Endocavity Guidance End User
*
1.
Country
(Required.)
2.
Facility
*
3.
Product(s) Used
(Required.)
Reusable endocavity needle guide
Disposable endocavity needle guide
Quick-release endocavity needle guide
Dual-path endocavity needle guide
4.
Item Number(s) Used
*
5.
Procedure(s) Performed
(Required.)
Biopsy
Fiducial marker placement
Drainage or aspiration
Drain placement
Aspiration
Other (please specify)
*
6.
Anatomy Targeted
(Required.)
Prostate
Ovary
Uterus
Adnexa
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 needle guide during the procedure.
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
Based on product design, how well does the needle guide fit the transducer?
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 well did the guide enable in-plane needle guidance compared to expectations?
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 guidance product?
No
Yes (if yes, please explain in Comment box below)
Comment
9.
Which ultrasound cover was used during the needle guided procedure?
NeoGuard®
CIV-Flex™
Latex
System Drape
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
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
11.
Please provide your email address in order for CIVCO to respond to any concerns.
