Personal Information

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Proﬁciency Scale:

1 – No Experience

2 – Need Training

3 – Able to perform with supervision

4 – Able to perform independently

ULTRASOUND

Aorta

Biliary System

Biopsy puncture

Breast

Carotid

Cyst aspiration

Doppler studies

Gall bladder

Heart

Liver

Neonatal head

OB/GYN

OPG eye

Pancreas

Pelvic

Popliteal

Renal

Thyroid

Transrectal procedure

Transvaginal procedures

UGI and small bowel

Venogram

EQUIPMENT

GE .5

GE 1.0

GE 1.5

Hitachi .5

Hitachi 1.0

Hitachi 1.5

Phillips .5

Phillips 1.5

Phillips 1.0

Picker .5

Picker 1.0

Picker 1.5

Siemens .5

Siemens 1.0

Siemens 1.5

Toshiba .5

Toshiba 1.0

Toshiba 1.5

RADIATION

Cobalt therapy

Dosimetry

Hyperthermia treatment

Linear accelerator with electrons

Linear accelerators

Ortho voltage radiation treatment

Strontium 90 therapy

Superficial radiation treatment

Treatment planning

Age Specific Competency

Able to ensure a safe and caring environment for the specific age groups indicated below; able to communicate and instruct patients from various age groups; able to evaluate age-appropriate behavior and skills.

Newborn (birth-30 days)

Infant (30 days-1 yrs)

Toddler (1-3 yrs)

Preschooler (3-5 yrs)

School Age (5-12 yrs)

Adolescents (12-18 yrs)

Young Adults (18-39 yrs)

Middle Adults (39-64 yrs)

Older Adults (64 yrs +)

Please list any additional areas of expertise below:

I certify that all the above information is correct, and that any misrepresentation or falsification of fact may be considered sufficient cause for immediate dismissal from the agency. I have filled out this skills checklist to the best of my knowledge and agree that all the information provided is correct.

Personal Information

Proﬁciency Scale:

CT Scanning

ULTRASOUND

NUCLEAR MEDICINE

EQUIPMENT

GENERAL DIAGNOSTICS

RADIATION

MRI

Age Specific Competency