Radiology Skills Checklist

First name:	Last name:
Phone:	Email:
SSN (last 4 only):	Date: (MM/DD/YYYY)

Key - for each box mark:

Limited or no experience
Somewhat experienced but may need review
Can function independently
Competent to supervise

	1	2	3	4
GENERAL DIAGNOSTIC
Abdomen
Abdominal arteriogram
Air-contrast barium enema
Angioplasty
Arch arteriogram
Barium enema
Barium swallow/small bowel series
Bone density
Brachial arteriogram
Bronchogram
C-arm fluoroscope
Carotid arteriogram
Cervical spine
Chest series
ER exams
ERCP
Esophogram
Extremities
Facial series
Femoral arteriogram
Foreign body localization
Gall bladder
GI series
Hip series
Hypotonic duodenography
Hysterosalpingogram
IVP
KUB
Lumbar spine
Lung biopsy
Mammogram
Mastoids
Mesenteric arteriogram
Myelogram
Needle localization
OR exams
Pediatric exams
Peripheral dexascan
Portables
Pulmonary arteriogram
Renal arteriogram
Renal cyst puncture
Salpingogram
Selective angiography
Sialography
Skull series
Small bowel series
Soft tissue
Specimen radiographs
Surgery experience - C-arm
Therapy placement films
Thoracic spine
Tomogram
Transhepatic cholangiogram
Trauma
T-Tube cholangiogram
Voiding cystourethrogram
CT SCANNING
Abdomen
Biopsy procedures
Brain with contrast
Brain without contrast
Cervical spine
Chest
Gradient echo imaging
IAC
Larynx
Liver
Lumbar spine
MR angiography
Multiplanar reconstruction
Orbits
Pancreas
Partial saturation image
Pelvis
Renal cyst puncture
Spin-echo images
Surface coils
Thoracic spine
TM joints

	1	2	3	4
NUCLEAR MEDICINE
Bone scan
Brain scan
Cerebral blood flow
Gallium scan
GI bleeding study
I-123 uptake
I-131 therapy
Liver scan
Lung scan
MUGA scan
Radionuclide arteriogram
Radionuclide venogram
Renal scan
SPECT scanning
Spleen scan
Thallium stress test
Thyroid scan
Thyroid therapy
ULTRASOUND
Aorta
Biliary tree
Biopsy puncture
Breast
Carotid
Cyst aspiration
Doppler studies
Gall bladder
Heart
Liver
Neonatal head
OB/GYN
OPG eye
Pancreas
Pelvic
Popliteal
Renal
Thyroid
Transrectal procedures
Transvaginal procedures
UGI and small bowel
Venogram
RADIATION THERAPY
Cobalt 60 therapy
Dosimetry
Hyperthermia treatment
Linear accelerator with electrons
Linear accelerator
Ortho voltage radiation treatment
Simulation of treatment sites
Strontium 90 therapy
Superficial radiation treatment
Treatment planning
MRI TECHNOLOGIST
Gradient echo imaging
Multiplanar reconstruction
Partial saturation images
Spin-echo images
Surface coils
T-1 weighted images
T-2 weighted images
EQUIPMENT
GE .5
GE 1.0
GE 1.5
Hitachi .5
Hitachi 1.0
Hitachi 1.5
Phillips .5
Phillips 1.0
Phillips 1.5
Picker .5
Picker 1.0
Picker 1.5
Siemens .5
Siemens 1.0
Siemens 1.5
Toshiba .5
Toshiba 1.0
Toshiba 1.5
Other:
Other:
Other:
Other:

Age Specific Experiences and Certifications

Age Specific Experiences	Infants and Toddlers (birth-2 years)	Children (3-12 years)	Adolescent (13-18 years)	Young Adult (19-39 years)	Middle Adults (40-64 years)	Older Adult (65+ years)
1. Knows the normal growth and development for each age group and adapts care accordingly.
2. Knows the different communication needs for each age group and changes communication methods and terminology accordingly.
3. Knows the different safety risks for each age group and alters the environment accordingly.
4. Knows the different medications, dosages, and possible side effects for each age group and administers medications accordingly.

My Experience is Primarily in:

Practice Area	Year(s)
Radiology	Year(s)

Certifications

BCLS	Expiration Date (mm/yyyy)
ACLS	Expiration Date (mm/yyyy)
CPR	Expiration Date (mm/yyyy)
Other:	Expiration Date (mm/yyyy)
Computerized charting system:	Expiration Date (mm/yyyy)

The information I have provided in this skills checklist is true and accurate to the best of my knowledge. I hereby authorize Fortus Group to release this information to client facilities in relation to consideration of my employment.