AccuCARE Stepper, Stabilizer & Grids End User Question Title * 1. Country Question Title * 2. Facility Question Title * 3. Product(s) Used Classic Stepper EX3™ Stepper Stabilizer System Multi-Purpose Workstation Template grid 14GA Template grid 17/18GA System drape Question Title * 4. Procedure(s) Performed Cryotherapy HDR Brachytherapy LDR Brachytherapy SpaceOAR hydrogel placement Transperineal biopsy Other (please specify) Question Title * 5. Anatomy Targeted Prostate Pelvis Other (please specify) Question Title * 6. 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 product in the clinical setting. Based on product design, rate the ease of use of the product in the clinical setting. 1-Low Satisfaction Based on product design, rate the ease of use of the product in the clinical setting. 2 Based on product design, rate the ease of use of the product in the clinical setting. 3 Based on product design, rate the ease of use of the product in the clinical setting. 4 Based on product design, rate the ease of use of the product 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 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 N/A How well did the template grid aid in positioning and placement of devices? How well did the template grid aid in positioning and placement of devices? 1-Low Satisfaction How well did the template grid aid in positioning and placement of devices? 2 How well did the template grid aid in positioning and placement of devices? 3 How well did the template grid aid in positioning and placement of devices? 4 How well did the template grid aid in positioning and placement of devices? 5-High Satisfaction How well did the template grid aid in positioning and placement of devices? N/A Comment Question Title * 8. Based on your clinical expertise, do you believe there is added patient risk associated with the use of a template grid? No Yes (if yes, please explain in Comment box below) Comment Question Title * 9. Based on your clinical expertise, do you believe there is added patient risk associated with the use of a stepper stabilizer system? No Yes (if yes, please explain in Comment box below) Comment Question Title * 10. Did you use the stepper stabilizer system drape during this procedure? No Yes Question Title * 11. How well did the system drape serve as a barrier to prevent contamination of the stepper? (Rank satisfaction with 1 being the lowest and 5 being the highest) 1-Low Satisfaction 2 3 4 5-High Satisfaction N/A 1-Low Satisfaction 2 3 4 5-High Satisfaction N/A Comment Question Title * 12. Please provide your email address in order for CIVCO to respond to any concerns. Done
