Attachment 2 Revisions and Additions to Previously Approved Questions

Attachment 2

Revisions and Additions to the Previously Approved U.S. Radiologic Technologists Study Radioisotope Procedures Questionnaire for the U.S. Nuclear Medicine Technologists Study Nuclear Medicine Procedures Questionnaire

OMB No. 0925-0656	U.S. Radiologic Technologists Study	OMB No. 0925-0656 Reinstatement with Revision Requested	U.S. Nuclear Medicine Technologists Study
Previously Approved Questions USRT Fourth Survey Radioisotope Procedures Questionnaire (Supplementary Document S1)		Revisions USNMT Nuclear Medicine Procedures Questionnaire (Attachment 1)
Study Title	U.S. Radiologic Technologists Study		U.S. Nuclear Medicine Technologists Study
Questionnaire Title	Radioisotope Procedures Questionnaire		Nuclear Medicine Procedures Questionnaire
Time Periods	1945-1964, 1965-1979, 1980-1989, 1990-1999, 2000-2009	All time period questions	<1980, 1980-1989, 1990-1999, 2000-2009, 2010-2016
Ever/Never Performed Procedures Q5, 15	How many TIMES per WEEK did you perform (procedure) in each time period?  Never (or NNN)	All procedure questions	Have you EVER performed or assisted with (procedure)?  No  Yes
PET-Brain Q5, next to last procedure	How many times per week did you perform All PET scans (Brain) with 18F-FDG in each time period? NNN	DP65	During each time period, how many total TIMES per WEEK did you usually perform or assist with PET scans (except cardiac) using 18F-FDG? NNN
PET-Other Q5, last procedure	How many times per week did you perform All PET scans except brain in each time period (using radioisotope)? 18F-FDG NNN 82Rb-chloride NNN	DP68 DP70	During each time period, how many total TIMES per WEEK did you usually perform or assist with Cardiac PET scans using 18F-FDG? NNN During each time period, how many total TIMES per WEEK did you usually perform or assist with Cardiac PET scans using 82Rb-chloride? NNN
All Other Questions			No changes

Previously Approved Questions USRT Fourth Survey General Questionnaire (Supplementary Document S2)		Revised Questions USRT Radioisotope Procedures Questionnaire (Attachment 1)
Q2	What is your DATE OF BIRTH? NN NN 19NN	GN2	What is your date of birth? DD/MM//YYYY
Q23	How many HOURS PER WEEK did you usually work during each time period? NN (no categories)	WH1	About how many HOURS per WEEK did you usually work in the field of nuclear medicine during each time period?  <20  20-29  30-35  36-44  45+  NA – did not work in nuclear medicine during this time
		Added Questions USRT Radioisotope Procedures Questionnaire (Attachment 1)
		GN1	What is your gender?  Male  Female
		WH2	What proportion of your time working in the field of nuclear medicine was spent on PATIENT CARE during each time period?  Less than 25%  25-49%  50-74%  75-100%

		WH3,5,7,9,11	Which of the following BEST describes the type of FACILITY you usually worked in (time period)?  University or other major medical center  General or community hospital  Outpatient imaging center or clinic  Physician office  NA – did not work in nuclear medicine during this time
		WH4,6,8,10,12	Was the facility you worked in (time period) a MILITARY facility?  No  Yes
		WH13	Which of the following BEST describes your JOB TITLE during each time period?  Staff technologist  PRN technologist  Chief technologist (clinical practice)  Chief technologist (administration)  Educator  Researcher  NA
		WH14	What is the name of your [current or most recent/next most recent] employer in the field of nuclear medicine?
		WH15	In what city and state [is/was] your [current or most recent/next most recent] employer in the field of nuclear medicine located?
		WH16a	What year did you FIRST work for this employer?
		WH16b	What year did you LAST work for this employer?
		WH17	Did you work for another employer in the field of nuclear medicine prior to this one?  No  Yes (WH14-WH16a repeated for each employer)