RADIOLOGY TECHNOLOGIST SKILLS CHECKLIST
  RADIOLOGY TECHNOLOGIST SKILLS CHECKLIST
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
       
Rating Stars (Click) SETTING 1 2 3 4  
Adult Inpatient  
ER/Trauma  
Adult Outpatient  
Pediatric Inpatient  
Pediatric Outpatient  
Rating Stars (Click) Procedures 1 2 3 4  
Chest Studies  
Abdominal Studies  
Foreign Body/Soft Tissue Studies  
Specimen Radiography  
Rating Stars (Click) Extremities 1 2 3 4  
Upper  
Lower  
Pelvis Obls/Judet Views  
Pelvis SI Joints  
Pelvis Sacrum/Coccyx  
Rating Stars (Click) Spine 1 2 3 4  
Cervical Spine-Obls/Flexion/Extension  
Thoracic Spine-Swimmer’s View  
Lumbar Spine-Obls/Flexion. Extension  
Rating Stars (Click) Head 1 2 3 4  
Facial Bones  
Mandible  
Rating Stars (Click) Head (cont.) 1 2 3 4  
Mastoids  
Orbits  
Sinus Series  
TMJ  
Skull Series  
Rating Stars (Click) Tomography 1 2 3 4  
Renal  
TMJ  
Spine  
Rating Stars (Click) Flouroscopy/Contrast Studies 1 2 3 4  
Barium Swallow/Esophagram  
Modified Barium Swallow/Protocol Swallow  
Swallow Studies with Videotaping  
Upper GI Series-Single Contrast  
Upper GI Series-Air Contrast  
Small Bowel Follow Through  
Rating Stars (Click) Enema Studies 1 2 3 4  
Barium Enema-Single Contrast  
Water Soluble Contrast Enema (e.g. Hypaque)  
Barium Enema-Air Contrast  
Lower GI Studies thru Colostomy  
Rating Stars (Click) Cystography 1 2 3 4  
Cystogram  
Voiding Cystogram  
Rating Stars (Click) Cystography (cont.) 1 2 3 4  
Urethrography  
Rating Stars (Click) Contrast Injection Studies 1 2 3 4  
IVP  
IVP with Tomograms  
Rating Stars (Click) Myelograms 1 2 3 4  
Cervical Spine  
Thoracic Spine  
Lumbar Spine  
Rating Stars (Click) Mobile C-Arm Flouroscopy 1 2 3 4  
Broncoscopy with Fluoro Guidance  
Bedside Line and Tube Placement  
Rating Stars (Click) OR Cases 1 2 3 4  
Sterile Procedures in OR  
Spine Work  
Operative Cholangiography  
Hip Studies  
Extremity Studies  
Cystography  
Retrograde Urography  
Rating Stars (Click) Patient Safety 1 2 3 4  
National Patient Safety Goals  
Computerized Charting  
Rating Stars (Click) Age Specific Practice Criteria 1 2 3 4  
Newborn/neonate (birth-30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschooler (3-5 years)  
School age children (5-12 years)  
Adolescents (12-18 years)  
Young adults (18-39 years)  
Middle adults (39-64 years)  
Older adults (64+)