SELF EVALUATION
MAMMOGRAPHY SKILLS PROFICIENCY CHECKLIST

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     Last Name: 
    First Name: 
Middle Initial: 
Years Experience:  years

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.

 SE =

Some Experience.
Need review and assistance or supervision.
VE =

Very Experienced.
Can perform well without assistance or supervision.

 NE = No Experience.
EX =

Experienced.
Competent; can perform independently; may need initial review or supervision.
EQUIPMENT: HP VE EX SE NE
Siemens
Phillips
Lo-Rad
Picker
Bennett Contour
G.E.
Toshiba
Other:
PROCEDURES: HP VE EX SE NE
Breast Localization
Ductogram
Galactogram
Stereotactic Core Biopsy
Specimen Imaging
Other:
Other:
Other:
QC TESTS: HP VE EX SE NE
Daily Processor Strips
Phantom Images
Darkroom Fog Test
Compression Test
Screen/Film Contact
Repeat Analysis
Fixer Retention
Crossover Procedure
Weekly QC Checklists
Quarterly QC Checklists
Biannual QC Checklists
PT Tracking Reports
Other:
Other:
Other:
ROUTINE EXAMS: HP VE EX SE NE
C.C.
MLO
90o Lateral
CV (Cleavage)
Spot Compression
Spot Magnification
LMO
Roll view
CONTINUOUS EXAMS: HP VE EX SE NE
XCCL
Axillary Tail
Tangential
Eckluno Views for Breast
Augmentation 
Submitted by:      Date: 
Phone / Email:

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