Please indicate your level of experience
A. Theory, no practice	C. One - two years experience
B. Intermittent experience	D. Two plus years experience

A. GENERAL DIAGNOSTIC
	1. Abdomen	A B C D
	2. Abdominal arteriogram	A B C D
	3. Air-contrast barium enema	A B C D
	4. Angioplasty	A B C D
	5. Arch arteriogram	A B C D
	6. Barium enema	A B C D
	7. Barium swallow/small bowel series	A B C D
	8. Bone density	A B C D
	9. Brachial arteriogram	A B C D
	10. Bronchogram	A B C D
	11. C-arm fluoroscope	A B C D
	12. Carotid arteriogram	A B C D
	13. Cervical spine	A B C D
	14. Chest series	A B C D
	15. ER exams	A B C D
	16. ERCP	A B C D
	17. Esophagram	A B C D
	18. Extremities	A B C D
	19. Facial series	A B C D
	20. Femoral arteriogram	A B C D
	21. Foreign body localization	A B C D
	22. Gall bladder	A B C D
	23. GI series	A B C D
	24. Hip series	A B C D
	25. Hypotonic duodenography	A B C D
	26. Hysterosalpingogram	A B C D
	27. IVP	A B C D
	28. KUB	A B C D
	29. Lumbar spine	A B C D
	30. Lung biopsy	A B C D
	31. Mammogram	A B C D
	32. Mastoids	A B C D
	33. Mesenteric arteriogram	A B C D
	34. Myelogram	A B C D
	35. Needle localization	A B C D
	36. OR exams	A B C D
	37. Pediatric exams	A B C D
	38. Peripheral Dexascan	A B C D
	39. Portables	A B C D
	40. Pulmonary arteriogram	A B C D
	41. Renal arteriogram	A B C D
	42. Renal cyst puncture	A B C D
	43. Hystersalpingogram	A B C D
	44. Selective angiography	A B C D
	45. Sialography	A B C D
	46. Skull series	A B C D
	47. Small bowel series	A B C D
	48. Soft tissue	A B C D
	49. Specimen radiographs	A B C D
	50. Surgery experience - C-arm	A B C D
	51. Therapy placement films	A B C D
	52. Thoracic spine	A B C D
	53. Tomogram	A B C D
	54. Transhepatic cholangiogram	A B C D
	55. Trauma	A B C D
	56. T-Tube cholangiogram	A B C D
	57. Voiding cystourethrogram	A B C D

B. CT SCANNING
	1. Abdomen	A B C D
	2. Biopsy procedures	A B C D
	3. Brain with contrast	A B C D
	4. Brain without contrast	A B C D
	5. Cervical spine	A B C D
	6. Chest	A B C D
	7. Gradient echo imaging	A B C D
	8. IAC	A B C D
	9. Larynx	A B C D
	10. Liver	A B C D
	11. Lumbar spine	A B C D
	12. MR angiography	A B C D
	13. Multiplanner reconstruction	A B C D
	14. Orbits	A B C D
	15. Pancreas	A B C D
	16. Partial saturation image	A B C D
	17. Pelvis	A B C D
	18. Renal cyst puncture	A B C D
	19. Spin-echo images	A B C D
	20. Surface coils	A B C D
	21. Thoracic spine	A B C D
	22. TM joints	A B C D

C. NUCLEAR MEDICINE
	1. Bone scan	A B C D
	2. Brain scan	A B C D
	3. Cerebral blood flow	A B C D
	4. Gallium scan	A B C D
	5. GI bleeding study	A B C D
	6. I-123 uptake	A B C D
	7. I-131 therapy	A B C D
	8. Liver scan	A B C D
	9. Lung scan	A B C D
	10. MUGA scan	A B C D
	11. Radionuclide arteriogram	A B C D
	12. Radionuclide venogram	A B C D
	13. Renal scan	A B C D
	14. SPECT scanning	A B C D
	15. Spleen scan	A B C D
	16. Thallium stress test	A B C D
	17. Thyroid scan	A B C D
	18. Thyroid therapy	A B C D
	19.  PET	A B C D

D. ULTRASOUND
	1. Aorta	A B C D
	2. Biliary tree	A B C D
	3. Biopsy puncture	A B C D
	4. Breast	A B C D
	5. Carotid	A B C D
	6. Cyst aspiration	A B C D
	7. Doppler studies	A B C D
	8. Gall bladder	A B C D
	9. Heart	A B C D
	10. Liver	A B C D
	11. Neonatal head	A B C D
	12. OB/GYN	A B C D
	13. OPG eye	A B C D
	14. Pancreas	A B C D
	15. Pelvic	A B C D
	16. Popliteal	A B C D
	17. Renal	A B C D
	18. Thyroid	A B C D
	19. Transrectal procedures	A B C D
	20. Transvaginal procedures	A B C D
	21. UGI and small bowel	A B C D
	22. Venogram	A B C D

E. RADIATION THERAPY
	1. Cobalt 60 therapy	A B C D
	2. Dosimetry	A B C D
	3. Hyperthermia treatment	A B C D
	4. Linear accelerator with electrons	A B C D
	5. Linear accelerator	A B C D
	6. Ortho voltage radiation treatment	A B C D
	7. Simulation of treatment sites	A B C D
	8. Strontium 90 therapy	A B C D
	9. Superficial radiation treatment	A B C D
	10. Treatment planning	A B C D

F. MRI TECHNOLOGIST
	1. Gradient echo imaging	A B C D
	2. Multiplanner reconstruction	A B C D
	3. Partial saturation images	A B C D
	4. Spin-echo images	A B C D
	5. Surface coils	A B C D
	6. T-1 weighted images	A B C D
	7. T-2 weighted images	A B C D

G. EQUIPMENT
	1. GE .5		A B C D
	2. GE 1.0		A B C D
	3. GE 1.5		A B C D
	4. Hitachi .5		A B C D
	5. Hitachi 1.0		A B C D
	6. Hitachi 1.5		A B C D
	7. Phillips .5		A B C D
	8. Phillips 1.0		A B C D
	9. Phillips 1.5		A B C D
	10. Picker .5		A B C D
	11. Picker 1.0		A B C D
	12. Picker 1.5		A B C D
	13. Siemens .5		A B C D
	14. Siemens 1.0		A B C D
	15. Siemens 1.5		A B C D
	16. Toshiba .5		A B C D
	17. Toshiba 1.0		A B C D
	18. Toshiba 1.5		A B C D
	19. Other		A B C D
	20. Other		A B C D
	21. Other		A B C D
	22. Other		A B C D

AGE SPECIFIC PRACTICE CRITERIA
Please check the boxes below for each age group for which you have expertise in providing age-appropriate nursing care.

A. Newborn/Neonate (birth - 30 days)	F. Adolescents (12 - 18 years)
B. Infant (30 days - 1 year)	G. Young adults (18 - 39 years)
C. Toddler (1 - 3 years)	H. Middle adults (39 - 64 years)
D. Preschooler (3 - 5 years)	I. Older adults (64+)
E. School age children (5 - 12 years)