Medical Dosimetry Program

Phone 616-331-5752, Fax 616-331-5632

College of Health Professions
Center for Health Sciences
301 Michigan Street, Suite 412
Grand Rapids, Michigan 49503

Student Name

Clinical Site:

Student Competency Checklist for Graduation

Mandatory (Must Complete All)

Evaluator

Date Performed

Image fusion for planning

Irregular Field Calc Plan
Pelvis 4 field
Abdomen 3 or 4 field
Para-aortic or Nodal Irradiation
Pelvis - 3 field with wedges
IMRT or Arc Plan (VMAT/Tomotherapy)
Intact Breast Tangentials
Chest Wall (Tangents or electrons)
Thoracic (Initial & Offcord)
Limb Sarcoma
Lymphoma
Prostate - IMRT/Conformal
Palliative
Parotid (wedge pair or mixed energy)
H&N IMRT/Conformal (Primary and Off Cord
plans)
H&N IMRT/Conformal (Boost and SC plans)

GVSU Medical Dosimetry Program Student Handbook

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Electron Beam Plan

Brain (Conformal/Fusion)
Intracavitary Implant Plan
Interstitial Implant Plan
Note: Completed Competency Evaluation Form Required for Each Mandatory
Competency
Optional (Must complete 5)

Evaluator

Date Performed

Observe High Dose Rate (Plan and Tx)

Observe SRS (Plan and Tx)
Observe SBRT (Plan and Tx)
Observe Respiratory Motion Mgmt (Plan and Tx)
Participate in Retreatment Planning
PA
Axillary Boost Plan or Calculations
Managemen(PlanandTx)
Clinical Dosimetrist Assignment *
Clinical Dosimetrist Assignment *
Observe Brachytherapy OR Insertion
( (Sim/Plan/Treatment)
Observe
Brachytherapy Source Preparation
Participate in Total Body Irradiation Planning
Participate in Cranio-Spinal Planning
Observe Patient Specific QA
Observe QA of equipment: Simulator
Observe QA of equipment: Other (HDR, etc.)
Observe QA of equipment: Linear Accelerator
* Could include special dosimetry measurements

GVSU Medical Dosimetry Program Student Handbook

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