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.

Trial NERVOUS SYSTEM Primary Brain Tumor 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 X X 2/26/13-SB X X 3/27/13-slm X 7/10/13-JR X X X Mandatory y Elective Date/Int 6/20/13-TH X X 5/30/13-JD X

Comp /Date Completed 10/11/13 10/16/13 10/17/13 6/12/13 10/17/13 Score 90 100 100 100

Verified By Hattie Hattie Hattie Narinian Hattie

Spot Check Date/ P or F

4/4/13 4/4/13

100 100

murphy/hall murphy/hall

5/28/13 4/15/13 3/6/13 6/13/13

100 100 100 100

Wooden Kontras Beck Hutchinson

Trial 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) X 1/28/13-JO X X X X X 3/8/13-TH(z) X X 7/23/13-LR X 6/14/13-TH(z) X X X Mandatory Elective Date/Int X

Date Completed Score

Verified By

Spot Check Date/ P or F

7/23/13 7/23/13 9/19/13 9/25/13 7/23/13

100 100 100 100 100

Rivera Rivera Griffin Griffin Rivera

7/25/13 4/17/13 6/20/13

100 100 100

Rivera Sproat Buerkel

1/24/13 3/1/13 5/23/13 6/18/13 6/12/13 2/15/13

100 100 100 100 100 100

Wooden Beck Oravecz Hutchinson Hutchinson DeVault

Trial SKELETAL Spine Spine y 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 Prostate Treatment Verification Procedure Axilla Treatment Verification Procedure New Start Patient w/o prior verification New Start Patient w/o prior verification lung imrt New Start Patient w/o prior verification lung imrt Treatment Accessory Devices Bolus Patient Transfer X X X X X X X X X X X X 3/6/13-TH(z) X X Mandatory Elective Date/Int 5/22/13-JD X 7/26/13- LR X

Date Completed 5/24/13 6/18/13 10/24/13 5/22/13 Score 100 100 100 100

Verified By DeVault Buerkel Barhorst DeVault

Spot Check Date/ P or F

3/6/13 7/26/13 9/25/13

100 100 100

Hutchinson Rivera LaPaglia

7/10/13 6/9/13

100 100

Hall Pearson

1/21/14 2/7/14

100 100

Kreger/Jordan Hutchinson

1/23/14 2/6/14 2/10/14

100 100 100

Nelson Hutchinson Hutchinson

5/28/13

Pass

Wooden

** Multi-field is defined as three or more fields on the same target volume or the same site of interest with different target volumes