Dosimetrist Skills Checklist

Dosimetrist Skills Checklist

First Name*

Last Name*

Years of Experience*

E-mail*

example@example.com

ANSWER KEY
 
PROFICIENCY
1=Not Applicable 2=No Experience 3=Some Experience
4=Experienced 5=Very Experienced
 
FREQUENCY
1=Never Performed 2=Assisted Only 3=Rarely Performed
4=Occasionally Performed 5=Regularly Performed

General*

Rows	Proficiency	Frequency
Physical Property of Atoms and Nuclei
Medical Linear Accelerators
Electron Beam Therapy
3-D Conformal Radiation Therapy
Basic Nuclear Transformations
Physical Properties of Dose and Exposure
IMRT (Intensity Modulated Radiation)

Interaction of High Energy Electrons and X-Rays*

Rows	Proficiency	Frequency
Photoelectric Effect
Campton Scatter
Pair Production

Dosimetry Equipment*

Rows	Proficiency	Frequency
Thermoluminescent Dosimetry
Ion Chambers
TG-51 (Calibration Protocol)

Beam Modifiers*

Rows	Proficiency	Frequency
Dynamic Wedges
Physical Wedges
Blocks

Basic Principals and Applications*

Rows	Proficiency	Frequency
MRI Machine
CT Scan
PET Scan

General*

Rows	Proficiency	Frequency
Systemic Errors
Procedure Checklists
Application Insertion
Treatment Prescription
Random Errors
Treatment Documentation
Intravascular Brachytherapy
Implant Localization and Stimulation

Implant Design and Evaluation*

Rows	Proficiency	Frequency
Localization
Computer Treatment Planning
Patient Preparation, Setup, and Treatment
Post Treatment Quality Assurance
Manual Verification of Computer Calculations

Emergency Procedures for HDR*

Rows	Proficiency	Frequency
Routine Emergency Equipment
Minor and Major Emergencies
Physical Plant Emergencies

Prostate Seed Implants*

Rows	Proficiency	Frequency
P-103 Seeds
I-126 Seeds

General*

Rows	Proficiency	Frequency
Quality Assurance
Auxiliary Devices (Digitizer, Plotter)
Software

General*

Rows	Proficiency	Frequency
TBI (Total Body Irradiation)
Intraoperative Electron Therapy
TSI (Total Skin Irradiation)
Intraoperative Electron Therapy
Other
SRS (Stereotactic Radiosurgery) Multileaf Collimators
Electron Arc Therapy
Data Input Treatment Planning
SRT (Stereotactic Radiotherapy)

General*

Rows	Proficiency	Frequency
Ensures Proper Patient Positioning
Ensures Proper Machine Settings
Deviation of Normal Parameters for Equipment
Ensures Accurate Dose

General*

Rows	Proficiency	Frequency
Field Shaping
Custom Blocking
Multileaf Collimators
Internal Shields
Body Positioning
Other
Eye Shields
In Vivo Dosimetry
Use of TLD (Thermoluminescent Dosimeters) Chips
Patient Positioning
Anatomic Landmarks
Half-Valve Thick Blocks
Gonadal Shields

Age Specific Criteria*

Rows	Proficiency	Frequency
Newborn / Neonatal (up to 30 days)
Infant (30 days to 1 year)
Toddler (1 to 3 years)
Preschooler (3 to 5 years)
School Age (5 to 12 years)
Adolescents (12 to 18 years)
Young Adults (18 to 39 years)
Middle Adults (40 to 64 years)
Older Adults (65 & up)

The information provided is true and to the best of my knowledge. I hereby authorize Summit Medical Staffing to present my Skills Checklist to facilities for the purpose of employment. Please Type Your Name in This Box to Electronically Sign this Form. *

First NameLast Name

Date*

MonthDayYear

Hour MinutesAM/PM Option

Form Reply Email Address

Salesforce Check

Radiation Therapy Physics

Brachytherapy Procedures

Treatment Planning

Special Techniques

Standards for Treatment Plans / Protocols

Treatment Aids