Brachytherapy Online Survey

Brachytherapy Online Survey...

      1. Do you currently perform prostate seed implants or are you
            planning on starting?
            Yes No Planning on starting: Month Year

        2. What equipment, accessories, and supplies will you be looking for?
             (Check all that apply).
             Stepper Stabilizer                    Implant Needles
             Needle Loading Accessories Seeds
             Stirrups                                    Seed Calibration Equipment
             Ultrasound                               Treatment Planning System

3. How many prostate seed implants do you perform per month?

4. When started, how many cases do you estimate monthly?

5. What type of procedures are you using or planning to use:
Planning in O.R. ("real time") Pre-Plan (Seattle)

6. Are you interested in learning more about 3-D gland modeling live
in the O.R.? Yes No

7. Planning in the O.R. is often considered a "real time" procedure. Is
this what you have also been lead to believe? Yes No

        8.  To be called "real time", the procedure should allow for reliable
             identification of all the implanted seeds and calculation of the
             resulting dose distribution to optimize the dosimetric coverage
             during the procedure. Do you agree? Yes     No
             Comments:

        9.  Are you currently performing or planning to perform cases with:
              Pre-Loaded Needles     Mick Applicator

             If Mick, would you load the magazines at:
              your facility    or utilize a loading service?

10. Would you see a benefit in loading magazines on-site, if a quick,
accurate means were available? Yes No

       11. What type of radioactive seeds are you currently using?
             I-125     Pd-103     Combination. If so, what percentage
             do you split?

12. Who is the manufacturer/distributor of your seeds?

       13. Are you satisfied with the price, service, and delivery from your
             current supplier of :
             Seeds? Yes   No          Needles? Yes   No

14. Would you consider another seed supplier? Yes No

15. What factors would affect your decision regarding a seed supplier?
(Check all that apply)

Delivery	Price		Customer Service
"One stop shopping"		Other

Comments:

       16. Regarding your prostate stepper/stabilizer, do you currently use a:
              Table Mount System     Floor Mount System
              Comments:

17. Does your current stabilizer system allow you to adjust the template
position to match the ultrasound? Yes No

       18. Are you satisfied with your current stepper/stabilizer system?
           Yes   No

              If no, would you like to try, at no charge, the Sure-Point system
              from Amertek Medical, Inc.?   Yes   No

19. How is your brachytherapy program marketed? (Check all that
apply)

Word of mouth	Yellow Pages
Hospital advertising	web site

20. If you have a web site, would you like to be linked to a prostate-
specific site? Yes No

21. Do you feel the Internet could help your program? Yes No

22. If you do not currently have a site for your program, would you be
interested in learning more about this opportunity? Yes No

Name:

Practice:

Address:

City:

State:

Zip Code:

Phone:

Fax:

E-mail:

Web Site:

For any additional information needed, contact us below:

Prostate Services of America, Inc.
2655 N. Ocean Drive Suite 405 ~ Singer Island, Fl. 33404
Toll free: 1-877-GET-I-125 0r 561-842-8900
Fax: 561-842-6660
E-mail: Info@prostateservices.com