THE OHIO STATE UNIVERSITY RADIATION THERAPY CLINICAL COMPETENCY EVALUATIONS Class of 2012 - 2014

All 36 of the mandatory treatment competencies and 4 of the elective competencies must be completed. 1 Comp on 5th rotation, 2 each on 6th 8th, 5 each on 9th - 14th and 3 on 15th 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.

NERVOUS SYSTEM Primary Brain Tumor Primary Brain Tumor Metastatic Brain Metastatic Brain HEAD AND NECK Wedge Pair (ie. Sinus, Parotid, Larynx, Orbit) IMRT without separate supraclav IMRT without separate supraclav IMRT with separate AP supraclav Multi-field** (ie. Bilateral Neck with AP Supraclav) Laterals only Boost Posterior Neck Electrons CHEST AP/PA Off Cord Obliques 3 or More Fields or IMRT 3 or More Fields or IMRT

Mandatory

Elective

Trial Date/Int X

Comp /Date Completed

Score

Verified By

Spot Check Date/ P or F

X X X X X

ENDOCRINE Primary (Pituitary, Thyroid, Adrenal) BREAST Tangents Only Tangents Only Tangents with Supraclav Tangents with Supraclav Tangents with Supraclav and Posterior Axilla Tangents with Supraclav and Internal Mammary ABDOMEN AP/PA 3 or More Fields or IMRT 3 or More Fields or IMRT Para-Aortic PELVIS AP/PA (ie, boost) IMRT/ Multi-field Pelvis (Supine) IMRT/ Multi-field Pelvis (Supine) IMRT/ Multi-field Pelvis (Cone Beam) IMRT/ Multi-field Pelvis (Prone) Inguinal (Photons or Electrons)

Mandatory

Elective

Trial Date/Int X

Date Completed

Score

Verified By

Spot Check Date/ P or F

X X X X

X X

X X X X

SKELETAL Spine 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 Bolus
R:Admin/Clin Therapist/Word as of 6/12

Mandatory

Elective

Trial Date/Int X

Date Completed

Score

Verified By

Spot Check Date/ P or F

X X

X X X X

X X X X X 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