VirtuTRAX End User
*
1.
Country
(Required.)
2.
Facility
*
3.
Product(s) Used
(Required.)
Tracking bracket
General purpose sensor
Tracking bracket with guidance
Endocavity tracking bracket
VirtuTRAX™
4.
Item Number(s) Used
*
5.
Procedure(s) Performed
(Required.)
Core biopsy
Radiofrequency ablation (RFA)
Microwave ablation
Cryoablation
Other (please specify)
*
6.
Anatomy Targeted
(Required.)
Abdomen
Pelvis
Liver
Kidney
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 VirtuTRAX set-up in the clinical setting.
1-Low Satisfaction
2
3
4
5-High Satisfaction
Comment
Based on product design, rate the ease of use of VirtuTRAX during the procedure.
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
Rate your satisfaction with VirtuTRAX device tracking during the procedure.
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 virtual tip tracking device?
No
Yes (if yes, please explain in Comment box below)
Comment
9.
Which ultrasound cover was used on the transducer during the procedure?
CIV-Flex™
PEELSafe Advantage™
Envision™
Polyethylene
Surgi-Tip™
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.
