Dosimetrist

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Director of Rehab

OT

COTA

PT

PTA

SLP/SLPA

CNA

Director of Nursing

LPN

MDS Coordinator

Medication Aide

LTC RN

Ambulatory RN

Antepartum Postpartum Nursery

Behavioral Health RN

Case Management

Cath Lab RN

Certified Surgical First Assistant

CVICU RN

CVOR RN

CVOR Surgical Tech

Dialysis RN

Endoscopy RN

Endoscopy Tech

ER RN

High Risk Skills

Home Health RN

Infection Prevention RN

Intensive Care RN

Infusion RN

LDRP RN

LTAC RN

Maternal Fetal/High Risk

Medical Surgical / Telemetry

Neonatal Intensive Care

Nurse Manager

OB Tech

Oncology

OR RN

OR/Surg Tech

PACU

Pediatric Emergency Room

Pediatric Intensive Care

Pediatric RN

Rehab RN

Sterile Processing Technologist

Surgical Tech

Tele, PCU, Stepdown RN

Transplant Coordinator RN

Home Health Case Manager

Home Health Clinical Manager

Home Infusion RN

Home Health LPN

Home Health RN

Hospice LPN

Hospice RN

Cath

CT Tech

Dosimetrist

Echo

High Risk Skills

Histotechnologist

Interventional Skills

Mammography Skills

MRI Technologist

Nuclear Medicine Technologist

OR/Surg Tech

Pharmacist

Pharmacy Technician

Radiologic Technologist

Radiation Therapist

Sterile Processing Tech

Ultrasound Tech

Vascular Ultrasound

Cytotechnologist

Histotechnologist

Medical Laboratory Technologist

Medical Technologist

Pathologist Assistant

Phlebotomy

Cath Lab RN

Cath Lab Technologist

Cath EP

Interventional Skills

Anesthesia Tech

Dietician

EKG Tech

Perfusionist

Polysomnographer / RPSGT

Respiratory Therapist

This self evaluation is for assessing your experience in specific clinical areas. This self evaluation will not be a determining factor in accepting your application to become an employee of Marvel Medical Staffing.
- 0 = Not Applicable
- 1 = No Experience
- 2 = Some Experience
- 3 = Intermittent Experience
- 4 = Experienced
- 5 = Very Experienced
*Required Field
RADIATION THERAPY PHYSICS

0 1 2 3 4 5

0 1 2 3 4 5

Proficiency Rating Frequency Rating
Physical property of atoms and nuclei*
Basic nuclear transformations*
Medical linear accelerators*
Physical properties of dose and exposure*
Radioactive isotopes*
Electron beam therapy*
IMRT (intensity modulated radiation)*
3-D conformal radiation therapy*
Interaction of high energy electrons and xrays*
Photoelectric effect*
Campton scatter*
Pair production*
Dosimetry equipment*
Ion chambers*
Thermolumuniscent Dosimetry*
TG-51 (calibration protocol)*
Beam modifiers*
Physical wedges*
Dynamic wedges*
Blocks*
Basic principals and applications of CT Scan*
Basic principals and applications of MRI Machine*
Basic principals and applications of PET Scan*

BRACHYTHERAPY PROCEDURES

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Systemic errors*
Random errors*
Treatment documentation*
Procedure checklists*
Application insertion*
Implant localization and stimulation*
Treatment prescription*
Intravascular brachytherapy*
Implant design and evaluation*
Localization*
Computer treatment planning*
Manual verification of computer calculations*
Patient preparation, setup, and treatment*
Post treatment quality assurance*
Emergency Procedures for HDR*
Routine emergency equipment*
Physical plant emergencies*
Minor and major emergencies*
Prostate seed implants - I-125 seeds*
Prostate seed implants - P-103 seeds*

TREATMENT PLANNING

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Auxiliary devices (digitizer, plotter)*
Software*
Quality Assurance*

SPECIAL TECHNIQUES

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

TBI (total body irradiation)*
Electron arc therapy*
Intraoperative electron therapy*
TSI (total skin irradiation)*
Intraoperative electron therapy*
SRS (stereotactic radiosurgery) Multileaf collimators*
Data input into treatment planning*
SRT (Stereotactic radiotherapy)*

STANDARDS FOR TREAMENT PLANS / PROTOCOLS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Ensures accurate dose*
Ensures proper patient positioning*
Ensures proper machine settings*
Deviation of normal parameters for equipment*

TREATMENT AIDS

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Field shaping*
Field shaping*
Multileaf collimators*
Half-value thick blocks*
Gonadal shields*
Eye shields*
Internal shields*
In vivo Dosimetry*
Use of TLD (Thermoluminescent Dosimeters) chips*
Patient positioning*
Body positioning*
Anatomic landmarks*

AGE SPECIFIC CRITERIA

0	1	2	3	4	5

0	1	2	3	4	5

Proficiency Rating	Frequency Rating

Newborn/Neonatal (up to 30 days)*
Infant (30 days to 1 year)*
Toddler (1 to 3 years)*
Pre-school (3 to 5 years)*
School Age (5 to 12 years)*
Adolescent (12 to 18 years)*
Young Adult (18 to 30 years)*
Mature Adult (30 to 60 years)*
Elderly (60 & up)*
Application Agreement*
- I certify that the test was filled out to the best of my knowledge.
Signature*
Date*
First Name*
Last Name*
Applicant Email*
Applicant Phone*

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