SELF EVALUATION
MRI SKILLS PROFICIENCY CHECKLIST

Print this form and fax or mail:
Fax to: (505) 797-3822
Mail to: 5150 San Francisco RD NE Albuquerque, NM 87109 
NAME: _____________________________________
      Last           First          M.I.
 
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.

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

PROFICIENCY LEVEL
PROCEDURES:

HP

VE

EX

SE

NE

    

HP

VE

EX

SE

NE
Warm-up Procedures   MR Angiography:  Circle of Willis

Spin Echo Images

   MR Brain (IAC’s, Pituitary Gland, Orbits
Sinuses, Pallidotomy X-Knife)

Fast Spin Echo Images

   MR Neck: Soft Tissue
T1 Weighted Images     Brachial Plexus
T2 Weighted Images   MR Spine:   Cervical
Gradient Echo Images     Dorsal
Venogram: Carotids Neck     Lumbar Sacrum
  Aorta   MR Chest: Lungs
  Renals     Mediastinum
  Pelvis   MR Abdomen: Liver
  Upper Extremities     Kidneys
  Lower Extremities     Pancreas
Inversion Recovery Images   MR Pelvis: Bony Pelvis
Fat Suppression Images   Internal Organs: Uterus
Partial Saturation Images     Ovaries
Surface Coils     Prostate
Multiplanar Reconstruction   MR Upper and Lower Extremities
MRCP Cholangiograms   IV Conscious Sedation
Other:   Anesthesia Sedation
EQUIPMENT:

HP

VE

EX

SE

NE

    

HP

VE

EX

SE

NE
Siemans   GE Horizon LX
GE Tesla   GE Signa
Hitachi Airus (open unit) Other:
Phillips     Other:
Toshiba Opart (open unit)   Other: 
Submitted by:      Date: 
Phone / Email:

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