SELF EVALUATION
MRI 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
PROCEDURES: HP VE EX SE NE
Warm-up Procedures
Spin Echo Images
Fast Spin Echo Images
T1 Weighted Images
T2 Weighted Images
Gradient Echo Images
Venogram: Carotids Neck
  Aorta
  Renals
  Pelvis
  Upper Extremities
  Lower Extremities
Inversion Recovery Images
Fat Suppression Images
Partial Saturation Images
Surface Coils
Multiplanar Reconstruction
MRCP Cholangiograms
Other:
MR Angiography:  Circle of Willis
MR Brain (IAC’s, Pituitary Gland, Orbits
Sinuses, Pallidotomy X-Knife)
MR Neck: Soft Tissue
  Brachial Plexus
MR Spine:   Cervical
  Dorsal
  Lumbar Sacrum
MR Chest: Lungs
  Mediastinum
MR Abdomen: Liver
  Kidneys
  Pancreas
MR Pelvis: Bony Pelvis
Internal Organs: Uterus
  Ovaries
  Prostate
MR Upper and Lower Extremities
IV Conscious Sedation
Anesthesia Sedation
EQUIPMENT: HP VE EX SE NE
Siemans
GE Tesla
Hitachi Airus (open unit)
Phillips  
Toshiba Opart (open unit)
GE Horizon LX
GE Signa
Other:
Other:
Other: 
Submitted by:      Date: 
Phone / Email:

    

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