CRF SURVEY ADMINISTRATOR PROTOCOL

DETECTING SILENT RUPTURE OF SILICONE GEL BREAST IMPLANTS UTILIZING HRUS

1. Enrollment Verification and Implant Information 
2. Pre-Scan Subject Survey
3. Ultrasound Technician Survey
4. Post Scan Subject Surveys (choose one)
   1. Post-Scan Subject Survey: NO Suspected Rupture (5a)
   2. Post Scan Subject Survey: Rupture Suspected (5b)
5. 3-Month Post Scan Telephone Survey