SECTION I – PERSONAL DETAILS

Questions 1-5: Kindy fill in the blanks and encircle your answers as appropriate

1. Age:
2. Gender: (1) Male
(2) Female
3. Current Rotation:
4. Have rotated in the Department of Radiology: ___________ (indicate if on Loop 1 or Loop 2 of
rotation)
5. Year Graduating from Medical School: ____

SECTION II – RADIATION AWARENESS AND PROTECTION

Questions 6-11: Please encircle the box corresponding to your answer.

6. In your opinion, how is your knowledge level about ionizing radiation related risks?
4 3 2 1
Excellent Good Sufficient Insufficient

7. How often do you attend training events and/or refresher courses on radiation
protection?
3 2
4 Once Once 1
Annually every 2 every 5 Never
years years
8. How much is radiation and radiation protection relevant to your practice?
4 3 2 1
Very Sometimes Rarely Never
relevant relevant relevant relevant

9. An on-the-job training/seminar on radiation safety and awareness is important and

relevant to your current training.
2
4 3 1
Disagree
Agree Agree Disagree
somewha
fully somewhat fully
t

10. I have been asked by my patients regarding radiation doses and risks.
4 3 2 1
Always Frequent Sometimes Never

11. I discuss radiation doses and risks with my patients being referred for imaging
procedures.
2
4 3 1
Sometime
Always Frequent Never
s
SECTION II – KNOWLEDGE ON RADIATION SAFETY
Questions 12-15: please encircle the box corresponding to your answer.

12. Which of the following patients is the most sensitive to ionizing

radiation?
a. 1 year old male
b. 1 year old female
c. 40 year old male
d. Ionizing radiation damage risk is unrelated to patient’s age and sex

13. Which of the following professionals are more likely to be exposed to

ionizing radiation because of their job?
a. Nuclear medicine physicians
b. Radiographers
c. Interventional radiologists and cardiologists
d. Non-interventional radiologists

14. Which of the following tissues is more susceptible to ionizing radiation-

related damage?
a. Breast
b. Bone
c. Liver
d. Muscle

15. There is scientific proof that radiation exposure has harmful effects on
patients / clinicians.
a. Yes, but only to patients
b. Yes, but only to clinicians
c. Yes, to both patients and clinicians
d. No, there is no scientific proof
SECTION III – RADIATION DOSE ASSESSMENT
Questions 16 & 17: please encircle the box corresponding to your answer.

16. Which is the average dose of radiation man is exposed to due to

background radiation?
a. < 0.01 mSv
b. 0.01 – 0.1 mSv
c. 0.1 – 1 mSv
d. 1 – 10 mSv
e. 10-100 mSv
f. >100 mSv

17. Which is the average dose of radiation for a PA chest radiograph?

a. < 0.01 mSv
b. 0.01 – 0.1 mSv
c. 0.1 – 1 mSv
d. 1 – 10 mSv
e. 10-100 mSv
f. >100 mSv

Questions 18-28: If a PA chest radiograph counts as 1 unit, how much is the

average dose of radiation due to the following imaging exams? (Tick the box
of your answer.) See Example.

(For example, if a non-contrast cranial CT scan exposes a patient to >100

times the radiation dose of a PA chest radiograph, then tick the box in the
column of >100.)

Imaging Procedure 0x 1-10x 10-50x 50- 100- >500x

 100x 500x

EXAMPLE ONLY Non-


contrast Cranial CT

18. Non Contrast

Abdominal CT

19. Triple phase

abdominal CT

20. Barium enema

21. Scout film of the

abdomen

22. Pelvic MRI

23. Whole abdominal

ultrasound

24. LGBPS ultrasound

25. Lumbar spine

radiograph

26. Conventional
Mammogram (bilateral, 2
projections each, i.e. 4
images in total)

27. Cerebral angiogram

28. Endoscopic retrograde

cholangiopancreatography
(ERCP)