THE OHIO STATE UNIVERSITY

RADIATION THERAPY
CLINICAL COMPETENCY EVALUATIONS
Class of 2014 - 2016

All 33 of the mandatory treatment competencies and 10 of the elective competencies must be completed. 1 Comp on 5th rotation, 2 each on 6th – 9th, 5 each
on 10th - 15th and 4 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
Boost Posterior Neck Electrons  X
CHEST
AP/PA  X
Off Cord Obliques  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
R:Admin/Clin Therapist/Word as of 8/