Endocavity Standoff End User Question Title * 1. Country Question Title * 2. Facility Question Title * 3. Product Used Endocavity standoff Question Title * 4. Item Number(s) Used Question Title * 5. Procedure(s) Performed Cryotherapy HDR Brachytherapy LDR Brachytherapy SpaceOAR hydrogel placement Transperineal biopsy Other (please specify) Question Title * 6. Anatomy Targeted Prostate Pelvis Other (please specify) Question Title * 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 standoff in the clinical setting. Based on product design, rate the ease of use of the standoff in the clinical setting. 1-Low Satisfaction Based on product design, rate the ease of use of the standoff in the clinical setting. 2 Based on product design, rate the ease of use of the standoff in the clinical setting. 3 Based on product design, rate the ease of use of the standoff in the clinical setting. 4 Based on product design, rate the ease of use of the standoff in the clinical setting. 5-High Satisfaction Comment How satisfied are you with the quality of this product? How satisfied are you with the quality of this product? 1-Low Satisfaction How satisfied are you with the quality of this product? 2 How satisfied are you with the quality of this product? 3 How satisfied are you with the quality of this product? 4 How satisfied are you with the quality of this product? 5-High Satisfaction Comment How well did the standoff aid in positioning the prostate compared to expectations? How well did the standoff aid in positioning the prostate compared to expectations? 1-Low Satisfaction How well did the standoff aid in positioning the prostate compared to expectations? 2 How well did the standoff aid in positioning the prostate compared to expectations? 3 How well did the standoff aid in positioning the prostate compared to expectations? 4 How well did the standoff aid in positioning the prostate compared to expectations? 5-High Satisfaction Comment Question Title * 8. Based on your clinical expertise, do you believe there is added patient risk associated with the use of this product? No Yes (if yes, please explain in Comment box below) Comment Question Title * 9. Please provide your email address in order for CIVCO to respond to any concerns. Done
