Age
< 20 years
20 - 30 years
31 - 40 years
41 - 50 years
51 - 60 years
> 61 years
Gender
Male
Female
Country
Select Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and The Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
What is your profession?
Healthcare Provider
Interventional Cardiologist
Interventional Radiologist
Nurse in cath lab
Radiologist Technician
Other
Do you regularly wear you collar radiation badge?
Always
Most of the time
Some of the time
Only occasionally
Never
Have you ever had to stop working in the cardiac catheterization or electrophysiology laboratory because of excessive radiation exposure limited by your radiation badge?
Yes
No
Have you ever initially not worn your radiation badge due to concerns that you will exceed your limit on radiation?
Yes
No
Do you routinely review your radiation exposure data?
Yes
No
How often do review your radiation exposure data?
Monthly
Quarterly
Bi-annually
Yearly
Do you wear thyroid collar?
Yes
No
Do you wear lead glasses?
Yes
No
Do you wear leg shields?
Yes
No
Did exposure to radiation influence your subspecialty choice within cardiology?
Yes
No
Please comment:
How many years have you been exposure to radiation? Include years in training
0 - 4
5 - 9
10 - 14
15 - 25
Over 25
Does your practice allow women in your laboratory to continue in the cardiac catheterization laboratory or electrophysiology laboratory during pregnancy?
Yes
No
To your knowledge are there any restrictions to women who are pregnant in your laboratory?
Yes
No
Please describe:
Do you have any health concerns related to radiation?
No
Cancer
Lymphoma
Leukemia
Blood count abnormalities
Eye problems/cataracts
Other
Have you ever experienced any cancers?
Yes
No
Which of the following cancer (select all that apply):
Breast Cancer
Brain Cancer
Colon Cancer
Prostatic Cancer
Skin Cancer
Lymphoma
Leukemia
Thyroid
Concerning colon, breast, brain and prostatic cancer, please specify :
Left
Right
Do you have any other health problems related to radiation and/or cath lab?
No
Blood count abnormalities
Eye problems/cataracts
Back or neck problems
Hip problems
Varicose veins
Other
Please describe your previous answer
Do you have children?
Yes
No
How many children did you have?
1
2
3
4
> 5
How many:
5
6
7
8
9
10
What are their ages?
First child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
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30
31
32
33
34
35
36
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40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Second child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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25
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31
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46
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49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Third child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
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25
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27
28
29
30
31
32
33
34
35
36
37
38
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40
41
42
43
44
45
46
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48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Fourth child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
More:
Fifth child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Sixth child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Seventh child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
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48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Height child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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25
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30
31
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34
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45
46
47
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49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Ninth child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Tenth child:
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
Did you continue to perform procedures after you discovered you were pregnant?
Yes
No
If no, from what week of pregnancy did you stop performing procedures?
select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Why did you do procedures during your pregnancy?
I had kids before I worked with radiation exposure
I intentionally stayed out of the lab throughout pregnancy
I intentionally stayed out of the lab during my first trimester due to radiation concerns
I stayed out of the lab at the end of my pregnancy due to anatomic limitations
I did not change my practice due to my pregnancy
Did you reduce your commitment?
No, I continued to work in the cath lab as normal.
I reduced my commitment by < 50%
I reduced my commitment by > 50%
During the first 20 weeks of pregnancy, on average, approximately how many hours did you spend in the cath lab performing procedures:
< 4 hours per week
4 - 8 hours per week
8 hours per week
During the last 20 weeks of pregnancy, on average, approximately how many hours did you spend in the cath lab performing procedures:
< 4 hours per week
4 - 8 hours per week
8 hours per week
Did you declare your pregnancy to your institution?
Yes, first trimester
Yes, second trimester
Yes, third trimester
No
Did you have any miscarriages?
Yes
No
Did you have any children born with any congenital issues?
Yes
No
Please describe your previous answer
Any children with childhood cancers?
Yes
No
Please describe your previous answer
Did you use any special protection from radiation during pregnancy?
Double lead apron
Pregnancy apron
Other
Please describe:
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www.cerc-europe.org
