SELF EVALUATION
DOSIMETRY TECHNOLOGY
SKILLS PROFICIENCY CHECKLIST

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If you prefer, you can print a form to fax or mail.
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     Last Name: 
    First Name: 
Middle Initial: 
 Years Experience
DIRECTIONS: Place an X in the box that best describes your level of proficiency for each of the skills presented.
 
LEVELS OF PROFICIENCY KEY:
HP = Highly Proficient. Extensively experienced; able to supervise and/or train others.
VE = Very Experienced. Can perform well, without assistance or supervision.
EX = Experienced. Competent; can perform independently; may need initial review or supervision.
SE = Some Experience. Need review and assistance or supervision.
NE = No Experience.

PROFICIENCY LEVEL
DOSIMETRY SKILLS: HP VE EX SE NE

TREATMENT PLANNING SYSTEMS
ADAC
CMS FOCUS
RAHD
THERAPLAN
ROCS
GE
CAD PLAN
ECLIPSE
PLATO
RENDER PLAN
PROWESS
AcUPLAN
HDR
VARIAN
NUCLETRON
GAMA MED
IMRT
ADAC
CORVUS
CMS
PLATO
RADIONICS

TREATMENT PLANNING

3D HP VE EX SE NE
CT SIMULATIONS
BREASTS
PROSTATES
LUNG
HEAD AND NECK
PELVIS
MANTLE
FUSIONS
MLC
DYNAMIC WEDGES
OTHER AREAS OF SKILL HP VE EX SE NE
(1)
(2)
(3)
2D HP VE EX SE NE
IRREG FIELDS
CONTOURS
RECORD AND VERIFY          
IMPAC
VARIS
FILMLESS          
PROTAL IMAGING
KODAK
EQUIPMENT USED: HP VE EX SE NE
(1)
(2)
(3) 
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