'UW-La Crosse Medical Dosimetry Program Master Competency Checklist student: Kristen Eberhard site: St Luke's Caner Cente Beisel Date Evaluation Performed Completed Head & Neck Primary Brain (Conformal, IMRT/VMAT) Primary H & N (IMRT/VMAT) Ithoracic Lung (Conformal, IMRT/VMAT) Esophagus (Conformal, IMRT/VMAT) Intact Breast Tangential Technique 1 A>JRD S3)a4]az Chest Wall Tangential Technique (bolus:non-bolus) w/Supraclav & Axilla Abdomen: Pancreas or GE Junction (Conformal, IMRT/VMAT) T Para-aortic or nodal irradiation (Conformal, IMRT/VMAT) T Pelvis 3 field Pelvis with Wedges | 4 field Pelvis Prostate with Nodes SIB Technique (IMRT/VMAT) Anus or Vulva Conventional 3D Technique* {Summer Semester} Extremities |_Limb Melanoma/Sarcoma (Conformal, IMRT/VMAT) Brachytherapy * t Taterstitial Tntracavitary HOR I [other ‘Craniospinal Irradiation® [Fall Semester] 4el® Palliative [ag] Upelge | Lymphoma (Mantie)* [Spring Semester] 4/4) 23 90. $3 Fo Electron Beam Plan gel? Fusion (MR, PET, etc) Balas 213, ee Re-leradiation ‘Stereotactic Body Radiation Therapy (SBRT)™ [allSemester sll” Sim & Start Tx Same Day Plan [22[za | eae ]aa__|* Pptional Proton Treatment Planning ‘Competency alt? (COMPETENCIES PER SEMESTER REQUIRED ‘# ACHIEVED ‘SPRING SEMESTER 5 ‘SUMMER SEMESTER & FALL SEMESTER ru ‘+ These competencies will be performed in a lab assignment. Students are encouraged to perform them in the clinical setting on actual patients if the opportunity arises. The lab will be included in the total competency requirement for the specific semester. + One Brachytherapy competency must be performed in the clinic. The lab will be Fall Semester.