University of Wisconsin-La Crosse

Medical Dosimetry Program

Competency Check list
Competencies CANNOT be performed on datasets
they must be performed on real patients

Student Name:_______________________________________________________
Clinical Site:_________________________________________________________
Competency Evaluators
initials
Date
Performed
First Rotation Palliative
Para-aortic or nodal irradiation
Pelvis-4 field
Abdomen-3 or 4 field
Off-axis prescription point
Pelvis-3 field
Second Rotation Palliative
Intact Breast Tangentials
Chest Wall Tangentials (bolus: non-bolus
weighting)

Breast or Chest wall with sclav and PAB
Thoracic (Conformal)
Limb Sarcoma
Lymphoma
Prostate (IMRT or conformal)*
True Vocal Cord
Third Rotation Palliative
H & N (IMRT or conformal)*
Electron Beam Plan
Brain (IMRT or conformal)*
Esophagus (IMRT or conformal)*
Intracavitary Implant plan
Interstitial Implant Plan
Other:
*The competencies with the asterisk can be done on either an IMRT plan OR a conformal plan. Please
make sure you fill out the appropriate form when completing the competency.