University of Wisconsin-La Crosse

Medical Dosimetry Program

Competency Check list
Competencies CANNOT be performed on datasets
they must be performed on real patients

Student Name: Heather Maurer

Clinical Site: University of Michigan Ann Arbor MI

Competency
First Rotation Palliative
Para-aortic or nodal irradiation
Pelvis-4 field
Abdomen-3 or 4 field
Off-axis prescription point
Pelvis-3 field
Second Rotation Palliative
Intact Breast Tangentials
Chest Wall Tangentials (bolus: non-bolus
weighting)
Breast or Chest wall with sclav and PAB
Thoracic (Conformal)
Limb Sarcoma
Lymphoma
Prostate (IMRT or conformal)*
True Vocal Cord
Third Rotation Palliative
H & N (IMRT or conformal)*
Electron Beam Plan
Brain (IMRT or conformal)*
Esophagus (IMRT or conformal)*
Intracavitary Implant plan
Interstitial Implant Plan
Other: RT SHOULDER RE-TX

Evaluators
initials

Date
Performed

LY

03-24-14 (1st Rot)

LY

11-10-14 (3rd Rot)

LY

06-23-14 (2ND Rot)

LY

07-24-14 (2nd Rot)

LY

11-17-14 (3RD Rot)

LY

04-03-14 (1st Rot)

LY

07-24-14 (2nd Rot)

LY

07-08-14 (2nd Rot)

LY

10-29-14 (3rd Rot)

LY

11-21-14 (3rd Rot)

LY

7-01-14 (2nd Rot)

LY

03-28-14 (1st Rot)

LY

10-01-14 (3rd Rot)

PGA

10-17-14 (3rd Rot)

LY

04-14-14 (1st Rot)

LY

09-29-14 (3rd Rot)

LY

11-13-14 (3rd Rot)

LY

03-25-14 (1st Rot)

LY

7-25-14 (2nd Rot)

LY

08-01-14 (2nd Rot)

LY

12-09-14 (3rd Rot)

LY

12-05-14 (3rd Rot)

LY

6-27-14 (2nd Rot)

*The competencies with the asterisk can be done on either an IMRT plan OR a conformal plan. Please
make sure you fill out the appropriate form when completing the competency.