THE OHIO STATE UNIVERSITY

RADIATION THERAPY
CLINICAL COMPETENCY EVALUATIONS
Class of 2017 - 2019

All 35 of the mandatory treatment competencies and 5 of the elective competencies must be completed. 1 Comp on 5th and 6th rotations, 2 each on 7th &
8th , 3 on the 9th, 5 each on 10th - 14th and 3 each on the 15th and 16th rotations. 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 
Metastatic Brain 
Metastatic Brain 
HEAD AND NECK
Wedge Pair (ie. Sinus, Parotid, Larynx, Orbit) 
IMRT or Arc to include supraclav 
IMRT or Arc to include supraclav 
IMRT or Arc to include supraclav 
3 Field* (ie. Bilateral Neck or IMRT with
separate AP Supraclav) 
Laterals only 
CHEST
Multi-field (non-IMRT) 
3 or More Fields or IMRT or Arc 

IMRT or Arc 
Trial Date Verified Spot Check
ENDOCRINE Mandatory Elective Score
Date/Int Completed By Date/ P or F
Primary (Pituitary, Thyroid, Adrenal) 
BREAST
Tangents Only - Supine 
Tangents Only - Prone 
Tangents with Supraclav 
Tangents with Supraclav and Posterior Axilla 
Special Set-up (e.g., Photon or Electron Boost,
IMRT, Gating) 

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

IMRT or Arc / Multi-field Pelvis (Cone Beam) 

IMRT or Arc / Multi-field Pelvis (Prone) 

Inguinal (Photons or Electrons) 
Trial Date Verified Spot Check
SKELETAL Mandatory Elective Score
Date/Int Completed By Date/ P or F
Single field Spine 
Multi field Spine 
Extremity 
Pelvic (ie. Hip, Sacrum or Iliacs) 
ELECTRON FIELDS
Single Field 
Single Field 
Abutting fields (Photon & e- or e- with e-) 
LOW VOLUME, HIGH RISK PROC.
Mantle 
Craniospinal Axis 
Total Body (assist) 
Total Skin (assist) 
VERIFICATION & NEW STARTS

Treatment Verification Procedure 

Treatment Verification Procedure 
Treatment Verification Procedure 
New Start Patient w/o prior verification 
New Start Patient w/o prior verification 
New Start Patient w/o prior verification 
Treatment Accessory Devices
Custom Bolus 
Patient Transfer 
Participation in Brachytherapy Procedures 
* 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/