RADIOLOGY TECHNICIAN SKILLS CHECKLIST
Name:
When completing this ckecklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark in box which best describes your expertiese with each skill.

The scale is as follows:
1. Not performed   2. Intermitten experience   3. Very experienced.
ABDOMEN
  1. Abdominal Series   1 2 3
  2. Erect/Decubitis Film   1 2 3
Certifications
  1. BLS   1 2 3
  2. ACLS   1 2 3
  3. ARRT   1 2 3
  4. Fluoroscopy   1 2 3
  5. CT: (Computerized Tomography)   1 2 3
  6. NMTCB (Nuclear Medicine)   1 2 3
  7. Radiography   1 2 3
  8. Interventional   1 2 3
  9. Radiation Therapy   1 2 3
  10. Mammography   1 2 3
  11. MRI   1 2 3
  12. ARDMS (Sonography)   1 2 3
CT (COMPUTERIZED TOMOGRAPHY)
  1. Chest   1 2 3
  2. Brain with contrast   1 2 3
  3. Brain without Contrast   1 2 3
  4. Cervical Spine   1 2 3
  5. Thoracic Spine   1 2 3
  6. Lumber Spine   1 2 3
  7. Abdomen Studies   1 2 3
  8. PET Scan   1 2 3
  9. 3-D or Multidimensional   1 2 3
  10. Skull/Facial/Orbits/Sinuses   1 2 3
  11. Biopsy/Angio Procedures   1 2 3
EQUIPMENT/SPECIAL PROCEDURES
  1. R & F Rooms   1 2 3
  2. C-Arm   1 2 3
  3. Portable Exams   1 2 3
  4. Automatic Processing/Darkroom   1 2 3
  5. Daylight System   1 2 3
  6. Panoramix   1 2 3
  7. Flouroscopy   1 2 3
  8. GI Tract (Upper & Lower)   1 2 3
  9. Barium Swallow   1 2 3
  10. Barium Enema   1 2 3
  11. Small Bowel Series   1 2 3
  12. Voiding Cystogram   1 2 3
  13. Myelgram   1 2 3
  14. IVP/Tomograms   1 2 3
  15. Trauma Cases   1 2 3
  16. Arterigram   1 2 3
  17. Bronchogram   1 2 3
  18. Tomography   1 2 3
  19. Bone Survey   1 2 3
  20. Surgery -(C-arm/Portable)   1 2 3
EXPERIENCE IN PRIMARY AREAS
  1. Hospital   1 2 3
  2. Clinic   1 2 3
  3. Nursing Home   1 2 3
  4. Home Health   1 2 3
EXTREMITIES
  1. Small Extremities   1 2 3
  2. Large Extremities   1 2 3
INTERVENTIONAL/SPECIALS/CARDIO
  1. Angiography/Arteriography   1 2 3
  2. Venography   1 2 3
  3. Aorterography   1 2 3
  4. Cardiac Catheterizations   1 2 3
  5. Digital Angiography (DSA)   1 2 3
  6. Lymphangiography   1 2 3
Mammography
  1. Screening Mammograms   1 2 3
  2. Diagnostic Mammograms   1 2 3
  3. Magnification Views   1 2 3
  4. Implants   1 2 3
  5. Sterotactic Biopsy   1 2 3
  6. Digital   1 2 3
  7. Needle Localiations   1 2 3
  8. Pacemaker   1 2 3
MRI
  1. Angio   1 2 3
  2. Multiplanar Reconstruction   1 2 3
  3. Contrast Studies   1 2 3
  4. Spin Echo Imaging   1 2 3
  5. Partial Saturation Imaging   1 2 3
  6. Surface Coils   1 2 3
  7. T1Weighted Imaging   1 2 3
  8. T2 Weighted Imaging   1 2 3
  9. Gradient Echo Imaging   1 2 3
PEDIATRICS
  1. Head/facial/scalp   1 2 3
  2. Chest/Abdomen   1 2 3
  3. Spine/Pelvis   1 2 3
  4. Extremities   1 2 3
RADIATION THERAPY
  1. Linear Accelerator   1 2 3
  2. Linear Accelerator with Electrons   1 2 3
  3. Superficial Treatment   1 2 3
  4. Ortho Voltage   1 2 3
  5. Hyperthermia Treatment   1 2 3
  6. Cobalt 60 Therapy   1 2 3
  7. Dosimetry   1 2 3
  8. Treatment Planning   1 2 3
RADIOGRAPHY: HEAD/SKULL
  1. Orbits   1 2 3
  2. Mandible   1 2 3
  3. Facial Bones   1 2 3
  4. Nasal Bones   1 2 3
Sonography/ultrasound
  1. General Chest Procedures   1 2 3
  2. General Abdominal Procedures   1 2 3
  3. Paracentesis   1 2 3
  4. Thoracentesis   1 2 3
  5. Breast   1 2 3
  6. Biopsies   1 2 3
  7. Upper Extremeties(Venous/Arterial)   1 2 3
  8. Lower Extremeties(Venous/Arterial)   1 2 3
  9. Female Pelvis   1 2 3
  10. Male Pelvis   1 2 3
  11. Transvaginal   1 2 3
  12. Doppler Studies   1 2 3
  13. Color Doppler Studies   1 2 3
  14. 2D and M-Mode   1 2 3
  15. Stress Testing   1 2 3
  16. Portable Studies   1 2 3
  17. Carotids   1 2 3
  18. Transrectal Procedures   1 2 3
  19. Transvaginal Procedures   1 2 3
SPINE/PELVIS
  1. Cervical Spine   1 2 3
  2. Thoracic Spine   1 2 3
  3. Lumber Spine   1 2 3
  4. SI Joints   1 2 3
  5. Scoliosis Studies   1 2 3
THORAX
  1. PA/Lat Chest   1 2 3
  2. Decubitus Chest   1 2 3
  3. Ribs   1 2 3
  4. Sternum   1 2 3
The information I have given is true and accurate to the best of my knowledge. Please sign and date below.
SIGNATURE: (Last 4 digits of your SSN)    Reenter your last 4 digits of your SSN:   DATE:

  
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