Radiology Technologist

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Name*

First Last

Phone*

Email*

Age Specific Care

Proficiency Rating

Frequency Rating

Newborn/Neonate (birth - 30 days) *

Newborn/Neonate (birth - 30 days) proficiency*

Newborn/Neonate (birth - 30 days) frequency*

Infant (30 days - 1 year) *

Infant (30 days - 1 year) proficiency*

Infant (30 days - 1 year) frequency*

Toddler (1 - 3 years) *

Toddler (1 - 3 years) proficiency*

Toddler (1 - 3 years) frequency*

Preschooler (3 - 5 years) *

Preschooler (3 - 5 years) proficiency*

Preschooler (3 - 5 years) frequency*

School Age Child (5 - 12 years) *

School Age Child (5 - 12 years) proficiency*

School Age Child (5 - 12 years) frequency*

Adolescents (12 - 18 years) *

Adolescents (12 - 18 years) proficiency*

Adolescents (12 - 18 years) frequency*

Young Adults (18 - 39 years) *

Young Adults (18 - 39 years) proficiency*

Young Adults (18 - 39 years) frequency*

Middle Adults (39 - 64 years) *

Middle Adults (39 - 64 years) proficiency*

Middle Adults (39 - 64 years) frequency*

Older Adults (64+ years) *

Older Adults (64+ years) proficiency*

Older Adults (64+ years) frequency*

Elderly Adults (over 79+ years) *

Elderly Adults (over 79+ years) proficiency*

Elderly Adults (over 79+ years) frequency*

Work Settings

Proficiency Rating

Frequency Rating

GE *

GE proficiency*

GE frequency*

List Types:

Philips *

Philips proficiency*

Philips frequency*

List Types:

Siemens *

Siemens proficiency*

Siemens frequency*

List Types:

Fuji *

Fuji proficiency*

Fuji frequency*

List Types:

Carestream *

Carestream proficiency*

Carestream frequency*

List Types:

Shinadzu *

Shinadzu proficiency*

Shinadzu frequency*

List Types:

Toshiba *

Toshiba proficiency*

Toshiba frequency*

List Types:

Ziehm *

Ziehm proficiency*

Ziehm frequency*

List Types:

O-arm *

O-arm proficiency*

O-arm frequency*

List Types:

Electronic Medical Recording

Proficiency Rating

Frequency Rating

Epic *

Epic proficiency*

Epic frequency*

Cerner *

Cerner proficiency*

Cerner frequency*

Meditech *

Meditech proficiency*

Meditech frequency*

McKesson *

McKesson proficiency*

McKesson frequency*

Allscripts *

Allscripts proficiency*

Allscripts frequency*

PACS

Proficiency Rating

Frequency Rating

McKesson *

McKesson proficiency*

McKesson frequency*

Centricity *

Centricity proficiency*

Centricity frequency*

Philips *

Philips proficiency*

Philips frequency*

Fujifilm *

Fujifilm proficiency*

Fujifilm frequency*

Erad *

Erad proficiency*

Erad frequency*

Syngo *

Syngo proficiency*

Syngo frequency*

Carestream Vue *

Carestream Vue proficiency*

Carestream Vue frequency*

Imaging Principles & Evaluation

Proficiency Rating

Frequency Rating

NPO, DNR, ALARA, GFR, BUN, AEC, kVp, mAs, etc. *

NPO, DNR, ALARA, GFR, BUN, AEC, kVp, mAs, etc. proficiency*

NPO, DNR, ALARA, GFR, BUN, AEC, kVp, mAs, etc. frequency*

Positioning and Planes *

Positioning and Planes proficiency*

Positioning and Planes frequency*

Projection (AP, RAO) *

Projection (AP, RAO) proficiency*

Projection (AP, RAO) frequency*

Central Ray (laterally, anteriorly) *

Central Ray (laterally, anteriorly) proficiency*

Central Ray (laterally, anteriorly) frequency*

Maintain/perform and adjust/modify instrumentation for image evaluation and quality *

Maintain/perform and adjust/modify instrumentation for image evaluation and quality proficiency*

Maintain/perform and adjust/modify instrumentation for image evaluation and quality frequency*

Brightness/Density *

Brightness/Density proficiency*

Brightness/Density frequency*

Contrast/gray scale *

Contrast/gray scale proficiency*

Contrast/gray scale frequency*

Distortion *

Distortion proficiency*

Distortion frequency*

Image artifacts *

Image artifacts proficiency*

Image artifacts frequency*

Identification markers *

Identification markers proficiency*

Identification markers frequency*

Anatomical markers *

Anatomical markers proficiency*

Anatomical markers frequency*

kVp *

kVp proficiency*

kVp frequency*

mA control *

mA control proficiency*

mA control frequency*

Timer *

Timer proficiency*

Timer frequency*

Distance *

Distance proficiency*

Distance frequency*

Grid *

Grid proficiency*

Grid frequency*

Beam restriction *

Beam restriction proficiency*

Beam restriction frequency*

Film screen speed *

Film screen speed proficiency*

Film screen speed frequency*

Filtration *

Filtration proficiency*

Filtration frequency*

Anode heel effect *

Anode heel effect proficiency*

Anode heel effect frequency*

Evaluate and communicate radiologic findings to radiologists *

Evaluate and communicate radiologic findings to radiologists proficiency*

Evaluate and communicate radiologic findings to radiologists frequency*

Perform digital imaging processing *

Perform digital imaging processing proficiency*

Perform digital imaging processing frequency*

Masking *

Masking proficiency*

Masking frequency*

Gray-scale rendition *

Gray-scale rendition proficiency*

Gray-scale rendition frequency*

Edge enhancement *

Edge enhancement proficiency*

Edge enhancement frequency*

Noise suppression *

Noise suppression proficiency*

Noise suppression frequency*

Contrast enhancement *

Contrast enhancement proficiency*

Contrast enhancement frequency*

Ghost imaging *

Ghost imaging proficiency*

Ghost imaging frequency*

Erasure *

Erasure proficiency*

Erasure frequency*

Dead pixels *

Dead pixels proficiency*

Dead pixels frequency*

Readout problems *

Readout problems proficiency*

Readout problems frequency*

Imaging Procedures

Proficiency Rating

Frequency Rating

Assess patient preparation (documents & labs) *

Assess patient preparation (documents & labs) proficiency*

Assess patient preparation (documents & labs) frequency*

Patient identification *

Patient identification proficiency*

Patient identification frequency*

History & Physical *

History & Physical proficiency*

History & Physical frequency*

Diagnosis *

Diagnosis proficiency*

Diagnosis frequency*

Obtain/verify consent *

Obtain/verify consent proficiency*

Obtain/verify consent frequency*

NPO status *

NPO status proficiency*

NPO status frequency*

Required lab results (BUN, Creatinine, GFR, etc.) *

Required lab results (BUN, Creatinine, GFR, etc.) proficiency*

Required lab results (BUN, Creatinine, GFR, etc.) frequency*

Pregnancy status *

Pregnancy status proficiency*

Pregnancy status frequency*

Implantable devices *

Implantable devices proficiency*

Implantable devices frequency*

Obtain/assess vital signs *

Obtain/assess vital signs proficiency*

Obtain/assess vital signs frequency*

Assess contraindications *

Assess contraindications proficiency*

Assess contraindications frequency*

Medication interactions *

Medication interactions proficiency*

Medication interactions frequency*

Allergic reactions *

Allergic reactions proficiency*

Allergic reactions frequency*

Abnormal lab results *

Abnormal lab results proficiency*

Abnormal lab results frequency*

Exam Types

Proficiency Rating

Frequency Rating

Anatomy and Physiology *

Anatomy and Physiology proficiency*

Anatomy and Physiology frequency*

Head (Facial, nasal, and orbital bones; mandible) *

Head (Facial, nasal, and orbital bones; mandible) proficiency*

Head (Facial, nasal, and orbital bones; mandible) frequency*

Spine (Cervical, thoracic, lumbar, and pelvis) *

Spine (Cervical, thoracic, lumbar, and pelvis) proficiency*

Spine (Cervical, thoracic, lumbar, and pelvis) frequency*

Chest/Thorax *

Chest/Thorax proficiency*

Chest/Thorax frequency*

Abdomen *

Abdomen proficiency*

Abdomen frequency*

Upper extremities *

Upper extremities proficiency*

Upper extremities frequency*

Lower extremities *

Lower extremities proficiency*

Lower extremities frequency*

Urinary system *

Urinary system proficiency*

Urinary system frequency*

Biliary system *

Biliary system proficiency*

Biliary system frequency*

Cardiovascular system *

Cardiovascular system proficiency*

Cardiovascular system frequency*

Reproductive systems *

Reproductive systems proficiency*

Reproductive systems frequency*

GI system *

GI system proficiency*

GI system frequency*

Recognize abnormal findings *

Recognize abnormal findings proficiency*

Recognize abnormal findings frequency*

Pneumothorax *

Pneumothorax proficiency*

Pneumothorax frequency*

Renal stones *

Renal stones proficiency*

Renal stones frequency*

Gallstones *

Gallstones proficiency*

Gallstones frequency*

Skeletal fractures *

Skeletal fractures proficiency*

Skeletal fractures frequency*

Obstructions (small bowel and colon) *

Obstructions (small bowel and colon) proficiency*

Obstructions (small bowel and colon) frequency*

Routine *

Routine proficiency*

Routine frequency*

Stats *

Stats proficiency*

Stats frequency*

Trauma *

Trauma proficiency*

Trauma frequency*

Codes *

Codes proficiency*

Codes frequency*

Maintain appropriate documentation *

Maintain appropriate documentation proficiency*

Maintain appropriate documentation frequency*

Assist physician/nurse during procedures *

Assist physician/nurse during procedures proficiency*

Assist physician/nurse during procedures frequency*

Assess and maintain IV site *

Assess and maintain IV site proficiency*

Assess and maintain IV site frequency*

Start peripheral IV *

Start peripheral IV proficiency*

Start peripheral IV frequency*

Bleeding *

Bleeding proficiency*

Bleeding frequency*

Ionic *

Ionic proficiency*

Ionic frequency*

Non-Ionic *

Non-Ionic proficiency*

Non-Ionic frequency*

Water Soluble *

Water Soluble proficiency*

Water Soluble frequency*

Barium *

Barium proficiency*

Barium frequency*

Fluoroscopy Exams *

Fluoroscopy Exams proficiency*

Fluoroscopy Exams frequency*

Barium enema *

Barium enema proficiency*

Barium enema frequency*

IVP *

IVP proficiency*

IVP frequency*

Myelogram *

Myelogram proficiency*

Myelogram frequency*

Surgery (C-Arm) *

Surgery (C-Arm) proficiency*

Surgery (C-Arm) frequency*

Surgery (Portable) *

Surgery (Portable) proficiency*

Surgery (Portable) frequency*

Trauma Cases *

Trauma Cases proficiency*

Trauma Cases frequency*

GI Tract (Upper and Lower) *

GI Tract (Upper and Lower) proficiency*

GI Tract (Upper and Lower) frequency*

Swallowing Studies *

Swallowing Studies proficiency*

Swallowing Studies frequency*

Patient Care & Education

Proficiency Rating

Frequency Rating

Knowledge of and ability to maintain patient medical equipment *

Knowledge of and ability to maintain patient medical equipment proficiency*

Knowledge of and ability to maintain patient medical equipment frequency*

Oxygen tank *

Oxygen tank proficiency*

Oxygen tank frequency*

Infusion pump *

Infusion pump proficiency*

Infusion pump frequency*

Nasogastric tube *

Nasogastric tube proficiency*

Nasogastric tube frequency*

Urinary catheter *

Urinary catheter proficiency*

Urinary catheter frequency*

Tracheostomy tube *

Tracheostomy tube proficiency*

Tracheostomy tube frequency*

Chest tube *

Chest tube proficiency*

Chest tube frequency*

Maintain safe and comfortable care *

Maintain safe and comfortable care proficiency*

Maintain safe and comfortable care frequency*

Maintain infection control practices *

Maintain infection control practices proficiency*

Maintain infection control practices frequency*

Standard precautions *

Standard precautions proficiency*

Standard precautions frequency*

Hand hygiene *

Hand hygiene proficiency*

Hand hygiene frequency*

Sterile technique *

Sterile technique proficiency*

Sterile technique frequency*

Isolation precautions *

Isolation precautions proficiency*

Isolation precautions frequency*

Disposal of contaminated materials *

Disposal of contaminated materials proficiency*

Disposal of contaminated materials frequency*

PPE *

PPE proficiency*

PPE frequency*

Maintain proper body mechanics during patient positioning for x-rays/procedures *

Maintain proper body mechanics during patient positioning for x-rays/procedures proficiency*

Maintain proper body mechanics during patient positioning for x-rays/procedures frequency*

Maintain proper body mechanics during transport and transfers *

Maintain proper body mechanics during transport and transfers proficiency*

Maintain proper body mechanics during transport and transfers frequency*

Perform basic life support/CPR *

Perform basic life support/CPR proficiency*

Perform basic life support/CPR frequency*

Perform basic computer skills *

Perform basic computer skills proficiency*

Perform basic computer skills frequency*

Data Entry *

Data Entry proficiency*

Data Entry frequency*

Image Retrieval *

Image Retrieval proficiency*

Image Retrieval frequency*

PACS *

PACS proficiency*

PACS frequency*

Printing *

Printing proficiency*

Printing frequency*

Perform interventions for medical emergencies *

Perform interventions for medical emergencies proficiency*

Perform interventions for medical emergencies frequency*

Allergic reactions (latex, contrast media) *

Allergic reactions (latex, contrast media) proficiency*

Allergic reactions (latex, contrast media) frequency*

Cardiac or respiratory arrest *

Cardiac or respiratory arrest proficiency*

Cardiac or respiratory arrest frequency*

Physical injury *

Physical injury proficiency*

Physical injury frequency*

Seizures *

Seizures proficiency*

Seizures frequency*

Diabetic reactions *

Diabetic reactions proficiency*

Diabetic reactions frequency*

Professional Practice

Proficiency Rating

Frequency Rating

Follow state, federal and hospital policies and protocols *

Follow state, federal and hospital policies and protocols proficiency*

Follow state, federal and hospital policies and protocols frequency*

Maintain ethical and legal conduct *

Maintain ethical and legal conduct proficiency*

Maintain ethical and legal conduct frequency*

Joint Commission standards *

Joint Commission standards proficiency*

Joint Commission standards frequency*

HIPAA *

HIPAA proficiency*

HIPAA frequency*

OSHA regulations *

OSHA regulations proficiency*

OSHA regulations frequency*

Patient rights *

Patient rights proficiency*

Patient rightsfrequency*

Patient restraints *

Patient restraints proficiency*

Patient restraints frequency*

Informed consent *

Informed consent proficiency*

Informed consent frequency*

Do-Not-Resuscitate *

Do-Not-Resuscitate proficiency*

Do-Not-Resuscitate frequency*

Advanced directives *

Advanced directives proficiency*

Advanced directives frequency*

Health care proxy *

Health care proxy proficiency*

Health care proxy frequency*

Maintain and follow medical records release protocols *

Maintain and follow medical records release protocols proficiency*

Maintain and follow medical records release protocols frequency*

Establish and maintain effective working relationships with patients, their families, coworkers and other members of the health care team *

Establish and maintain effective working relationships with patients, their families, coworkers and other members of the health care team proficiency*

Establish and maintain effective working relationships with patients, their families, coworkers and other members of the health care team frequency*

Maintain and perform within scope of practice *

Maintain and perform within scope of practice proficiency*

Maintain and perform within scope of practice frequency*

Report incidents outside of code of ethics *

Report incidents outside of code of ethics proficiency*

Report incidents outside of code of ethics frequency*

Maintain continuing education requirements *

Maintain continuing education requirements proficiency*

Maintain continuing education requirements frequency*

Maintain chain of command and follow appropriate communication channels *

Maintain chain of command and follow appropriate communication channels proficiency*

Maintain chain of command and follow appropriate communication channels frequency*

Radiation Awareness

Proficiency Rating

Frequency Rating

Maintain and apply basic methods for radiation safety, protection and minimize exposure *

Maintain and apply basic methods for radiation safety, protection and minimize exposure proficiency*

Maintain and apply basic methods for radiation safety, protection and minimize exposure frequency*

Correct dosages *

Correct dosages proficiency*

Correct dosages frequency*

Proper shielding techniques *

Proper shielding techniques proficiency*

Proper shielding techniques frequency*

Dosimeters *

Dosimeters proficiency*

Dosimeters frequency*

Biological aspects of radiation *

Biological aspects of radiation proficiency*

Biological aspects of radiation frequency*

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Date*

Skills/Competences

Proficiency

Frequency

RADIOLOGY TECHNOLOGIST

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