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