US state or territory where currently practicing/training/conducting residency: Outside US Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennesee Texas Utah Vermont Virgin Islands Virginia Washington (state) West Virginia Wisconsin Wyoming * If Outside the U.S., please specify the country:

Gender: Female Male *

Age:*

Race: Asian/Pacific Islander Black/ African American Caucasian/White Hispanic/Latino Other * If other, please list:

Level of training: Medical student Resident Attending Physician Assistant Nurse Practitioner Other *

Years: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21+ *

Specialty: Anesthesiology Dermatology Emergency Medicine Family Medicine Internal Medicine Neurology Obstetrics and Gynecology Ophthalmology Orthopaedics Otolaryngology/Head & Neck Surgery Pathology and Laboratory Medicine Pediatrics Psychiatry Radiation Oncology Radiology Surgery & Subspecialties

Previous Training in Radiology: Lectures Courses reading Continuing medical education classes Hours of Training in past 5 years: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21+ *

Previous Training in EKG Interpretation: Lectures Courses reading Continuing medical education classes Hours of Training in past 5 years: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21+ *

Self-rated Expertise in Following Fields (1=lowest to 5=highest):*

X-ray:

1 2 3 4 5

Ultrasound:

1 2 3 4 5

CT:

1 2 3 4 5

MRI:

1 2 3 4 5

EKG:

1 2 3 4 5

Fluoroscopy:

1 2 3 4 5

Your Institution (if any): None or OtherAlabama ------ University of Alabama at Birmingham Arizona ------ Maricopa Medical Center University of Arizona Arkansas ------ University of Arkansas California ------ Arrowhead Regional Medical Center Kern Medical Center University of California - Fresno Loma Linda University UCLA - Olive View-UCLA Emergency Medicine LAC/USC Medical Center Martin Luther King Hospital Highland General Hospital University of California, Irvine Medical Center University of California Davis Medical Center Naval Medical Center/San Diego Medical Center University of California, San Diego Stanford University/Kaiser Permanente Harbor-UCLA Medical Center Colorado ------ The Denver Health And Hospitals Connecticut ------ University of Connecticut Health Center Yale-New Haven Medical Center Delaware ------ Christiana Care Health System District of Columbia ------ Georgetown University George Washington University Florida ------ University of South Florida University of Florida - Jacksonville Orlando Regional Medical Center Georgia ------ Emory University Medical College of Georgia Illinois ------ Northwestern University University of Illinois at Chicago Cook County Hospital University of Chicago/Lutheran General Hospital Christ Medical Center University of Illinois College of Medicine at Peoria/OSF St. Francis Medical Center Resurrection Indiana ------ Indiana University Iowa ------ The Iowa Emergency Medicine Program Kentucky ------ University of Kentucky University of Louisville Louisiana ------ Louisiana State University - Baton Rouge Louisiana State University/Charity Hospital Louisiana State University Health Sciences Center - Shreveport Maine ------ Maine Medical Center Maryland ------ University of Maryland Johns Hopkins Massachusetts ------ Boston Medical Center Baystate Medical Center Beth Israel Deaconess Medical Center Harvard Affiliated University of Massachusetts Medical Center Brigham and Women's/Massachusetts General Hospital Michigan ------ University of Michigan Wayne State University/Detroit Medical Center Henry Ford Hospital Wayne State University/Sinai-Grace Hospital St. John Hospital and Medical Center Grand Rapids MERC/MSU Michigan State University - Kalamazoo Michigan State University - Lansing William Beaumont Hospital Synergy Medical Education Alliance Minnesota ------ Hennepin County Medical Center Mayo Clinic Regions Hospital/Healthpartners Institute of Medical Education Mississippi ------ University of Mississippi Missouri ------ University of Missouri - Kansas City/Truman Medical Center Washington University Nebraska ------ University of Nebraska New Jersey ------ Cooper Hospital/University Medical Center Atlantic Health System - Morristown Memorial Hospital Newark Beth Israel Medical Center UMDNJ - New Jersey Medical School New Mexico ------ University of New Mexico New York ------ New York Hospital Medical Center of Queens Maimonides Medical Center New York - Presbyterian Hospital Albany Medical Center Jacobi/Montefiore Emergency Medicine Program Affiliate of Albert Einstein College of Medicine The Brooklyn Hospital Center Lincoln Medical and Mental Health Center New York Methodist Hospital North Shore University Hospital State University of New York - Health Sciences Center at Brooklyn State University of New York at Buffalo Stony Brook University State University of New York Upstate Medical University Long Island Jewish Medical Center The Albert Einstein College of Medicine Residency Program/ Beth Israel Medical Center New York University/Bellevue Hospital Center St. Luke's-Roosevelt Hospital Center Metropolitan Hospital Center Mount Sinai School of Medicine Integrated Residency University of Rochester/Strong Memorial Hospital North Carolina ------ University of North Carolina Carolinas Medical Center Duke University Medical Center East Carolina University School of Medicine Wake Forest University Ohio ------ Akron General Medical Center Northeastern Ohio Universities (Neoucom)/Summa Health System University of Cincinnati Medical Center Case Western Reserve University/Metrohealth Medical Center The Ohio State University Wright State University St. Vincent Mercy Medical Center Oregon ------ Oregon Health and Science University Pennsylvania ------ Penn State University/Milton S. Hershey Medical Center Geisinger Medical Center Emergency Medicine Program Thomas Jefferson University Hospital/Emergency Medicine Albert Einstein Medical Center Drexel University College of Medicine Allegheny General Hospital University of Pittsburgh St. Luke's Hospital York Hospital / Pennsylvania State University University of Pennsylvania Emergency Medicine Residency Temple University Hospital Puerto Rico ------ University of Puerto Rico Rhode Island ------ Brown University South Carolina ------ Palmetto Richland Memorial Hospital Tennesee ------ Vanderbilt University Hospital Texas ------ Texas Tech University Darnall Army Community Hospital San Antonio Uniformed Services Education Consortium University of Texas Medical School at Houston Scott and White Memorial Hospital University of Texas Southwestern Utah ------ University of Utah Health Sciences Center Virginia ------ University of Virginia Health Sciences Center Eastern Virginia Medical School Medical College of Virginia Hospitals/Virginia Commonwealth University Portsmouth Naval Hospital Washington ------ Madigan - University of Washington West Virginia ------ West Virginia University Wisconsin ------ Medical College of Wisconsin