SELF EVALUATION
X-RAY 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: yrs.

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.
CHEST/THORAX: HP VE EX SE NE
Chest – 2v
Chest – Lordotic
Ribs
Cardiac Series
Sternum
SPINE: HP VE EX SE NE
Cervical w Obl
Thoracic
Lumbar w Obl
Swimmer’s
Other:
HEAD: HP VE EX SE NE
Skull
Facial Bones
Orbits
Nasal Bones
Zygoma
Mandible
Mastoids
IACs
Panorex
SURGERY/PORTABLE: HP VE EX SE NE
Port Chest
Port Abdomen
Port Spines
Port Extremities
Portables in OR
C-Arm in OR
Cysto in OR
FLUOROSCOPY: HP VE EX SE NE
Upper GI
Barium Swallow
Barium Enema
Gall Bladder
T-Tube
Arthrogram
Myleogram
UPPER EXTREMITIES: HP VE EX SE NE
Fingers
Hand
Wrist
Navicular
Forearm
Elbow
Humerus
Shoulder
Shoulder - Y
Shoulder - Notch
AC Joints
Bone Age
LOWER EXTREMITIES: HP VE EX SE NE
Toes
Foot
Ankle
Tibia/Fibula
Knee
Knee – Patella
Knee – Notch View
Femur
Hip
PELVIC: HP VE EX SE NE
Pelvis
SI Joints
Coccyx
GU: HP VE EX SE NE
IVP
Tornograms
Cystogram
VCU
MISCELLANEOUS: HP VE EX SE NE
Pelvimetry
Sialogram
Salpingogram
Veinogram
Trama - Radiography
Trama - Portable 
Submitted by:      Date:

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