omniTRAX End User
*
1.
Country
(Required.)
2.
Facility
*
3.
Product(s) Used
(Required.)
Tracking bracket
General purpose sensor
Tracking bracket with guidance
Endocavity tracking bracket
omniTRAX™ MR
omniTRAX™ CT
4.
Item Number(s) Used
*
5.
Procedure(s) Performed
(Required.)
Image registration
Fusion imaging with needle guided procedure
Other (please specify)
*
6.
Anatomy Targeted
(Required.)
Abdomen
Pelvis
Chest
Prostate
Thyroid
Other (please specify)
7.
Rate satisfaction on a scale of 1 to 5 (1 being the lowest level of satisfaction & 5 being the highest level of satisfaction)
1-Low Satisfaction
2
3
4
5-High Satisfaction
Based on product design, rate the ease of use of the product in the clinical setting.
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
How satisfied are you with the quality of this product?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
How satisfied are you with the use of the product to enable image registration compared to manual registration?
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
8.
Based on your clinical expertise, do you believe there is added patient risk associated with the use of this product?
No
Yes (if yes, please explain in Comment box below)
Comment
9.
Which ultrasound cover was used during the procedure?
NeoGuard™
CIV-Flex™
PEELSafe Advantage™
Envision™
Polyethylene
Surgi-Tip™
Latex
Not Applicable (N/A)
Other (please specify)
10.
How well did the ultrasound cover serve as a sterile barrier? (Rank satisfaction with 1 being the lowest and 5 being the highest)
1-Low Satisfaction
2
3
4
5-High Satisfaction
N/A
1-Low Satisfaction
2
3
4
5-High Satisfaction
N/A
Comment
11.
Please provide your email address in order for CIVCO to respond to any concerns.
