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Skills Assessment - Radiology
 
The following checklist will be used to match your skills and interests with available assignments. Please enter your information, and we will store this information with your application/profile. Please indicate your level of proficiency by marking the appropriate number.
 
First Name:
Middle Initial:
Last Name:
SSN: - -
E-mail Address:
Home Phone: - -
Work Phone: - -
Cell Phone: - -
City:
State:
 
 
0. Theory, no practice   1. Limited   2. Confident   3. Very Confident
 
General Diagnostic: Experience:
Abdomen 0   1   2   3  
Abdominal arteriogram 0   1   2   3  
Air-contrast barium enema 0   1   2   3  
Angioplasty 0   1   2   3  
Arch arteriogram 0   1   2   3  
Barium enema 0   1   2   3  
Barium swallow/small bowel series 0   1   2   3  
Bone density 0   1   2   3  
Brachial arteriogram 0   1   2   3  
Bronchogram 0   1   2   3  
C-arm fluoroscope 0   1   2   3  
Carotid arteriogram 0   1   2   3  
Cervical spine 0   1   2   3  
Chest series 0   1   2   3  
ER exams 0   1   2   3  
ERCP 0   1   2   3  
Esophagram 0   1   2   3  
Extremities 0   1   2   3  
Facial series 0   1   2   3  
Femoral arteriogram 0   1   2   3  
Foreign body localization 0   1   2   3  
Gall bladder 0   1   2   3  
GI series 0   1   2   3  
Hip series 0   1   2   3  
Hypotonic duodenography 0   1   2   3  
Hysterosalpingogram 0   1   2   3  
IVP 0   1   2   3  
KUB 0   1   2   3  
Lumbar spine 0   1   2   3  
Lung biopsy 0   1   2   3  
Mammogram 0   1   2   3  
Mastoids 0   1   2   3  
Mesenteric arteriogram 0   1   2   3  
Myelogram 0   1   2   3  
Pediatric exams 0   1   2   3  
Peripheral DEXAscan 0   1   2   3  
Portables 0   1   2   3  
Pulmonary arteriogram 0   1   2   3  
Renal arteriogram 0   1   2   3  
Renal cyst puncture 0   1   2   3  
Salpingogram 0   1   2   3  
Skull series 0   1   2   3  
Small bowel series 0   1   2   3  
Surgery experience - C-arm 0   1   2   3  
Thoracic spine 0   1   2   3  
Tomogram 0   1   2   3  
Transhepatic cholangiogram 0   1   2   3  
T-Tube cholériforme 0   1   2   3  
Voiding cystourethrogram 0   1   2   3  
 
CT Scanning:
Abdomen 0   1   2   3  
Biopsy procedures 0   1   2   3  
Brain with contrast 0   1   2   3  
Brain without contrast 0   1   2   3  
Cervical spine 0   1   2   3  
Chest 0   1   2   3  
IAC 0   1   2   3  
Larynx 0   1   2   3  
Liver 0   1   2   3  
Lumbar spine 0   1   2   3  
Orbits 0   1   2   3  
Pancreas 0   1   2   3  
Partial saturation image 0   1   2   3  
Pelvis 0   1   2   3  
Thoracic spine 0   1   2   3  
TM joints 0   1   2   3  
 
Nuclear Medicine:
Bone scan 0   1   2   3  
Brain scan 0   1   2   3  
Cerebral blood flow 0   1   2   3  
Gallium scan 0   1   2   3  
GI bleeding study 0   1   2   3  
I-123 uptake 0   1   2   3  
I-131 therapy 0   1   2   3  
Liver scan 0   1   2   3  
Lung scan 0   1   2   3  
MUGA scan 0   1   2   3  
Radionuclide arteriogram 0   1   2   3  
Radionuclide venogram 0   1   2   3  
Renal scan 0   1   2   3  
SPECT scanning 0   1   2   3  
Spleen scan 0   1   2   3  
Thallium stress test 0   1   2   3  
Thyroid scan 0   1   2   3  
Thyroid therapy 0   1   2   3  
 
Ultrasound:
Aorta 0   1   2   3  
Biliary tree 0   1   2   3  
Breast 0   1   2   3  
Carotid 0   1   2   3  
Cyst aspiration 0   1   2   3  
Doppler studies 0   1   2   3  
Gall bladder 0   1   2   3  
Heart 0   1   2   3  
Liver 0   1   2   3  
Neonatal head 0   1   2   3  
OB/GYN 0   1   2   3  
OPG eye 0   1   2   3  
Pancreas 0   1   2   3  
Pelvic 0   1   2   3  
Popliteal 0   1   2   3  
Renal 0   1   2   3  
Thyroid 0   1   2   3  
UGI and small bowel 0   1   2   3  
Venogram 0   1   2   3  
 
Radiation Therapy:
Cobalt 60 therapy 0   1   2   3  
Dosimetry 0   1   2   3  
Hyperthermia treatment 0   1   2   3  
Linear accelerator with electrons 0   1   2   3  
Linear accelerator 0   1   2   3  
Ortho voltage radiation treatment 0   1   2   3  
Simulation of treatment sites 0   1   2   3  
Strontium 90 therapy 0   1   2   3  
Superficial radiation treatment 0   1   2   3  
Treatment planning 0   1   2   3  
 
MRI Technologist:
Gradient echo imaging 0   1   2   3  
Multiplanar reconstruction 0   1   2   3  
Partial saturation images 0   1   2   3  
Spin-echo images 0   1   2   3  
Surface coils 0   1   2   3  
T-1 weighted images 0   1   2   3  
T-2 weighted images 0   1   2   3  
 
Equipment:
GE .5 0   1   2   3  
GE 1.0 0   1   2   3  
GE 1.5 0   1   2   3  
Hitachi .5 0   1   2   3  
Hitachi 1.0 0   1   2   3  
Hitachi 1.5 0   1   2   3  
Phillips .5 0   1   2   3  
Phillips 1.0 0   1   2   3  
Phillips 1.5 0   1   2   3  
Picker .5 0   1   2   3  
Picker 1.0 0   1   2   3  
Picker 1.5 0   1   2   3  
Siemens .5 0   1   2   3  
Siemens 1.0 0   1   2   3  
Siemens 1.5 0   1   2   3  
Toshiba .5 0   1   2   3  
Toshiba 1.0 0   1   2   3  
Toshiba 1.5 0   1   2   3  
 
Age-Specific Practice Criteria:
Please check the box corresponding to each age group for which you have expertise in providing age-appropriate nursing care. Pediatric (1 - 12years)  
Adolescents (12 - 18 years)  
Adult (19 - 65 years)  
Older Adult (Older than 65 years)  
 
Experience With Age Groups:
Understand age-specific safety risks 0   1   2   3  
Use age-appropriate communication skills 0   1   2   3  
Provide age-appropriate education 0   1   2   3  
 
 
 
 


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