UW-La Crosse Medical Dosimetry Program Master Competency Checklist Student: Kearla Betz _ Site Bares Cree Date] Evaluation ‘Competency Performed | completed Primary Brain (Conformal, IMRT/VMAT) Ty y sa (RT vMAT) — Lung Conformal IMRT/VMT) Esophagus (Conformal, IMRT/VMAT) By HY Intact Breast Tangentals Sha +y ‘Chest Wal Tangentias(bolus'non-bolus) w/Supraia & Ala Pancreas or GE Junction (Conformal, IMRT/VMAT) 2 Para-aortic or nodal radiation (Conformal, IMAT/VMAT) 3 fd Pelvis with Wedges “fd Pelvis 4p Prostate with Nodes SIB Technique {IMRT/VMAT) ‘Anus or Vulva Conventional 30 Technique™ Limb Melanoma/Sarcoma (Conformal, IMRT/VMAT] Interstitial Intracavtary HOR Craniospnalirradiation* Pealiative Yf2n Lymahema (Wantle)™ ale Electron Beam Pan vi by Fusion (MR, PET, eta) Yee yp Re-Iradiation u ‘Stereotactic Soy Radiation Therapy (SBRT)> wias 1 Ky Sim & start Tx Same Day Pan Proton Treatment Planning Ld EE ‘SPRING SEMESTER [Mantle ta includ) 5 'SUMMER SEMESTER [8 (Vulva Lab incudeo) FALL SEMESTER 10 (CS & SBRT labs included) + These competencies willbe performed in a lab assignment. Student are encouraged to perform them inthe Clinical setting on actual patients if the opportunity arises. +t One Brachytherapy competency must be performed in the clink‘ical nsctrs (JACOBSON Kevin) ‘uents (Gen Kear) nena Completes: ‘yiaro2a 2057 MCT 1. Slat he extra beam MAT planing competency rm te drop own menu below: 2. ther competency spect the ype hee sor 2. Plaaae asin each ak acoef Saison ox Unatitsctoy. Unaatistctry nay esertal task consti empetency ore “The tuent ll peat he competency at oer date Dieunes he an presrpion wth he yan satefcton leo Loads te patent imanog ste io the slening conor sattcory teow ‘Acct ses nage dat sts ogee safety eo Comours he spropnlte anton onthe mage et set saetacton, tept ‘Suecetstuty ices acer ing srs ta, Suetactry feo Comey cotmatea anes tiiatcanomeal Sty ott Ceverate pon mth prope eves Satistectny teow ‘ete menipute ROVPTY consainsintheopbmizerio chan an Sttctary teow pina ‘Accu optzes and generates concomitant boos pan, wa sect grt on nil DVM comoatte VM or ‘Sattar teptal comet # orc). Lntestade he concept pescting spots. pesciting to Sttctn, teow) aolune and ale to aust the pon %normotzaton a neede, ‘Communicates effectively wth physician fer plan review andmakes Satisfactory pu) changes a reauested rooting ln ta saitctory teow ‘Acutely errate the OA forthe pan satiny bo eur cost prameters for ats cht satatctory bos Pete pretest kant. satatcory teow) ‘bse MT Ok and ani of A satectny teow observes patent eaten sateen, eos Mean: 2.00 of2 Points: 24 Seore: 100.0%‘Survey: "3D- CRT Photon Planning Competency Evaluation” Revit: Cina! nstctors (JACOBSON Ken) Revie: Suge (Bert Kea) ‘Survey Peri mena Complete: 29202320722 PM CT 1. Select he external beam photon planning competeny fom the dropdown menu below Primary an 211 omer competency, plese spec the ype hee: 2. Plasee asian each ak score of Satis ox Unsatisfactory, Unaatisectry nay essenal tas onatiutes competency fale ‘The ent wl epet the conpeteney at ne date Deusen the oan resent the yan Sattctry teow Londen pet maging sisi te pling comer Satter owt ors te arose nat onthe mage ats Satter pet Suceestay paces ne ocenarvsngsmdston sa. svetectny bee Cec generates ln ung Hace wages serarteis Stason aoe CGeeate pant aproeate weare Safety aot evr pan its prope eerie. satfectny os Accra greta an OV ercorposie DVM (lor ——_aactoy eo coect #0! Facts), feo ptt Perea a veteatio sean fan A stings satfctory eon fever const parameter rh ptt hat sateen feo) Putonms pitts chect/ekevitons safactony feo Utes spat going inematontcetemine eprom WA tse patent eset Safeco, feos Moan: 2.00 of Points: 28 Sore: 100.0% 4 ovrtratng: eee os Mean: 2.00 0f2 Points: 2 Score: 100.0% ‘Total points for al rating scale questions: 30 Mean percentage score for all rating scale questions: 100.0% (eschman question ely nied 4Ciicalinsinctrs (JACOBSON, Kevin) Students (Bez Kear) 1. Selec the external beam IMRT planing competency rom the hop down mantlow Abdominal MT other compton. pei the pe hee: (6 Jueton MAT 2. Plaae seg ech tata score of Stsfactary or Unesco. ‘Unetstatry nan essential tsk conttites competency flute "The student wil opeat he competency atte date Decurts te pan prescription wth the pyiin Load e patent maggie it the planning computer ‘Accurately uses image daa sts together Comtur the ogroprite aston onthe image data et, ‘Seeesfuly paces the accent using radon dat, Comet enarates optima bea angles for pase anatomic! Generates pln wth aprorote energies, ‘bet manguite ROUPTV contrainte inthe optimise to bien ‘ptimal pan ‘Accurately optnzes a gnats» concomtnt best la ‘Acca geertes an indi DVM of compose DVM fr cares #of factions), Understands the conceot of pesrbing fo ott vs. rescrbng to ‘volume and ia to act the plan reason a need, ‘Communcatesetecrey wth physican fer plan review and makes changes 0 rues xpons/Pints soporte plan ds, ‘Accurately gtretates he OA forthe plan Evers n covet granites footer het Peron pateatment heck/eaeitins neers MT QA sn ana of 8 Sattactory ‘Satetatoy ‘Satatecton, satiatcory Satatectry ‘Satetectory Saitctory satitctny Sattectony Satstoctoy Satistctony Satetsctoy Satetsctoy Mean: 2.00 0f2 Points: 36 Score: 100.0% repr pu (eet (ept) pt) taps tepu teen) feo) tas) pe) ps) apts em ps) eps pu weincl insets (JACOBSON Kei) ‘Sudents (Benz Kear) serzeza anirzoaa 11022 AMCT 1. select te enamel Beam IME planing competency rom the op down menu below 2. ote compateney, speci the ype het 2. Pleue assign each task sor ofStsfactory of Unasiactory. ‘Unsatetactry nan essnta task contiutes competency flue ‘The sent wl opt he competency alate date Discusses te slan presripion wih the pysian Lande he patent imagiag sues it the planning computer Accu tures image dat ets ogee Comaur he pop nara the wage dt. Successful paces the oceter using siruston dota Coectygenetes opin bem sgl or pei naomi Generates plan with peropeate energies ‘Atle to manipulate ROVPTY cna nthe oper ban an ‘ota son Accurate ootmizes and geretees 3 cancomtant boos plan Accurately generates an dvd DV or cmpaste DV (or corect # of action) LUnrstans the concapt of prescring oa pit petrbing to 2 elume ans aleto aust the plan normalization as nese Communicates effect wth pyscon for plan evi ae makes changes as reauetes spots apropriate plan Accurately generate the OA forthe pan bers WRT OA an ana of OA serves pate Hest Satatectry ‘attactoy ‘satetetory ‘Ssatetsctory satisfactory satitcory sutctry satiatctny atatectry Sattetory Sattectry satiatcory satistctory ‘Mean: 2.00 of2 Points: 36 Score: 100.0% leew pu pe) (pt) (pt) tpt) eps) Reps ep tape pu tpt) ape) pt) eps) eps) eps ew 1.Survey: "IMRT Planning Competency Evaluation” Revewee: Survey Paid Completed: Cine! strctors JACOBSON, Kev) Stuoens (er Kea) ener2023 ane/2az3 voas4oaM cr 1. Select he extra beam MRT planning competency rm te drop own menu blow “Torale MT (6 Ling, Esphegue.) 2.tfother competency spect the type nee Esophagus MAT ‘The stdent wil repeat he competency a ltr Ste Dicuss the plan preserston wth the physician Loads he atin maging sue it th planning compute Accurtly fuses image dat see oper Comtour the apprpnat anatomy onthe mage data et Successful paces the ocete using ston dota Cconeth greats optima be agi for pei natomies Senerts pan wth apport eerie Able to mandate ROVPTY constant ihe opterizs to ta an ‘otinal pan ‘Accurately opmiaes and generate concomitant boos plan. Aceuatelygeertes annual DVH of compost DVM fr cares #0 fotos), Understans th concent of pesrbing oot. presribing to ‘volume ad nal to aust the pan ormalzaton a ede, ‘Communicates efetively wah physician for pln review ard makes changes a reves spon /Pinsapropate plan ta. ‘Accurate generates th forte pan rer in covet parameters for patent hart Pets oetestrar checks /elitions beers MTOR ad sii of OA, serves patent este Mean: 2.00 of 2 Points: 36 Seore: 100.0% Satstctony Satisfactory Satatectory ‘Sattectory Saistctny satetetory Satisfactory Satatectory satstoctoy satiatcony Satitactny Sattotoy Setstecton eps) pu taps ap tape) tata) pt) ew eps feo) pt) pe eeu eps) tpt) pe) ep) taps} 42Survey: "IMRT Planning Competency Evaluation” Survey Paid Completed: Cina! strctrs JACOBSON, Kei) sucers (rz Kea) 77912073 30340 PM oT 1. Select the extra beam MRT planning competency rom te drop down meu blow Prostate wth ode IMRT 2tfoter competency spect the pe here: 2 Pate asin each tank scare of Satin or Unettatoy. Unsatfectr inary essential tsk constutes competency fale “he eudent wl repeat the competency a ltr cate Discusses the plan pescrnton wth the physican. Load he pet maging sacs eto he planing comer Accurately fuses mage dat sete oper ‘Contours he aprorateanetomy on the mage data se Succesfuly places the socentr using siuiaton data Carecty geresates otal bem ngs for specif anatomical Generates pan with aperoprat recs ‘ale manipulate ROUPTY consis nthe opie to btn an pts lon, Accurate optimizes and gerrates 3 encomtant oos pan ‘Accurately generates an dal DVM or compost DVM (for ‘corect # of ation) Understands te concept of prescribing toa pant ve. precrbing to 3 youme ands ble to oust the plan normaizaon as reese. Communicates effective wth pyscan forpan ew and makes chong recused xpos Pints appropriate pan data ‘Accurate generates the Oh forte plan rer in cvs parameter fr patent chart Prrfome tetrestmentcheks/ekutons (serves MT OA a nails of OF (bers patent eaten Satitctony Satisfactory Sattectory Satisfaction swtstctny Satistctony Sattectory satietcory Satitctny Satitctry ‘Sattstory satistctony ‘Action Comment. Kea generated an excelent plan Mean: 2.00 of2 Points: 36 Score: 100.0% tpt) pt) (pe eps eps taps) eet) tpt eps lepra tap tpt) pt) bepts eps fers) ew) eps we‘Survey: “External Beam ELECTRON Planning Competency" Revie Cincal ntrctrs (JACOBSON, Ker) eves: Studer (ert Ket) Survey Pei ananeea complet: eni2023 1007 ssaM CT 1. Pest assign each tak score of Stic or Uastitctony. neaistctor/ nan eset tank constitutes compen ore ‘Theale it epat the competency a ter Ste Discusses the plan prescription wih the physician, Loads the patient maging studs int the planning computer, Contours the appropriate anatomy onthe image dataset Suecessful places feld/SSO using simulation data Correcty generates plan using sppropristecone/cutout size Generates plan with comect reference depth ‘Generates plan with appropiate enery. Correctly ads the appropiate thickness of bolus Generates boli to adequtely cover restment eld borders ‘Accurately calculates dal dose for testment Feld using prescription %. ‘and weighting ‘Accurately generates a single fraction DVH or composite OVE (for correct ot factions). Communicates effectively with physician for plan review and makes changes as requested Exporte/Prints appropriate plan data, Performs hand vtieation calculations for pan MU stings using data/cale books Entersin cortect parameters fo patient chat Performs pretreatment checks/calculations (Observes patent treatment 2. oval tg: Pass 3. Adional Comments: Satisfactory Satisfactory Saistactry Satisfactory Saistoctry Satisfactory Setistactory Satisfactory Setiatactory Satisfactory Satisfactory Satisfactory WA ‘Aaltional Comment: We generally donot do hand calculations. Satisfoctory Satisfactory Satistactory uw