Radiology Skills Checklist

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First name*
Last name*
 
 
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)  

EXPERIENCE WITH AGE GROUPS: A B C D E F G H I
Able to adapt care to incorporate normal growth and development.
Able to adapt method and terminology of patient instructions to their age, comprehension and maturity level.
Can ensure a safe environment reflecting specific needs of various age groups.

My experience is primarily in: (Please indicate number of years.)
     
Practice area: year(s)
Radiology year(s)

Certification:
Please check the boxes below and indicate the expiration date for each certificate that you have. If you do not know the exact date, please use the last date of the specific month (e.g., 08/31/2003).
 
  BCLS
  Exp. date:
 (mm/dd/yyyy)
  ACLS 
  Exp. date:
 (mm/dd/yyyy)
  CPR
  Exp. date:
 (mm/dd/yyyy)
  Other (type):
Exp. date:
 (mm/dd/yyyy)
  Computerized charting system:
Exp. date:
 (mm/dd/yyyy)

The information I have given is true and accurate to the best of my knowledge. I hereby authorize MedTeam Staffing to release this Radiology Skills Checklist to client facilities of MedTeam Staffing in relation to consideration of my employment with those facilities.