and provide a detailed quote?
What is your approximate timeline for the project delivery?*
Note that the standard delivery timeframe for Concierge orders is 60 days post-contract signature.
What is your approximate budget (in USD)? *
You can list per case or the total budget for the volume you requested.
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform