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

Mandatory

Primary Brain Tumor

Primary Brain Tumor

Metastatic Brain

Metastatic Brain

Elective

Trial
Date/Int
X

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

Comp /Date
Completed

Score

Verified
By

Spot Check
Date/ P or F

ENDOCRINE

Mandatory

Primary (Pituitary, Thyroid, Adrenal)

Elective

Trial
Date/Int

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)

Date
Completed

Score

Verified
By

Spot Check
Date/ P or F

SKELETAL

Mandatory

Spine

Spine

Extremity

Elective

Date
Completed

Score

Pelvic (ie. Hip, Sacrum or Iliacs)

Trial
Date/Int

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)

X
X

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

** Multi-field is defined as three or more fields on the same target volume or the same site of interest with different target volumes
R:Admin/Clin Therapist/Word

as of 6/12

Verified
By

Spot Check
Date/ P or F