Skills Checklist

This Skills Checklist is a self-evaluation to assess your recent experience in various clinical settings focusing on the past 2 years.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

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AGE

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Newborn/Neonate (birth to 30 days)
Infant (1 month to 1 year)
Toddler (1 year to 3 years)
Preschooler (3 years to 5 years)
School Age Child (5 years to 12 years)
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adults (64+ years)

GENERAL SKILLS

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Venipuncture/IV Placement
Preparation of Examination Room
Identification of Patient
Patient Assessment & Education Regarding Procedure
Patient Assessment and/or Administration of Contrast Media When Indicated
Patient Positioning
Protocol Selection
Parameter Selection
Image Display & Archiving
Documentation of Procedure, Treatment, & Patient Data
Patient Discharge with Post Procedure Instructions
CDC Standard Precautions
Radiation Safety

Head, Spine, & Musculoskeletal

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Head w/o Contrast
Head w/ Contrast
Trauma Head
Vascular Head (CTA/CTV)
Brain Perfusion
Pituitary Fossa
Temporal Bones/IACs
Orbits
Sinuses
Facial Bones/ Mandible
Cervical Spine
Thoracic Spine
Lumbar Spine
Spinal Trauma
Upper Extremity
Lower Extremity
Shoulder and/or Scapula
Bony Pelvis and/or Hips
Musculoskeletal Trauma
Vascular Extremity/ Runoff (CTA/CTV)

Neck and Chest

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Soft Tissue Neck
Vascular Neck (CTA/CTV)
Chest w/o Contrast
Chest w/ Contrast
HRCT
Lung Nodule Study
Low Dose Lung Screening
Chest Trauma
Vascular Chest (ex: PE, CTA/CTV, AORTA)
Heart (ex: Calcium Scoring, Coronary Angiography)

Abdomen and Pelvis

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Abdomen/ Pelvis w/ Contrast
Abdomen/ Pelvis w/o Contrast
Liver (Multi-phase)
Kidney (Multi-phase)
Pancreas (Multi-phase)
Adrenals
Enterography Study
Appendicitis Study
Renal Stone Protocol (w/o IV Contrast)
Abdominal Trauma
Vascular Abdomen (CTA/CTV)
Intravenous Urogram/ IVU
Bladder
Pelvic Trauma
Vascular Pelvis (CTA/CTV)
Colorectal Studies (Rectal Contrast)

Additional Procedures

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Biopsies
Drainages
Aspirations
Pediatric
Arthrography
Discography
Myelography

Image Display and Post Processing

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Geometric, Distance, or Region of Interest (ROI) Measurements
Multiplanar Reconstruction (MPR)
3D Rendering (MIP, SSD, VR)
Retrospective Reconstruction in a New DFOV

Quality Assurance

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Calibration Checks
CT Number and Standard Deviation (Water Phantom)

EQUIPMENT

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Scanners
Power Injectors
Phillips
Telerad
Nighthawk

EMR

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eClinicalworks
EPIC
McKesson
Care 360
Allscripts
Cerner
Optum Insight
NextGen
Greenway

PACS

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Ambra Health
Sectra
Infinitt
IBM Merge
McKesson
Philips
FujiFilm
Impax
Centricity
Carestream Vue
Clarity
eRad PACS
Syngo

GE

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16 Slice
32 Slice
64 Slice
128 Slice
256 Slice
512 Slice

Siemens

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16 Slice
32 Slice
64 Slice
128 Slice
256 Slice
512 Slice

Toshiba

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16 Slice
32 Slice
64 Slice
128 Slice
256 Slice
512 Slice

Hitachi

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16 Slice
32 Slice
64 Slice
128 Slice
256 Slice
512 Slice

Position Category

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Total Years of Experience

First Name

Last Name

Social Security #

Date of Birth

Email

Phone

Attestation

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified, particularly within the last 2 years. I hereby authorize Alliant Personnel Resources (The Company) to collect, store, and release any information that I have provided in this Skills Checklist and/or any other documentation and information they have collected or that I have submitted in any form to its parent company(s), its subsidiaries, or other subcontractors/its service providers as it deems necessary in its business operations as well as to individuals and companies in relation to consideration of employment as a Healthcare Professional with those companies and individuals. I acknowledge that The Company will take precaution and care to protect my personal information that is collected/stored/shared but cannot guarantee permanent data security and I release The Company from all related liability for damages or punitive liability.

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Skills Checklist - CT