Case Report Information

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

General Information

Participants

  • Sales Rep

  • Clinical Support Lead

  • Other MRI members

General Information

  • Date

  • Scanner

  • Patient position

  • Hospital

  • Software Version

  • Type of Procedure

  • Surgeon

  • MRI Tech

  • Target

  • Fellow(s)

  • Uni or Bilateral

Procedure (If you want to add note for your answer, just double click on the border)

  • Clearpoint product used

  • Is the Surgeon/Fellow trained to use product with completed -0079?

  • Is there a defined workflow and checklist for this procedure?

  • Was the workflow and checklist used during the procedure?

  • Where there deviations from the workflow and checklist during this procedure?

  • Were there any MR related scan issues?

  • Were there any Software issues?

  • Were there any product complaints during the procedure?

  • What info is there to pass along for the next case?

  • Action items to address?

  • Was there any discussion on potential next case or new use of product?

Procedure

Time (military)

  • Patient arrived to the MRI suite

  • Anesthesia, Patient Asleep, Foley, etc.

  • Patient pinned

  • Marking grid/Incision

  • SmartFrame build complete

  • Trajectory planning complete

  • Alignment complete

  • Insertion complete

  • Therapy complete (if applicable)

  • Out of Room

Total Time

  • Patient IN to OUT of room

  • Patient pinned to insertion

  • Initial Scanning and entry point planning

  • Surgical Time from Incision to complete build

  • Scanning and Target replanning

  • Time for Alignment

  • Anesthesia Time

  • Time for Therapy

  • Closing and out of room

ClearPoint Data

Left Side

  • Projected Error

  • Trajectory View

  • Actual Error

  • Trajectory View

  • Was bias compensation used?

  • Did bias compensation work?

  • What was the final 2D radial error after compensation?

  • How did you rule out other factors in order to use bias compensation?

Right Side

  • Projected Error

  • Trajectory View

  • Actual Error

  • Trajectory View

  • Was bias compensation used?

  • Did bias compensation work?

  • How did you rule out other factors in order to use bias compensation?

  • What was the final 2D radial error after compensation?

  • How did you rule out other factors in order to use bias compensation?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.