X-ray Technicians -- Second survey

[X-ray and other radiation exposures (personal history)]{.underline}

28. Please indicate how frequently you had any of the following
    DIAGNOSTIC PROCEDURES during the specified calendar years. If you
    never had a particular procedure, mark the box for "Never had" and
    leave all other columns blank for that procedure. Please count the
    number of times you had a procedure, NOT the number of individual
    films taken.

Ο I have not had any of the procedures listed below (GO TO QUESTION 29)

<table>
<colgroup>
<col style="width: 34%" />
<col style="width: 8%" />
<col style="width: 4%" />
<col style="width: 4%" />
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<col style="width: 4%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"><p><strong>PROCEDURES</strong></p>
<p><strong>PERFORMED ON YOU</strong></p></td>
<td rowspan="2"><h1 id="never-had">NEVER HAD</h1></td>
<td colspan="4"><p><strong>Before 1980</strong></p>
<h3 id="number-times">NUMBER TIMES</h3></td>
<td colspan="4"><p><strong>1980-1989</strong></p>
<h3 id="number-times-1">NUMBER TIMES</h3></td>
<td colspan="4"><p><strong>1990 or later</strong></p>
<h3 id="number-times-2">NUMBER TIMES</h3></td>
</tr>
<tr class="even">
<td><strong>0</strong></td>
<td><strong>1</strong></td>
<td><strong>2-4</strong></td>
<td><strong>5+</strong></td>
<td><strong>0</strong></td>
<td><strong>1</strong></td>
<td><strong>2-4</strong></td>
<td><strong>5+</strong></td>
<td><strong>0</strong></td>
<td><strong>1</strong></td>
<td><strong>2-4</strong></td>
<td><strong>5+</strong></td>
</tr>
<tr class="odd">
<td><p>Upper gastrointestinal (GI) series</p>
<p>Barium swallow</p>
<p>Barium enema</p>
<p>Cholecystogram or cholangiogram</p>
<p>Retrograde or intravenous pyelogram</p>
<p>Renal arteriogram</p>
<p>Urethrogram or cystogram</p>
<p>Multi-film procedure, other than above</p>
<p>Angiogram, other than above</p>
<p>Fluoroscopic procedure,</p>
<p>other than above</p>
<p>CAT or CT scan</p>
<p>MRI procedure</p>
<p>Skull x-ray</p>
<p>Cervical spine x-ray</p>
<p>Sinus x-ray</p>
<p>Head/neck x-ray, other than above</p>
<p>Collarbone x-ray</p>
<p>Shoulder x-ray</p>
<p>Rib x-ray</p>
<p>Thoracic spine x-ray</p>
<p>Lumbar spine x-ray</p>
<p>Lumbosacral spine x-ray</p>
<p>Abdomen x-ray</p>
<p>Kidney/ureter/bladder x-ray</p>
<p>Pelvis x-ray</p>
<p>Extremities (arms, legs) x-ray</p>
<p>Mammography x-ray</p></td>
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</tr>
</tbody>
</table>

29. **Please indicate how frequently you had DENTAL OR CHEST X-RAYS
    during the specified calendar years. If you never had a particular
    procedure, mark the square for "Never had" and leave all other
    columns blank for that procedure. Please count the number of times
    you had a procedure, NOT the number of individual films taken.**

<table>
<colgroup>
<col style="width: 22%" />
<col style="width: 9%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 8%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2"><p><strong>PROCEDURES</strong></p>
<p><strong>PERFORMED ON YOU</strong></p></td>
<td rowspan="2"><h1 id="never">NEVER</h1>
<h1 id="had"> HAD</h1></td>
<td colspan="4"><p><strong>BEFORE 1980</strong></p>
<h2 id="number-times-3">NUMBER TIMES</h2></td>
<td colspan="4"><p><strong>1980-1989</strong></p>
<h2 id="number-times-4">NUMBER TIMES</h2></td>
<td colspan="4"><p><strong>1990 OR LATER</strong></p>
<p><strong>NUMBER TIMES</strong></p></td>
</tr>
<tr class="even">
<td><strong>0</strong></td>
<td><strong>1-9</strong></td>
<td><strong>10-24</strong></td>
<td><strong>25+</strong></td>
<td><strong>0</strong></td>
<td><strong>1-9</strong></td>
<td><strong>10-24</strong></td>
<td><strong>25+</strong></td>
<td><strong>0</strong></td>
<td><strong>1-9</strong></td>
<td><strong>10-24</strong></td>
<td><strong>25+</strong></td>
</tr>
<tr class="odd">
<td><p>Dental x-ray</p>
<p>Chest x-ray</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
<td><p>Ο</p>
<p>Ο</p></td>
</tr>
</tbody>
</table>

30. **As a PATIENT, have you undergone any RADIOTHERAPY procedures,
    including radium implants or other brachytherapy? Here, we are
    interested in procedures performed ON YOU, not those performed BY
    YOU.**

> Ο No (GO TO QUESTION 31)
>
> Ο Yes **→** Please indicate whether you [received]{.underline}
> radiotherapy to any of the following body areas for cancer or any
> other condition during the specified calendar years. If you did not
> receive radiotherapy during a specific time period, leave items under
> that column blank. If you never received radiotherapy to a particular
> body area, mark the square for "Never received" and leave all other
> columns blank for that body area.

+---------------+-------+--------------+--------------+--------------+
| **BODY AREA** | **Ne  | **Before     | **1980 -     | **1990+**    |
|               | ver** | 1980**       | 1989**       |              |
| **TREATED     |       |              |              | **For Not    |
| WITH**        | **    | **For Not    | **For Not    | for**        |
|               | recei | for**        | for**        |              |
| **R           | ved** |              |              | **Cancer     |
| ADIOTHERAPY** |       | **Cancer     | **Cancer     | Cancer**     |
|               |       | Cancer**     | Cancer**     |              |
+---------------+-------+--------------+--------------+--------------+
| Head or neck  | Ο     | Ο Ο          | Ο Ο          | Ο Ο          |
+---------------+-------+--------------+--------------+--------------+
| Shoulder      | Ο     | Ο Ο          | Ο Ο          | Ο Ο          |
+---------------+-------+--------------+--------------+--------------+
| Chest or      | Ο     | Ο Ο          | Ο Ο          | Ο Ο          |
| spine         |       |              |              |              |
+---------------+-------+--------------+--------------+--------------+
| Abdomen       | Ο     | Ο Ο          | Ο Ο          | Ο Ο          |
+---------------+-------+--------------+--------------+--------------+
| Pelvis        | Ο     | Ο Ο          | Ο Ο          | Ο Ο          |
+---------------+-------+--------------+--------------+--------------+
| Extremities   | Ο     | Ο Ο          | Ο Ο          | Ο Ο          |
+---------------+-------+--------------+--------------+--------------+
| Other,        | Ο     | Ο Ο          | Ο Ο          | Ο Ο          |
| specify:      |       |              |              |              |
|               |       |              |              |              |
| \_\_\_\_\_\   |       |              |              |              |
| _\_\_\_\_\_\_ |       |              |              |              |
+---------------+-------+--------------+--------------+--------------+

31. **As a PATIENT, have you undergone any NUCLEAR MEDICINE procedures?
    Here, we are interested in procedures performed ON YOU, not those
    performed BY YOU.**

> Ο No (GO TO THE NEXT SECTION)
>
> Ο Yes **→** Please indicate whether you [received]{.underline} any of
> the following radionuclides for a diagnostic or therapeutic reason
> during the specified calendar years. If you did not receive
> radionuclides during a specific time period, leave items under that
> column blank. If you never received a particular radionuclide, mark
> the square for "Never received" and leave all other columns blank for
> that radionuclide.

+------------+--------+---------------+---------------+---------------+
| **TYPE     | **N    | **Before      | **1980 -      | **1990+**     |
| OF**       | ever** | 1980**        | 1989**        |               |
|            |        |               |               | **For For**   |
| **RADI     | **rece | **For For**   | **For For**   |               |
| ONUCLIDE** | ived** |               |               | **Diagnosis   |
|            |        | **Diagnosis   | **Diagnosis   | Therapy**     |
|            |        | Therapy**     | Therapy**     |               |
+------------+--------+---------------+---------------+---------------+
| ^131^      | Ο      | Ο Ο           | Ο Ο           | Ο Ο           |
| Iodine     |        |               |               |               |
+------------+--------+---------------+---------------+---------------+
| ^125^      | Ο      | Ο Ο           | Ο Ο           | Ο Ο           |
| Iodine     |        |               |               |               |
+------------+--------+---------------+---------------+---------------+
| ^99m^      | Ο      | Ο Ο           | Ο Ο           | Ο Ο           |
| Technecium |        |               |               |               |
+------------+--------+---------------+---------------+---------------+
| ^201^      | Ο      | Ο Ο           | Ο Ο           | Ο Ο           |
| Thallium   |        |               |               |               |
+------------+--------+---------------+---------------+---------------+
| Other,     | Ο      | Ο Ο           | Ο Ο           | Ο Ο           |
| specify:   |        |               |               |               |
|            |        |               |               |               |
| \_\_       |        |               |               |               |
| \_\_\_\_\_ |        |               |               |               |
| \_\_\_\_\_ |        |               |               |               |
+------------+--------+---------------+---------------+---------------+
| Type       | Ο      | Ο Ο           | Ο Ο           | Ο Ο           |
| unknown    |        |               |               |               |
+------------+--------+---------------+---------------+---------------+