X-ray Technicians -- Second survey

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

16. **In what years did you begin TRAINING and/or WORKING with medical
    radiation procedures?**

Ο Never trained Ο Never worked

Ο Began training in \_\_\_\_\_\_\_ Ο Began working in year
\_\_\_\_\_\_\_

17. In total, how many years have you TRAINED and/or WORKED with medical
    radiation procedures? Exclude years when you were not personally
    working or assisting with medical radiation procedures for patient
    care. If none, record " 00 " and go to next section.

> **\|\_\_\_\|\_\_\_\|** NUMBER OF YEARS

18. For each of the following time periods, please indicate how many
    years you TRAINED and/or WORKED with medical radiation procedures.
    If none, record " 00".

> NUMBER OF YEARS
>
> Before 1950 \|\_\_\_\|\_\_\_\|
>
> 1950's \|\_\_\_\|\_\_\_\|
>
> 1960's \|\_\_\_\|\_\_\_\|
>
> 1970's \|\_\_\_\|\_\_\_\|
>
> 1980's \|\_\_\_\|\_\_\_\|
>
> 1990 or later \|\_\_\_\|\_\_\_\|

19. In what year did you stop TRAINING and/or WORKING with medical
    radiation procedures?

> Ο Currently working (GO TO THE NEXT SECTION)
>
> Ο Stopped training and/or working → YEAR STOPPED
>
> 19 \_\_\_\_\_\_\_\_\_\_\_

20\. What is your LIFETIME TOTAL RADIATION EXPOSURE received while
working in the field of medical radiation?

> (1000 mrad = 1 rad = 1 rem = 1 cGy = 10mSv)

Ο None (GO TO THE NEXT SECTION)

Ο \< 1,000 mrad

Ο 1,000 -- 4,999 mrad

Ο 5,000 -- 9,999 mrad

Ο 10,000 -- 24,999 mrad

Ο 25,000 -- 49,999 mrad

Ο  50,000 mrad

Ο Don't know (GO TO THE NEXT SECTION)

21. Is your answer estimated or taken from your dosimetry reports?

Ο Estimated

Ο Taken from dosimetry reports

Ο Combination of both

22. While working in the field of medical radiation, about how many
    times were you removed from receiving additional radiation exposure
    for any length of time because you reached your exposure limit?

> Ο None
>
> Ο 1
>
> Ο 2 -- 4
>
> Ο 5 -- 9
>
> Ο 10+
>
> Ο Don't know

23. About how many times has your WHITE BLOOD CELL COUNT been depressed
    below normal as a result of working in the field of medical
    radiation?

> Ο None
>
> Ο 1
>
> Ο 2 -- 4
>
> Ο 5 -- 9
>
> Ο 10+
>
> Ο Don't know
>
> Ο Never tested

24. Please indicate how frequently you worked or assisted on a regular
    basis with each of the following procedures during the specified
    calendar years. If you never worked with a particular procedure,
    mark the box for "Never worked with" and leave all other columns
    blank for that procedure.

<table>
<colgroup>
<col style="width: 18%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 6%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="2">PROCEDURES YOU WORKED WITH</td>
<td rowspan="2"><p>Never</p>
<p>worked</p>
<p>with</p></td>
<td colspan="4"><p>BEFORE 1980</p>
<p>FREQUENCY</p></td>
<td colspan="4"><p>1980 – 1989</p>
<p>FREQUENCY</p></td>
<td colspan="4"><p>1990 or later</p>
<p>FREQUENCY</p></td>
</tr>
<tr class="even">
<td colspan="4"><p>Never Monthly Weekly Daily or</p>
<p>rarely</p></td>
<td colspan="4"><p>Never Monthly Weekly Daily or</p>
<p>rarely</p></td>
<td colspan="4"><p>Never Monthly Weekly Daily or</p>
<p>rarely</p></td>
</tr>
<tr class="odd">
<td><p>Fluoroscopy</p>
<p>Dental X-ray</p>
<p>Routine Diagnostic X-rays</p>
<p>Multi-film Procedures (e.g,IVP)</p>
<p>Other Angiography</p>
<p>Portable X-ray</p>
<p>CAT or CT Scan</p>
<p>Interventional Radiography</p>
<p>Diagnostic Radionuclide</p>
<p>Diagnostic Ultrasound</p>
<p>External Beam Therapy (MeV)</p>
<p>Orthovoltage Therapy</p>
<p>Brachytherapy (radium or other)</p>
<p>Radioactive Iodine Therapy</p>
<p>Other Radionuclide Therapy</p>
<p>Microwave or Ultra- sound Diathermy</p>
<p>Mammography</p>
<p>MRI, Magnetic Reas- onance Imaging</p>
<p>Any other proce- dures, specify: ________________</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
<td><p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p>
<p>|_|</p></td>
</tr>
</tbody>
</table>

25. Please indicate how frequently you HELD PATIENTS during any X-ray,
    radionuclide, or radiotherapy procedures listed above during the
    specified calendar years. If you never held a patient during any
    procedure, mark the square for "Never held" and leave all other
    columns blank.

<table style="width:100%;">
<colgroup>
<col style="width: 10%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3">HELD PATIENTS</td>
<td rowspan="2"><p>Never</p>
<p>held</p></td>
<td colspan="4">BEFORE 1980 FREQUENCY</td>
<td colspan="4">1980 – 1989 FREQUENCY</td>
<td colspan="4">1990 or later FREQUENCY</td>
</tr>
<tr class="even">
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
</tr>
<tr class="odd">
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
</tr>
</tbody>
</table>

26. Please indicate how often you wore a LEAD APRON or stood behind a
    LEAD SHIELD while working or assisting with any procedure listed
    above during the specified calendar years. If you never used a lead
    apron or shield, mark the square for "never used" and leave all
    other columns blank.

<table style="width:100%;">
<colgroup>
<col style="width: 10%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3">USED LEAD APRON OR SHIELD</td>
<td rowspan="2"><p>Never</p>
<p>used</p></td>
<td colspan="4">BEFORE 1980 FREQUENCY</td>
<td colspan="4">1980 – 1989 FREQUENCY</td>
<td colspan="4">1990 or later FREQUENCY</td>
</tr>
<tr class="even">
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
</tr>
<tr class="odd">
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
</tr>
</tbody>
</table>

27. Please indicate how often you developed or processed X-RAY FILM
    during the specified calendar years. If you never developed or
    processed an x-ray film, mark the square for "Never processed" and
    leave all other columns blank.

<table style="width:100%;">
<colgroup>
<col style="width: 10%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3">X-RAY FILM PROCES-SING</td>
<td rowspan="2"><p>Never</p>
<p>proc-essed</p></td>
<td colspan="4">BEFORE 1980 FREQUENCY</td>
<td colspan="4">1980 – 1989 FREQUENCY</td>
<td colspan="4">1990 or later FREQUENCY</td>
</tr>
<tr class="even">
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
<td>Never or rarely</td>
<td>Monthly</td>
<td>Weekly</td>
<td>Daily</td>
</tr>
<tr class="odd">
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
<td>Ο</td>
</tr>
</tbody>
</table>