Table 6.

Preoperative questionnaire

Patient code:	Date:
Do you consider the above-mentioned patient feasible for IORT?
□ yes
□ questionable (planning for IORT, but feasibility uncertain)
□ no
If no, why?
□ insufficient tumor–skin distance
□ large tumor cavity
□ a combination of both
□ others, please specify
Reporting physician (name, signature):