Dosimetrist Checklist


Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  AGE OF PATIENTS CARED FOR         Rating Stars (Click) 1 2 3 4
  Newborn/Neonate (birth to 30 days)  
  Infant (1 month to 1 year)  
  Toddler (1 year to 3 years)  
  Preschooler (3 years to 5 years)  
  School Age Child (5 years to 12 years)  
  Adolescents (12 years to 18 years)  
  Young Adults (18 years to 39 years)  
  Middle Adults (39 years to 64 years)  
  Older Adults (64 years to 79 years)  
  Elderly Adults (over 79+ years)  
  GENERAL SKILLS         Rating Stars (Click) 1 2 3 4
  Standard Precautions  
  Isolation Precautions  
  Pediatric Respiratory/ Cardiac Arrest  
  Adult Respiratory/ Cardiac Arrest  
  Crash Carts  
  Defibrillators  
  RADIATION THERAPY PHYSICS         Rating Stars (Click) 1 2 3 4
  Physical Property of Atoms and Nuclei  
  Basic Nuclear Transformations  
  Medical Linear Accelerations  
  Interaction of High Energy Electrons & X-Rays with Matter         Rating Stars (Click) 1 2 3 4
  Photoelectric Effect  
  Campton Scatter  
  Pair Production  
  Physical Properties of Dose and Exposure  
  Dosimetry Equipment         Rating Stars (Click) 1 2 3 4
  Ion Chambers  
  Thermoluminescent Dosimetry  
  TG-51 (Calibration Protocol)  
  Radioactive Isotopes  
  Electron Beam Therapy  
  IMRT (Intensity Modulated Radiation Therapy)  
  Beam Modifiers         Rating Stars (Click) 1 2 3 4
  Physical Wedges  
  Dynamic Wedges  
  Blocks  
  3-D Conformal Radiation Therapy  
  Basic Principles and Applications         Rating Stars (Click) 1 2 3 4
  CT Scan  
  MRI Machine  
  PET Scan  
  BRACHYTHERAPY PROCEDURES         Rating Stars (Click) 1 2 3 4
  Systemic Errors  
  Random Errors  
  Treatment Documentation  
  Procedure Checklists  
  & Forms  
  Application Preparation  
  Application Insertion  
  Implant Localization and Stimulation  
  Treatment Prescription  
  Implant Design and Evaluations         Rating Stars (Click) 1 2 3 4
  Localization  
  Computer Treatment Planning  
  Manual Verification of Computer  
  Patient Preparation  
  Setup  
  and Treatment  
  Post Treatment Quality Assurance  
  Emergency Procedures for HDR         Rating Stars (Click) 1 2 3 4
  Routine Emergency Equipment  
  Physical Plant Emergencies  
  Minor and Major Emergencies  
  Intravascular Brachytherapy  
  Prostate Seed Implants:         Rating Stars (Click) 1 2 3 4
  I-125 Seeds  
  P-103 Seeds  
  Ommaya Reservoir  
  TREATMENT PLANNING         Rating Stars (Click) 1 2 3 4
  Auxiliary Devices (Digitizer  
  Plotter)  
  Software  
  Quality Assurance  
  SPECIAL TECHNIQUES         Rating Stars (Click) 1 2 3 4
  TBI (Total body Irradiation)  
  Electron Arc Therapy  
  Interoperative Electron Therapy  
  TSI (Total Skin Irradiation)  
  SRS (Stereotactic Radiosurgery)  
  Beam Data Acquisition for Small Fields  
  Treatment Planning Computer Data Input  
  SRT (Stereotactic Radiotherapy)  
  STANDARDS FOR TREATMENT PLANS/PROTOCOLS         Rating Stars (Click) 1 2 3 4
  Ensures Accurate Dose  
  Ensures Proper Patient Positioning  
  Ensures Proper Machine Settings  
  Deviation of Normal Parameters for Equipment  
  Field Shaping         Rating Stars (Click) 1 2 3 4
  Custom Blocking  
  Multileaf Collimators  
  Half-Value Thick Blocks  
  Gonadal Shields  
  Eye Shields  
  Internal Shields  
  In Vivo Dosimetry  
  TLD (Thermoluminescent Dosimeters) Chips  
  Patient Positioning         Rating Stars (Click) 1 2 3 4
  ImmobilizationDevices  
  Anatomic Landmarks  
  Certifications         Rating Stars (Click) 1 2 3 4
  Medical Dosimetrist Certification Board