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Data Project Proposal to ICRN Data Committee
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Contact Information
First Name
Last Name
Phone
Title
Email Address
Institution
Years in current position
Supervisor / Mentor (optional; as relevant)
1. Specialty (select all that apply)
Basic Scientist
Medical Oncologist
Radiation Oncologist
Surgical Oncologist
Intervention Radiologist
Radiologist
Hepatologist
Gastroenterologist
Pathologist
Epidemiologist
Other (please specify)
2. Title of Project:
3.
Research Proposal Background: please describe the current state of the field related to your proposal, e.g., what is known about your topic of interest in cholangiocarcinoma, key questions outstanding, relevant findings from other cancer types (1-5 sentences):
4.
Research Proposal Objectives: please describe an overall question
and
hypothesis; up to 1 paragraph:
5.
Research Proposal Methodology: at a high-level, describe how you will address these objectives, e.g., what type of data will you be using, what will you be calculating, any comparators (1-5 sentences):
6.
Research Proposal References: list publications relevant to your proposal (up to 5):
7.
Research Team: describe your team and their roles, potential collaborators, etc; include name and institution for each:
8.
Desired Timeline for Completion:
9.
Publication Goal (check all that apply):
Manuscript
Conference (abstract / poster) - please specify which one(s)
Conference(s)
10. Data Sources Requested (check all that apply):
ICPR/Citizen (Medical Records Registry) Dataset
Komodo Healthcare Map (Claims) Dataset
Tempus Lens (Biomarkers + Medical Records)
Not sure
Other (please specify)
Other
11. Analytics Support Requested (check one):
11. Analytics Support Requested (check one):
No - I have the necessary capabilities and resourcing to complete this project upon receipt of the data.
Yes - I may need help with analytics (please specify, e.g., dataset formatting, queries, statistics).
Assistance Needed
12.
Funding Required (check one):
12. Funding Required (check one):
No
Yes (note: applicant is responsible for securing funding)
13.
Required Approvals (IRB) - to be confirmed during CCF Research Team discussion:
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