University of Wisconsin~La Grosse Medical Dosimetry Program Competency Check list Student Name: PFIFON y Bird a Clinical Site: MV. \aury Regional) Meolical center Competency Date Typhon Performed | Evaluation Completed Palliative (Spine, Hip, Ribs, etc) eee AEST Leak Para-aortic or nodal irradiation Limb Sarcoma Pelvis -GYN Lymphoma Intact Breast Tangents S-2h- VF [23-1 | ost Chest Wail Tangents (bolus: non-bolus weighting) with S’Clav and PAB ReTreat avoiding or matching old port (any area) ‘Lung with Boost (conformal) Abdominal IMRT (e.g. Pancreas) Brain IMRT with MR fusion Prostate IMRT MJ} (4-29-12 pate Prostate with nodes (IMRT) H&NIMRT Thoracic IMRT (eg. Esophagus or Lung) Electron Beam Plan Me WL=TE [24 -(3 [ase Brachytherapy Intracavitary or Interstitial Implant Plan *Other (suggested): Plan a patient that is to be Simulated and Treated on the same day (to experience time) *Not mandatory — strongly suggested Please make sure to fill out the appropriate form in Typhon when the student completes a competency. 1 Semester (Spring) — 4 competencies must be completed 2" Semester (Summer) — 6 competencies must he completed 3° Semester (Fall) — 7 competencies must be completed