CT / MRI / Radiography / Mammography

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CT/MRI/Radiography/Mammography Skills Checklist

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only

1 = Limited Experience / Rarely Done (<6 times/year)

2 = May Need Some Review / Occasionally Done (1 - 2 times/month)

3 = Experienced / Frequently Done (daily or weekly)

AGE OF PATIENTS CARED FOR

Newborn/Neonate (birth to 30 days)

1

2

3

Infant (31 days to 12 months)

1

2

3

Toddler/Preschool (13 months to 5 years)

1

2

3

School Age Child/adolescent (6 years to 18 years)

1

2

3

Young Adults/Middle Adult (19 years to 64 years)

1

2

3

Older Adults/Elderly (65+ years)

1

2

3

GENERAL SKILLS

Hospital Experience

1

2

3

Clinic Experience

1

2

3

Teaching/Educational Facility

1

2

3

Vital Signs

1

2

3

Care of patients in restraints

1

2

3

Use of transfer/lifting devices

1

2

3

Care of patients in isolation

1

2

3

National Patient Safety Goals

1

2

3

Knowledge of "Do Not Use Abbreviations"

1

2

3

Do you have charge/supervisor experience?

Yes

No

Knowledge of current Joint Commission National Patient Safety Goals

1

2

3

Knowledge/familiarity with HCAHPS scores

1

2

3

IV Pumps

Alaris

Baxter

IVAC

Alibaba

Braun

Zynomed

Bard

CADD

N/A

Other IV Pumps:

CT

Venipuncture

1

2

3

Upper extremities

1

2

3

Lower extremities

1

2

3

Upper extremities with contrast

1

2

3

Lower extremities with contrast

1

2

3

RF Ablations with CT

1

2

3

CT Guided Drainage

1

2

3

Adrenal

1

2

3

Appendix

1

2

3

Aortic Dissection

1

2

3

Aortic Aneurysm

1

2

3

Pediatric CT Exams

1

2

3

Abdomen

1

2

3

Biopsy

1

2

3

Brain without contrast

1

2

3

Brain with Contrast

1

2

3

Cervical Spine

1

2

3

Circle of Willis

1

2

3

CTA

1

2

3

Chest

1

2

3

Facial Bones/Maxillofacial

1

2

3

GI tract

1

2

3

IAC

1

2

3

Injection

1

2

3

Joint Studies ( Hip, knee ankle)

1

2

3

Larynx

1

2

3

Liver

1

2

3

Lumbar spine

1

2

3

Lung Biopsy

1

2

3

Pancreas

1

2

3

Pelvis

1

2

3

Pulmonary Embolism study

1

2

3

Radiation Therapy

1

2

3

RFA

1

2

3

Soft Tissue Neck

1

2

3

Spleen

1

2

3

Trauma Patients

1

2

3

TM Joints

1

2

3

3D Imaging

1

2

3

Smart Prep

1

2

3

Smart View

1

2

3

MRI

Gradient Echo Imaging

1

2

3

Muliplanar Reconstruction

1

2

3

Partial Saturation Images

1

2

3

Spin Echo Images

1

2

3

Surface Coils

1

2

3

T-1 Weighted Images

1

2

3

T-2 Weighted Images

1

2

3

Open

1

2

3

Closed

1

2

3

Brain

1

2

3

Extremities

1

2

3

Injections

1

2

3

Spine

1

2

3

RADIOLOGY

Abdomen

1

2

3

Arthrograms

1

2

3

Bone Density

1

2

3

Chest

1

2

3

ER Exams

1

2

3

GI Series

1

2

3

Hip

1

2

3

Hysterosalpingogram

1

2

3

OR Exams

1

2

3

PACS System

1

2

3

Portable Exams

1

2

3

Renal Tomography

1

2

3

Soft Tissue Studies

1

2

3

Trauma Exams

1

2

3

Urethrography

1

2

3

Extremities

Pelvic/Obliques/Judet Views

1

2

3

Pelvic Sacrum/Coccyx

1

2

3

Pelvic SI Joints

1

2

3

Upper/Lower

1

2

3

Skull

Facial

1

2

3

Mandible

1

2

3

Orbits

1

2

3

Sinus Series

1

2

3

Spine

Cervical Spine

1

2

3

Cervical Spine-Obls/Flexion/Extension

1

2

3

Lumbar spine

1

2

3

Lumbar Spine-Obls/Flexion/Extension

1

2

3

Thoracic Spine

1

2

3

Thoracic Spine-Swimmer's View

1

2

3

MAMMOGRAPHY

Bilateral Mammogram

1

2

3

Density Settings

1

2

3

Digital Mammography

1

2

3

Implants

1

2

3

Irradiated Breasts

1

2

3

Male Breast Scan

1

2

3

Mammography Quality Standards Act

1

2

3

Needle Aspiration

1

2

3

Needle Localization

1

2

3

Optical Breast Screening

1

2

3

Post Partum Mastitis

1

2

3

Reduction Mammoplasty

1

2

3

Specimen Radiographs

1

2

3

Spot Compression View

1

2

3

Stereotactic Core Biopsy

1

2

3

Self Breast Exams

1

2

3

FLUOROSCOPY

Angiogram

1

2

3

Arteriogram

1

2

3

Barium Enema

1

2

3

Bronchogram

1

2

3

ERCP

1

2

3

Esophagram

1

2

3

Gallbladder

1

2

3

Myelogram

1

2

3

Sialogram

1

2

3

Small Bowel Follow Through

1

2

3

Small Bowel Series

1

2

3

Tomogram

1

2

3

T-Tube Cholangiogram

1

2

3

Upper GI Series-Air Contrast

1

2

3

Upper GI Series-Single Contrast

1

2

3

Venograms

1

2

3

Voiding Cystogram

1

2

3

Barium Swallow

Modified Barium Swallow/Protocol Swallow

1

2

3

Swallow Studies with Videotaping

1

2

3

C-Arm Use

Mobile C-Arm Bronchoscopy with Fluoro Guidance

1

2

3

IVP

IVP with Tomograms

1

2

3

EQUIPMENT

GE

1

2

3

Philips

1

2

3

Siemens

1

2

3

Toshiba

1

2

3

PACS System

1

2

3

RIS-Cerner

1

2

3

MYELOGRAMS

Cervical Spine

1

2

3

Lumbar Spine

1

2

3

Thoracic Spine

1

2

3

OR CASES

Cystography

1

2

3

Extremity Studies

1

2

3

Hip Studies

1

2

3

Operative Cholangiography

1

2

3

Retrograde Urography

1

2

3

Spine Work

1

2

3

Sterile Procedures in OR

1

2

3

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