Case Report Information
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
General Information
Participants
-
Sales Rep
-
Clinical Support Lead
- Alaine Keebaugh
- Craig Walters
- Eddie Kelly
- Geoffrey Bates
- Shruti Gupta
- Tim Goble
-
Other MRI members
General Information
-
Date
-
Scanner
-
Scanner Model
- GE 1.5 HDX and GE 3T
- GE 3T Signa HDX
- GE Excite HD
- GE HDW
- GE Signa 1.5 HD
- GE Signa iMRI
- GE Signa iMRI 3T
-
Scanner Model
-
Scanner Model
-
Scanner Model
-
Notes
-
Patient Position
-
Hospital
- Akon
- Baptist - Memphis
- Brainlab
- Brigham & Women
- Children Healthcare of Atlanta
- Cincinnati Children Hospital
- Cleveland Clinic Hospital
- Cook Children Medical Center
- Emory Healthcare
- Geisinger
- Glenbrook
- Hackensack Univ. Medical Center
- Henry Ford Health Sys
- Joan and Stanford Weill Medical College
- John Hopkins (Research)
- Lebonhuer (Memphis)
- Loyola
- Mayo
- MD Anderson Cancer Center
- Memorial Sloan-Kettering Cancer Center
- Methodist Hospital
- NBR
- Northwestern Memorial
- NY Psychiatric Institute
- Ohio State University
- Oregon Health & Science University
- Robert Wood Johnson
- Spectrum
- Swedish
- Thomas Jefferson
- Tocagen
- UCLA
- UCSD
- UCSF Medical Center
- UMASS Medical Center
- University of Colorado
- University of Utah
- University of Wisconsin
- UPMC
- UT San Antonio
- UVA
- VA - San Francisco
- Valley Biosystem, Inc.
- Wake Forest
- Willis Knighton
- Yale University
-
Software Version
-
Type of Procedure
- Abliation
- Biopsy
- CED
- DBS
- Drug Delivery
- Visualase
-
Surgeon
-
MRI Tech
-
Target
- Brainstem
- GPI
- Hippocampus
- Putament
- STN
- Tumor
-
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
- X Value
- Y Value
- 2D radial error
-
Actual Error
-
Trajectory View
- X Value
- Y Value
- 2D radial error
-
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
- X Value
- Y Value
- 2D radial error
-
Actual Error
-
Trajectory View
- X Value
- Y Value
- 2D radial error
-
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?
