Eval d606 2015-16

Summer II Clinical Assignment / Evaluations 2015
General Topics
Points
1. Social Interaction & Safety Procedures
Points Earned
5
_______
2. Electronic Medical Record and Chart Management
14
_______
3. Overview of CT / Sim Requirements for Dosimetry
12
_______
4. Monitor Unit Calculations
14
_______
Basic Treatment Planning
Points
1. Acquiring / Importing Images

From the Planning CT
From MR, PET, and Diagnostic
14
_______
2. Registration of images
CT to MR
CT to PET & PETct
14
_______
3. Contouring Tools
24
_______
4. Creating 2D SAD Plan (whole brain)
25
_______
5. Creating 2D SSD Plan (spine)
21
_______
6. Creating 3D Coplanar Plan (4 field box, other)
25
_______
Conferences
Points
1. Peer Review Attendance
Total points Earned ______
_______
Percentage _______
Total Points Possible: 170

>= 93 % A
>= 90 % A>= 87 % B+
>= 83% B
>= 80% B-
Graduate Medical Dosimetry Certificate

Indiana University School of Medicine
Department of Radiation Oncology
RAON D606
Clinical Practicum I Intro to General Dosimetry
Clinical Site:__________________________
Date:_______________
Social Interaction and Safety Procedures

Performance Standard
Meets Required
Standards
.5 each
Needs
Improvement
1. Is on time and meets attendance requirements.

a. All time off requests are in writing.
b. Clinical supervisor and/or preceptor
a. Is polite and respectful of other students.
b. Is polite and respectful of department staff.
knowledge with fellow students.
b. Works well with all clinical staff.
are notified when unexpected absence

is necessary.
2. Displays the ability to prioritize time.
a. Work area and assignments are wellorganized.
b. Displays efficiency and time management.
3. Communicates effectively with coworkers.
4. Demonstrates teamwork.
a. Is willing to learn from and share
5. Follows radiation safety guidelines.

a. Wears film badge when appropriate for
clinical procedures.
b. Maintains film badge storage and returns
to clinical supervisor for exchange.

TOTAL POINTS EARNED
________
This form must be completed and signed by a clinical instructor or preceptor at each
clinical site.
Social Interaction and Safety Procedures
Student Signature / date _____________________________

Comments: ____________________________________________
_______________________________________________________
Clinical Supervisor / date ____________________________
Comments: ____________________________________________
_______________________________________________________
Course Instructor for RAON D606
__________________________________
Marvene M. Ewing, CMD

RAON D606
Clinical Site:__________________________
Date:___________________
Electronic Medical Record Chart Management

Score of >= 80% required.
YES (1)
NO (0)
1. Patient Manager Documentation

The student can identify or locate in EMR:
a. Customized Time Planner on

his/her workstation.
b. Is familiar with the tasks system

and can create them.
c. Understands the system for

scheduling a patient to begin
treatment.
a. Patient Registration Info

b. Insurance Authorization
c. Physicians Intent
The student has successfully created:
a. MD Treatment Planning Order
b. Daily Treatment Log
2. RT Chart
In RT Chart, the student is able to complete:
a. Plan Prescription page
b. Plan Parameters page
c. Reference Point page
d. Patient Scheduling
1) standard treatment
2) delay in treatment start
3) image scheduling
3. Time Planner
The student has successfully:
Electronic Medical Record Chart Management

Total Points Earned: ____________
Percentage: ________

Comments: ____________________________________________
_______________________________________________________
Pas

Comments: ____________________________________________
_______________________________________________________
__________________________________

RAON D606
Clinical Site:__________________________
Date:___________________
Overview of CT / Simulation Requirements for Dosimetry

Score of >=80% required.
YES
(1)
NO
(0)
a. The patient is straight and centered on

the table.
If not, why not?_____________________
__________________________________
b. The student will observe / assist with

the fabrication of the immobilization device.
c. The student will provide documentation

photographs of the patient position in EMR.
d. The student will complete the simulation

worksheet correctly.
a. Confirm that the patient is completely within

the field of view.
b. Discuss with a dosimetrist or physicist the

issues that can arise when part of the patient
anatomy is not in the field of view.
c. Communicate with the physician about the

placement of the reference mark @ CT.
d. Accurately label the patient orientation at

the time of CT acquisition
e. Review the process of editing orientation

labeling in Eclipse.
1. Positioning and Immobilization Checklist
2. Dosimetric Concerns for CT Acquisition

The student will:
4.
3. Export / Import of Images

The student will:
a. Export the CT images to the TPS.
b. Import the Images into the TPS.
i) Set origin to reference mark.
ii) Label the 3D image set by institutional
guidelines.
Overview of CT / Simulation Requirements for Dosimetry

YES
(1)
NO
(0)
4. Radiation Safety Procedures

The student has followed appropriate Radiation
Safety Guidelines.
Total Points Earned: ____________
Percentage: ________

Comments: ____________________________________________
_______________________________________________________
Comments: ____________________________________________
_______________________________________________________
__________________________________

RAON D606
Clinical Site:__________________________
Date:___________________
Monitor Unit Calculations

Score of 100% required.
YES
(2)
NO
(0)
a. SSD setup, Photon, Single Field Calculation
b. SAD setup, Photon, Parallel Opposed
c. SAD setup, Photon, Off Axis Calculation
d. Electron MU Calculation
a. SSD setup, Photon, Single Field Calculation
b. SAD setup, Photon, Parallel Opposed
c. Electron MU Calculation
1. Manual Monitor Unit Calculations
2. Rad Calc or MU Calc Programs
TOTAL POINTS
___________
Monitor Unit Calculations

Comments: ____________________________________________
_______________________________________________________
Comments: ____________________________________________
_______________________________________________________
__________________________________
10

RAON D606
Clinical Site:__________________________
Date:___________________
Acquiring / Importing Images into the TPS

Minimum score of 80% required.
YES
(1)
NO
(0)
d. Place the Plan Origin appropriately.
e. Import the Structure Template.
1. From The Planning CT

The student will successfully:
a. Import the planning CT into the TPS.
b, Set the Plan Origin.
c. Label the Series and 3D image correctly.
d. Create the DRR for the reference beams.
e. Export the images from the CT to Eclipse.
2. From Synapse
The student will successfully use Synapse to:
a. Move the scan from Synapse to the Local Server.
b. Import the scan into Eclipse.
3. At the TPS
The student will:
a. Identify the difference between a Study and
a Series.
b. Import the images into Eclipse.
i) For MR:
T1 + C and T2 or Flair
ii) For PET:
PET corrected WB
CTpet WB
c. Correctly label the Series and the 3D image

by the institutional preferences.
TOTAL POINTS
________
11
12
Acquiring / Importing Images into the TPS

Comments: ____________________________________________
_______________________________________________________
Comments: ____________________________________________
_______________________________________________________
__________________________________
13

RAON D606
Clinical Site:__________________________
Date:___________________
Selection / Registration of Images in Eclipse

YES
(1)
NO
(0)
1. The Selection Workspace

The student will demonstrate proficiency in navigating the Selection workspace by:
a. Creating a new 3D image for an existing scan.
b. Extrapolating images to the 3D image.
c. Demonstrating the mechanisms for changing
the patient position. (drop down menu)

d. Demonstrating the mechanisms for changing
the patient orientation. (icons)
2. The Registration Workspace
The student will successfully be able to:
a. Navigate in Eclipse to the Registration page.
b. Open the primary scan for registration.
c. Select the secondary scan for registration.
d. Identify and demonstrate the process for using
the registration tools.
i) Manual match of images.
ii) Auto match Pixel to Pixel
3. Smart Adapt
The student will be able to:
a. Navigate to the Smart Adapt feature in Eclipse.
b. Demonstrate understanding of deformable
registration.
4. Verification of Registrations
a. Performs MR registration T1+C, T2 or Flair.
14
b. Performs PET registration of images.

c. Performs CT to CT registration or images.
Selection / Registration of Images in Eclipse

YES
(1)
NO
(0)

Comments: ____________________________________________
_______________________________________________________
Comments: ____________________________________________
_______________________________________________________
__________________________________
15

RAON D606
Clinical Site:__________________________
Date:___________________
Using Eclipse Tools in the Contouring Workspace

YES
(1)
NO
(0)
1. Creating the BODY Structure

The student will demonstrate proficiency with:
a. BODY contouring tool
b. Verification of accuracy of auto-contour
c. Using the post-processing tool
2. Structure Properties
The student will be able to:
a. Create a new structure in Eclipse.
b. Describe the structure types.
c. Demonstrate the use of the color &
style choices.
3. Manual Contouring Tools
The student will show proficiency with:
a. Pencil, Paintbrush and Eraser tools
b. Editing functions including cut, copy,
paste, clear the slice.
4. Auto-Segmentation Tools
The student will demonstrate the functionality of:
a. Segmentation Wizard Tool
i) Brain
ii) Lung
b. Interpolation Tool
i) Spinal Cord
c. Flood fill Tool
i) Kidney, or other structure
d. Create Margin Tool
16
i) Expand margin to create PTV

ii) Expand margin for OAR
Using Eclipse Tools in the Contouring Workspace

YES
(1)
NO
(0)
5. Boolean Operators
The student will successfully:
a. Combine two or more structures
b. Subtract one structure from another
6. Post Processing Tools
The student will successfully demonstrate the
feature of the Post Processing dialog box, including:
a. The clean up method.
b. The enhancement feature.
c. The extraction method.
7. Auto - Editing Tools
The student will successfully demonstrate the:
a. Crop Structure Function
b. Extract a Wall Function (for skin)
8. Measuring Tools
The student will demonstrate the:
a. Linear measurement tool
b. Density measurement tool
c. Measurement of HU and articulate the
meaning and value of these #s.
TOTAL POINTS
_________

Comments: ____________________________________________
_______________________________________________________
Comments: ____________________________________________
_______________________________________________________
__________________________________
17

RAON D606
Clinical Site:__________________________
Date:___________________
Creating and Calculating the 2D SAD Plan Whole Cranium

YES
(1)
NO
(0)
a. Demonstrate knowledge of dose matrix

and dose grid.
b. Demonstrate location of the calculation

algorithm.
c. Complete the plan calculation.
Upon successful completion of this competency,

the student will be able to:
1. Create and Setup a Plan in Eclipse
a. Create a new plan
b. Contour the brain and lens of the eye
c. Establish Rt and Lt lateral treatment fields for
d. Generate DRR for each field
e. Create setup fields.
2. Create Field Shaping Devices
a. Create eye block for each field.
b. Create MLC for each field.
3. Input Prescription Information
a. Enter prescription on the prescription tab
4. Establish Reference and Calculation Points
a. Place and locate a point at the isocenter.
b. Create the DPV and explain its purpose.
5. Determine the Plan Normalization
a. Select the appropriate plan normalization type.
6. Perform the Plan Calculation
7. Confirm the MU Calculation in RadCalc.

a. Export the beam data to RadCalc.
b. Complete the calculation in RadCalc.
18
Creating and Calculating the 2D SAD Plan Whole Cranium

YES
(1)
NO
(0)
8. Demonstrate Communication Skills

a. Discuss the planning process with the CMD.
b. Explain any changes or edits made to the plan.
9. Complete EMR Documentation
a. Create appropriate forms in Patient Manager
i) MD order sheet
ii) Daily Treatment Log
b. Finalize the documentation in RT chart.
i) Prescription
ii) Parameters page
iii) Reference point page
iv) Scheduling
c. Demonstrate knowledge of appropriate billing
procedures.
TOTAL POINTS
_________

Comments: ____________________________________________
_______________________________________________________
Comments: ____________________________________________
_______________________________________________________
__________________________________
19

RAON D606
Clinical Site:__________________________
Date:___________________
Creating and Calculating the 2D SSD Plan Spine

YES
(1)
NO
(0)
a. Demonstrate knowledge of dose matrix

and dose grid.
b. Demonstrate location of the calculation

algorithm.
c. Complete the plan calculation.

1. Create and Setup an SSD Plan in Eclipse
a. Create a new SSD plan.
b. Create single PA spine field, SSD technique.
c. Generate the DRR for the field.
2. Input Prescription Information
a. Enter prescription on the prescription tab
3. Establish Reference and Calculation Points
a. Place and locate a point as specified
b. Create the DPV and explain its purpose.
4. Determine the Plan Normalization
a. Select the appropriate plan normalization type.
5. Perform the Plan Calculation
6. Confirm the MU Calculation in RadCalc.

a. Export the beam data to rad calc.
b. Complete the calculation in rad calc.
7. Demonstrate Communication Skills
a. Discuss the planning process with the CMD.
20
b. Explain any changes or edits made to the plan.
21
Creating and Calculating the 2D SSD Plan Spine

YES
(1)
NO
(0)
8. Complete EMR Documentation.

a. Create appropriate forms in Patient Manager
i) MD order sheet
ii) Daily Treatment Log
b. Finalize the documentation in RT chart.
i) Prescription
ii) Parameters page
iii) Reference point page
iv) Scheduling
c. Demonstrate knowledge of appropriate billing
procedures.
TOTAL POINTS
_________
______________________________________________________________________________

Comments: ____________________________________________
_______________________________________________________
Comments: ____________________________________________
_______________________________________________________
__________________________________
22

RAON D606
Clinical Site:__________________________
Date:___________________
Creating and Calculating a 3D Plan 4 Field Box

YES
(1)
NO
(0)
a. Demonstrate understanding of the Physicians

Intent in Patient Manager
b. AP, PA, Rt and Lt Lateral Fields to be created.

1. Complete Required Contouring
a. OAR bladder, rectum, femoral heads
b. PTV margin as instructed
2. Generate the Plan & Treatment Fields
c. Generate the DRR for each field.

d. Create MLC aperture as instructed.
3. Create Reference Points and Plan Normalization
a. Create DPV for prescription dose.
b. Create and place the calculation point.
c. Establish the appropriate plan normalization.
4. Generate the Isodose Curves
a. Perform the 3D Dose Calculation
b. Apply beam weighting changes as needed.
c. Discuss with the CMD the viability of wedges
and their impact on the isodose curves.
5. Evaluate Plan by DVH and Isodose Lines
a. Display the Dose Volume Histogram
b. Review the doses to targets & OAR.
c. Evaluate the location of the maximum doses
on axial slices.
d. Discuss with the CMD any potential changes.
23
Creating and Calculating a 3D Plan 4 Field Box

YES
(1)
NO
(0)
a. Make any changes to the plan as determined

above.
b. Re-evaluate the DVH and isodose curves.
a. Discuss with the CMD the appropriate

documentation in RT chart.
b. Verify the appropriate documentation in

Patient Manager.
c. Verify with the CMD correct billing processes.
6. Edit the Plan
7. Generate Monitor Unit Check

a. Export the beam information to Rad Calc.
b. Verify the Monitor units from the TPS.
8. Confirm EMR Processes.
d. Demonstrate knowledge of creating tasks in

Time Planner.
i) Plan Approval & MD order sheet
ii) Physics Check
TOTAL POINTS
__________

Comments: ____________________________________________
_______________________________________________________
Comments: ____________________________________________
_______________________________________________________
__________________________________
24

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Summer II Clinical Assignment / Evaluations 2015

1. Social Interaction & Safety Procedures

2. Electronic Medical Record and Chart Management

3. Overview of CT / Sim Requirements for Dosimetry

4. Monitor Unit Calculations

Basic Treatment Planning

1. Acquiring / Importing Images

4. Creating 2D SAD Plan (whole brain)

5. Creating 2D SSD Plan (spine)

6. Creating 3D Coplanar Plan (4 field box, other)

1. Peer Review Attendance

Total points Earned ______

Total Points Possible: 170

Graduate Medical Dosimetry Certificate

Social Interaction and Safety Procedures

1. Is on time and meets attendance requirements.

b. Clinical supervisor and/or preceptor

a. Is polite and respectful of other students.

b. Is polite and respectful of department staff.

knowledge with fellow students.

b. Works well with all clinical staff.

are notified when unexpected absence

5. Follows radiation safety guidelines.

to clinical supervisor for exchange.

Social Interaction and Safety Procedures

Student Signature / date _____________________________

Graduate Medical Dosimetry Certificate

Electronic Medical Record Chart Management

1. Patient Manager Documentation

a. Customized Time Planner on

b. Is familiar with the tasks system

c. Understands the system for

a. Patient Registration Info

Electronic Medical Record Chart Management

Student Signature / date _____________________________

Clinical Supervisor / date ____________________________

Graduate Medical Dosimetry Certificate

Overview of CT / Simulation Requirements for Dosimetry

a. The patient is straight and centered on

b. The student will observe / assist with

c. The student will provide documentation

d. The student will complete the simulation

a. Confirm that the patient is completely within

b. Discuss with a dosimetrist or physicist the

c. Communicate with the physician about the

d. Accurately label the patient orientation at

e. Review the process of editing orientation

1. Positioning and Immobilization Checklist

2. Dosimetric Concerns for CT Acquisition

3. Export / Import of Images

Overview of CT / Simulation Requirements for Dosimetry

4. Radiation Safety Procedures

Student Signature / date _____________________________

Graduate Medical Dosimetry Certificate

Monitor Unit Calculations

a. SSD setup, Photon, Single Field Calculation

b. SAD setup, Photon, Parallel Opposed

c. SAD setup, Photon, Off Axis Calculation

a. SSD setup, Photon, Single Field Calculation

b. SAD setup, Photon, Parallel Opposed

1. Manual Monitor Unit Calculations

2. Rad Calc or MU Calc Programs