Dosimetrist

Dosimetrist Skills Checklist

Answer Key:

1. No Experience

2. Limited Experience

3. Experienced

4. Very Experienced

Age of Patients

Rows	1	2	3	4
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 to 79 years)*
Elderly Adults (over 79+ years)*

Skills

Rows	1	2	3	4
Standard Precautions
Isolation Precautions
Pediatric Respiratory/ Cardiac Arrest
Adult Respiratory/ Cardiac Arrest
Crash Carts
Defibrillators

Radiaton Therapy Physics

Rows	1	2	3	4
Physical Property of Atoms and Nuclei
Basic Nuclear Transformations
Medical Linear Accelerations

Interaction of High Energy Electrons & X-Rays with Matter

Rows	1	2	3	4
Photoelectric Effect
Campton Scatter
Pair Production
Physical Properties of Dose and Exposure

Dosimetry Equipment

Rows	1	2	3	4
Ion Chambers
Thermoluminescent Dosimetry
TG-51 (Calibration Protocol)
Radioactive Isotopes
Electron Beam Therapy
IMRT (Intensity Modulated Radiation Therapy)

Beam Modifiers

Rows	1	2	3	4
Physical Wedges
Dynamic Wedges
Blocks
3-D Conformal Radiation Therapy

Basic Principles and Applications

Rows	1	2	3	4
CT Scan
MRI Machine
PET Scan

Brachytherapy Procedures

Rows	1	2	3	4
Systemic Errors
Random Errors
Treatment Documentation, Procedure Checklists, & Forms
Application Preparation
Application Insertion
Implant Localization and Stimulation
Treatment Prescription

Implant Design and Evaluations

Rows	1	2	3	4
Localization
Computer Treatment Planning
Manual Verification of Computer
Patient Preparation, Setup, and Treatment
Post Treatment Quality Assurance

Emergency Procedures for HDR

Rows	1	2	3	4
Routine Emergency Equipment
Physical Plant Emergencies
Minor and Major Emergencies
Intravascular Brachytherapy

Prostate Seed Implants

Rows	1	2	3	4
I-125 Seeds
P-103 Seeds
Ommaya Reservoir

Treatment Planning

Rows	1	2	3	4
Auxiliary Devices (Digitizer, Plotter)
Quality Assurance

Special Techniques

Rows	1	2	3	4
TBI (Total body Irradiation)
Electron Arc Therapy
Interoperative Electron Therapy
TSI (Total Skin Irradiation)
SRS (Stereotactic Radiosurgery)
Beam Data Acquisition for Small Fields
Treatment Planning Computer Data Input
SRT (Stereotactic Radiotherapy)

Standards for Treatment Plans and Protocols

Rows	1	2	3	4
Ensures Accurate Dose
Ensures Proper Patient Positioning
Ensures Proper Machine Settings
Deviation of Normal Parameters for Equipment

Field Shaping

Rows	1	2	3	4
Custom Blocking
Multileaf Collimators
Half-Value Thick Blocks
Gonadal Shields
Eye Shields
Internal Shields
In Vivo Dosimetry
TLD (Thermoluminescent Dosimeters) Chips

Patient Positioning

Rows	1	2	3	4
Immobilization Devices
Anatomic Landmarks

Certifications

Rows	Yes	No
Medical Dosimetrist Certification Board

I attest that this checklist represents a true reflection of my experience to the best of my knowledge. By electronically signing this form I give my permission for it to be shared with facilities as a way to assess my skill level and be considered for employment opportunities.

Digital Signature

Phone Number

Area CodePhone Number

Date