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Physics & Dosimetry
Radiation Therapy Skills Checklist

DIRECTIONS: By completing this checklist to the best of your ability, you will help us match your skills and areas of interest with our available assignments. Please place a Check in the column that most accurately describes your level of experience with each skill.
EXPERIENCE LEVELS
4 = VERY EXPERIENCED (can perform well independently)
3 = EXPERIENCED (Need initial review, then can perform independently)
2 = SOME EXPERIENCE (Require assistance/supervision)
1 = NO EXPERIENCE


CONTACT INFORMATION
Name: (Required)
Cell Number:
Home Number:
Email Address: (Required)
Recruiters Name: (If known)
CERTIFICATIONS

RT: . . . . RTT: . . . . CMD: . . . . BE: . . . . BC:


ABR/ABMP: . . . Part1: . . . Part2: . . . Conditional:


SPECIALTY: Therapy: . . . . Diagnostic: . . . . Nuclear:


NRC/AMP: . . . HDR: . . . RSO: . . . VetPro:


Additional Certifications:
Highest Education:
Other Languages Spoken:
STATE LICENSE INFO
States Licensed In:
Enter State/Lic.#/Exp. Date
ACCELERATOR
Varian: . . . 1: . . . 2: . . . 3: . . . 4:
Models:
Novalis TX: . . . 1: . . . 2: . . . 3: . . . 4:
Models:
Siemens: . . . 1: . . . 2: . . . 3: . . . 4:
Models:
Elekta: . . . 1: . . . 2: . . . 3: . . . 4:
Models:
CyberKnife: . . . 1: . . . 2: . . . 3: . . . 4:
Models:
Tomotherapy: . . . 1: . . . 2: . . . 3: . . . 4:
Models:
Gamma Knife: . . . 1: . . . 2: . . . 3: . . . 4:
Gamma Knife Models:
Proton: . . . 1: . . . 2: . . . 3: . . . 4:
Proton Models:
Additional Accelerator:
TREATMENT PLANING
ADAC/Pinnacle: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Smart ARC: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Eclipse: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Rapid ARC: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
CMS (XiO/Focus): . . . 1: . . . 2: . . . 3: . . . 4:
Version:
CMS Monaco: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Hi-Art (Tomo): . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Variseed LDR: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Plato-HDR: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Oncentra-HDR: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Brachyvision-HDR: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
iPlan-SRS: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Fastplan-SRS: . . . 1: . . . 2: . . . 3: . . . 4:
Version:
Additional Treatment Planning:
HDR Equip
Nucletron: . . . 1: . . . 2: . . . 3: . . . 4:
Varisource: . . . 1: . . . 2: . . . 3: . . . 4:
GammaMed: . . . 1: . . . 2: . . . 3: . . . 4:
Additional HDR Equip:
HDR Treatments
Mammosite: . . . 1: . . . 2: . . . 3: . . . 4:
Contura: . . . 1: . . . 2: . . . 3: . . . 4:
Savi: . . . 1: . . . 2: . . . 3: . . . 4:
Prostate: . . . 1: . . . 2: . . . 3: . . . 4:
Gyn: . . . 1: . . . 2: . . . 3: . . . 4:
Additional HDR Treatments:
LDR Seed Sources:
Therapy Types
3D Conformal: . . . 1: . . . 2: . . . 3: . . . 4:
IMRT: . . . 1: . . . 2: . . . 3: . . . 4:
Vmat: . . . 1: . . . 2: . . . 3: . . . 4:
IGRT: . . . 1: . . . 2: . . . 3: . . . 4:
SRS: . . . 1: . . . 2: . . . 3: . . . 4:
SBRT: . . . 1: . . . 2: . . . 3: . . . 4:
TBI: . . . 1: . . . 2: . . . 3: . . . 4:
TSI: . . . 1: . . . 2: . . . 3: . . . 4:
BrainLab: . . . 1: . . . 2: . . . 3: . . . 4:
Additional Therapy Types:
Record & Verify
Lantis: . . . 1: . . . 2: . . . 3: . . . 4:
Impac: . . . 1: . . . 2: . . . 3: . . . 4:
Mosaiq: . . . 1: . . . 2: . . . 3: . . . 4:
Varis: . . . 1: . . . 2: . . . 3: . . . 4:
Aria: . . . 1: . . . 2: . . . 3: . . . 4:
Additional Record & Verify:
 


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