UW-La Crosse Medical Dosimetry Program Master Competency Checklist formes Cashaer Site: St Harjs ~ SC& Health ed Date Evaluation Competency Performed | Completed + V| Primary Brain (Conformal, IMRT/VMAT) &/r]zz nb = a HEN ware a1 ee/t2 ae — | Lung (Conformal, IMRT/VMAT) qlsofzn | M4 + v| Esophagus (Conformal, IMRT/VMAT) ase | WS '* V| Intact Breast Tangentials w[3fez MS — | Chest Wall Tangentials (bolus:non-bolus) w/Supractav & Axilla wy j22 iw * V|_Pancreas or GE Junction (Conformal, IMRT/VMAT) Flaster | NG — | Para-aortic or nodal irradiation |, IMRT/VMAT tolia| ee At 3 fid Pelvis with Wedges Se )ar es + fafa Pelvis Glas/da + v/ Prostate with Nodes SIB Technique (IMRT/VMAT) 0/22/22 + ¥/ Anus or Vulva Conventional 3D Technique™ silat SET ng Limb Melanoma/Sarcoma |, IMRT/VMA 4[21]23. Interstitial Uf2olze [re gos! Intracavitary HOR wizalez [ab —| Craniospinal irradiation* Meter 120.5/123 *4¥. Palliative 3/31)a2 Wo Lymphoma (Mantle)* 2laylaa [34] sq= 88.94, —| Electron Beam Plan elgglaz Fusion (MR, PET, etc) ‘alar/oa_| NB = | Re-trradiation fofaej22 | _wy — | Stereotactic Body Radiation Therapy (SBRT)* Uf3el22 _|1SPfisv * [00 «vj Sim & Start Tx Same Day Plan o/ar (22, wh Proton Treatment Planning REQUIRED ACHIEVED SPRING SEMESTER 5 (Mantle Lab included) 5 SUMMER SEMESTER | 8 (Vulva Lab included) 8 FALL SEMESTER 10 (CSI & SBRT labs included) 1. ‘+ These competencies will be performed in a lab assignment. Students are encouraged to perform them in the clinical setting on actual patients ifthe opportunity arises. ‘t One Brachytherapy competency must be performed in the clinic.