University of Wisconsin--La Crosse Cc Medical Dosimetry Program - Competency Check list Student Name: Fei cia_Chu. Clinical Site:__Laey Hlaspitai (Buttington, MA) | Competency Date == Typhon | Performed | Evaluation | Completed / | Palliative (Spine, Hip, Ribs, etc) 4[s/i RED */ Para-aortic or nodal irradiation . = (/ Limb Sarcoma [57/0/74 #7 (Pelvis - GYN | la/ig/ig GEO Lymphoma rhifia | ‘/ Intact Breast Tangents Afie/iq | Chest Wall Tangents (bolus: non-bolus weighting) with Cc | $°Clav and PAB GI /2014 REO. "| ReTreat avoiding or matching old port (any area) 4[20/iq | RFD 7 | Lung with Boost (conformal) G/7/ 2914] REO » | Abdominal IMRT (e.g. Pancreas) Hi] 21 [20.q | RbaBs + 'v | Brain IMRT with MR fusion 9113/2019 | Reo | Prostate IMRT 6/5/2019 | RED + | Prostate with nodes (IMRT) 1/24 prod RED + 7, |H&NIMRT & ", | Thoracic IMRT (e.g. Esophagus or Lung) | 4193/29] RES 7 | Electron Beam Plan 7 3/29/14 REO 7 | Brachytherapy Intracavitary or Interstitial Implant Plan 4 6192014 [REC _ *Other (suggested): Plan a patient that is to be Simulated and Treated on the same day (to experience time) |_*Not mandatory — strongly suggested Whig gr. Please make sure to fill out the appropriate form in Typhon when the student completes a competency. é 1° Semester (Spring) - 4 competencies must be completed 2" Semester (Summer) ~ 6 competencies must be completed 3" Semester (Fall) — 7 competencies must be completed