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During clinical procedures, the student must demonstrate competency of the following:

1. Review chart, and DRRs or simulation films prior to preparing patient for

-review patient set up and assures understanding

-utilize DRRs or simulation films for set-up on initial treatment
-recognize need for port films

2. Checks prescription with total dose currently delivered.

-read prescription daily

-check daily prescribed dose against daily treatment dose
-check total prescribed dose against current total delivered
-check addition of total dose

3. Prepare treatment room with appropriate equipment

-utilize set-up information in chart

-set out appropriate positioning aids, custom blocks and wedges

4. Greet and assist patient to and from the treatment area

-greet patient
-confirm patient identity
-introduce self and other pertinent personnel to patient
-ask as to patient's general condition

5. Explain procedure if new to the patient and confirm patient's understanding

-explain purpose and procedure to be done

-use language that is non-technical and appropriate to patient understanding
-confirm patient understanding

6. Assist patient into treatment position

__ Ambulatory, ___ Wheel Chair ___ Cart

-assist patient to treatment table from wheelchair

-assist in safely lifting patient from cart
-assist patient by supporting back/neck and lifting legs while reclining
-position headrest and other devices for proper function and patient comfort

7. Position patient to reproduce set-up indicated in treatment chart

-utilize any and all appropriate positioning aids

-position extremities as indicated in chart
-correct for any misalignment before proceeding with treatment
Clinical Competency Objectives Cont.

8. Immobilize patient

-use all appropriate immobilization devices as indicated in

-utilize safety belts as needed if patient is not secure on table
-assure patient comfort within guidelines of immobilization device use

9. Aligns Tx field & Set treatment parameters to reproduce set-up as indicated in

chart or EMR

-assure correct field size is set

-use correct patient markings
-accurately align radiation light field with accurate markings
-set correct SSD/SAD
- assure correct table/couch angle is set
- assure correct gantry angle is set
- assure correct collimator angle is set

10. Select and place correct blocks, wedges, compensators, bolus, etc.

-check chart/simulation sheet or prescription for required beam modifying devices

-check films for correct placement of MLCs or custom blocks
-check treatment plan for correct wedges and the orientation of wedges
-place and secure blocks and wedges into proper orientation and location
-place bolus as indicated
-double check for correctness of devices before administering treatment

11. Recheck set-up with set-up indicated in electronic chart and films

-recheck prescription, films, set-up instructions, and compare to actual patient

-resolve any discrepancies if field alignment does not match
-call for assistance from technical supervisor, dosimetrist, or physician if
discrepancies are not resolved

12. Indicate to patient that treatment is to begin

-instruct patient to remain still during treatment

-inform patient that treatment is to begin
-close door to treatment room

13. Set appropriate controls on treatment machine console treating through the record
and verify system.

-set timer/monitor units as indicated in chart if paper chart

-assure back-up timer allows adequate time for treatment
-set accurate rad/degree for rotational treatment
-select correct electron/photon energy
Clinical Competency Objectives Cont.

14. Performs verbal timeout.

-state patient name, treatment site, treatment fraction, and/or any other
information required by the institution prior to activating machine for treatment
or localization.

15. Performs IGRT and aligns the patient appropriately. ____Conebeam _____OBI
_____Exact Trac _____Vision RT

-use appropriate equipment to obtain adequate imaging prior to treatment.

-view images and adjust table parameters to align fudicials or
bony landmarks as indicated.
-patient alignment should be within approximately 3mm of where the therapist or
physician approves.

16. Activate machine to deliver prescribed dose

-perform appropriate procedures in proper sequence to beam on

17. Monitor patient during treatment

-assure clear view of camera during treatment

-communicate to patient via audio monitors if necessary
-turn off treatment unit if patient moves or appears to be in distress

18. Monitor treatment unit function during treatment delivery

-check for rad on

-check for operating lights
-check treatment unit for output

19. Verifies (EMR) or records (paper chart) technical data was documented in patient

-verify correct MUs and dose were recorded if EMR

-write appropriate figures in required spaces
-add columns correctly
-note wedge checks
-note port films taken
-check co-workers charting

20. Records patient data in treatment chart

-write appropriate technical notes

-documents bolus, SSDs, etc.
-create patient checklists if applicable
Clinical Competency Objectives Cont.

21. Set up opposing/additional portals correctly

-follow all previously listed behaviors to set-up additional ports

22. Utilize all treatment equipment safely

-move gantry and table with care

-lift blocks and wedges so as not to drop them
-place and secure equipment safely
-use equipment so as not to frighten or harm the patient
-utilize the equipment so as not to incur equipment damage

23. Assist patient from treatment table

-help patient sit up, supporting patient's back and neck

-help patient move legs off table
-assure patient is standing steadily before leaving them
-help patient into wheelchair
-assist in securely lifting patient from table to stretcher

24. Answer patient questions

-attempt to answer questions from patients and families

-direct questions to others if unable to answer

25. Answer therapist questions relevant to the procedure

-set-up and/or treatment delivery questions asked by a therapist to verify the

students understanding of concepts relevant to the procedure performed are
answered appropriately.

26. Attend to additional patient care details

-send patient for laboratory tests when needed

-send patient to be weighed when needed
-keep patient for physician examination when necessary
-schedule simulation when necessary
-inform patient of upcoming scheduled events

27. Display ethical standards and maintain a level of professionalism

-speak in manner appropriate to the situation

-refer to patients, physicians, co-workers with respect
-refrain from discussion of inappropriate topics in the
treatment area
-treat patients and families with respect and dignity
-demonstrate a confident and competent manner