Administrative Registered Nurse Skills Checklist

Dosimetrist Skills Checklist

Fill Out and Submit your Skills Checklist

(Dosimetrist Skills Checklist)

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I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions:This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Proficiency Scale:

1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

Age of Patients Cared For

Newborn/Neonate (birth–30 days):

★★★★

Infant (1 month–1 year):

★★★★

Toddler (1–3 years):

★★★★

Preschooler (3–5 years):

★★★★

School Age Child (5–12 years):

★★★★

Adolescents (12–18 years):

★★★★

Young Adults (18–39 years):

★★★★

Middle Adults (39–64 years):

★★★★

Older Adults (64–79 years):

★★★★

GENERAL SKILLS

Standard Precautions:

★★★★

Isolation Precautions:

★★★★

Pediatric Respiratory/Cardiac Arrest:

★★★★

Adult Respiratory/Cardiac Arrest:

★★★★

Crash Carts:

★★★★

Defibrillators:

★★★★

RADIATION THERAPY PHYSICS

Physical Property of Atoms and Nuclei:

★★★★

Basic Nuclear Transformations:

★★★★

Medical Linear Accelerators:

★★★★

INTERACTION OF HIGH ENERGY ELECTRONS & X-RAYS WITH MATTER

Photoelectric Effect:

★★★★

Compton Scatter:

★★★★

Pair Production:

★★★★

Physical Properties of Dose and Exposure:

★★★★

DOSIMETRY EQUIPMENT

Ion Chambers:

★★★★

Thermoluminescent Dosimetry:

★★★★

TG-51 (Calibration Protocol):

★★★★

Radioactive Isotopes:

★★★★

Electron Beam Therapy:

★★★★

IMRT (Intensity Modulated Radiation Therapy):

★★★★

BEAM MODIFIERS

Physical Wedges:

★★★★

Dynamic Wedges:

★★★★

Blocks:

★★★★

3-D Conformal Radiation Therapy: [rating 3d-crt]

BASIC PRINCIPLES & APPLICATIONS

CT Scan:

★★★★

MRI Machine:

★★★★

PET Scan:

★★★★

BRACHYTHERAPY PROCEDURES

Systemic Errors:

★★★★

Random Errors:

★★★★

Treatment Documentation, Procedure Checklists, & Forms:

★★★★

Application Preparation:

★★★★

Application Insertion:

★★★★

Implant Localization and Simulation:

★★★★

Treatment Prescription:

★★★★

IMPLANT DESIGN & EVALUATIONS

Localization:

★★★★

Computer Treatment Planning:

★★★★

Manual Verification of Computer:

★★★★

Patient Preparation, Setup, and Treatment:

★★★★

Post Treatment Quality Assurance:

★★★★

EMERGENCY PROCEDURES FOR HDR

Routine Emergency Equipment:

★★★★

Physical Plant Emergencies:

★★★★

Minor and Major Emergencies:

★★★★

Intravascular Brachytherapy:

★★★★

PROSTATE SEED IMPLANTS

I-125 Seeds:

★★★★

Pd-103 Seeds:

★★★★

Ommaya Reservoir:

★★★★

TREATMENT PLANNING

Auxiliary Devices (Digitizer, Plotter):

★★★★

Software – List Types:

Quality Assurance:

★★★★

SPECIAL TECHNIQUES

TBI (Total Body Irradiation):

★★★★

Electron Arc Therapy:

★★★★

Intraoperative 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 & PROTOCOLS

Ensures Accurate Dose:

★★★★

Ensures Proper Patient Positioning:

★★★★

Ensures Proper Machine Settings:

★★★★

Deviation of Normal Parameters for Equipment:

★★★★

TREATMENT AIDS

Custom Blocking:

★★★★

Multileaf Collimators:

★★★★

Half-Value Thick Blocks:

★★★★

Gonadal Shields:

★★★★

Eye Shields:

★★★★

Internal Shields:

★★★★

In Vivo Dosimetry:

★★★★

TLD (Thermoluminescent Dosimeters) Chips:

★★★★

Immobilization Devices:

★★★★

Anatomic Landmarks:

★★★★

CERTIFICATIONS

Medical Dosimetrist Certification Board (MDCB):

EMR / TREATMENT PLANNING SYSTEMS USED

Please list the EMR Systems you have used:

Dosimetrist Skills Checklist

Fill Out and Submit your Skills Checklist

(Dosimetrist Skills Checklist)

Proficiency Scale:

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