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THE OHIO STATE UNIVERSITY

RADIATION THERAPY
CLINICAL COMPETENCY EVALUATIONS
Class of 2015 - 2017

All 32 of the mandatory treatment competencies and 8 of the elective competencies must be completed. 1 Comp on 5th and 6th rotations, 2 each on 7th
9th, 5 each on 10th - 15th and 2 on 16th rotation. The students will demonstrate their skills on the patients of their choice except for spot checks which will be
chosen by the instructor. Students must perform the competency with the Clinical Supervisor, Clinical Instructor (having greater than 2 yrs. experience as a
therapist), Clinical Coordinator or the Program Director. The front of the competency form must be completed prior to performing a clinical competency.

Trial Comp /Date Verified Spot Check


NERVOUS SYSTEM Mandatory Elective Score
Date/Int Completed By Date/ P or F
Primary Brain Tumor
Primary Brain Tumor X
Metastatic Brain

Metastatic Brain X
HEAD AND NECK
Wedge Pair (ie. Sinus, Parotid, Larynx, Orbit) X
IMRT to include supraclav
IMRT to include supraclav X
IMRT to include supraclav X
3 Field* (ie. Bilateral Neck or IMRT with
separate AP Supraclav) X

Laterals only X
CHEST
AP/PA X
3 or More Fields or IMRT

3 or More Fields or IMRT X


Trial Date Verified Spot Check
ENDOCRINE Mandatory Elective Score
Date/Int Completed By Date/ P or F
Primary (Pituitary, Thyroid, Adrenal) X
BREAST

Tangents Only
Tangents Only X

Tangents Only - Prone X

Tangents with Supraclav

Tangents with Supraclav X


Tangents with Supraclav and Posterior Axilla X
Tangents with Supraclav and Internal
Mammary X

ABDOMEN
AP/PA** X

3 or More Fields or IMRT


3 or More Fields or IMRT X
Para-Aortic X
PELVIS
AP/PA** (ie, boost) X
IMRT/ Multi-field Pelvis (Supine)

IMRT/ Multi-field Pelvis (Supine) X

IMRT/ Multi-field Pelvis (Cone Beam) X

IMRT/ Multi-field Pelvis (Prone) X

Inguinal (Photons or Electrons) X


Trial Date Verified Spot Check
SKELETAL Mandatory Elective Score
Date/Int Completed By Date/ P or F
Spine
Spine X
Extremity
Pelvic (ie. Hip, Sacrum or Iliacs) X
ELECTRON FIELDS
Single Field
Single Field X
Abutting fields (Photon & e- or e- with e-) X

LOW VOLUME, HIGH RISK PROC.


Mantle X
Craniospinal Axis X
Total Body (assist) X
Total Skin (assist) X
VERIFICATION & NEW STARTS

Treatment Verification Procedure X

Treatment Verification Procedure X


Treatment Verification Procedure X

New Start Patient w/o prior verification X

New Start Patient w/o prior verification X


New Start Patient w/o prior verification X
Treatment Accessory Devices
Bolus X
* Multi-field is defined as three or more fields on the same target volume or the same site of interest with different target volumes
** AP/PA Abdomen and AP/PA Pelvis does not include treatments for metastatic spine disease