THE OHIO STATE UNIVERSITY RADIATION THERAPY CLINICAL COMPETENCY EVALUATIONS Class of 2012 - 2014

All 36 of the mandatory treatment competencies and 4 of the elective competencies must be completed. 1 Comp on 5th rotation, 2 each on 6th 8th, 5 each on 9th - 14th and 3 on 15th rotation The students will demonstrate their skills on the patients of their choice except for spot checks which will be chosen by the instructor. Students must perform the competency with the Clinical Supervisor, Clinical Instructor (having greater than 2 yrs. experience as a therapist), Clinical Coordinator or the Program Director. The front of the competency form must be completed prior to performing a clinical competency.

Trial NERVOUS SYSTEM Primary Brain Tumor Primary Brain Tumor Metastatic Brain Metastatic Brain HEAD AND NECK Wedge Pair (ie. Sinus, Parotid, Larynx, Orbit) IMRT without separate supraclav ith t separate t supraclav l IMRT without IMRT with separate AP supraclav Multi-field** (ie. Bilateral Neck with AP Supraclav) Laterals only Boost Posterior Neck Electrons CHEST AP/PA Off Cord Obliques q 3 or More Fields or IMRT 3 or More Fields or IMRT X X 7/25/13-TH(Z) X X 5/24/13-AC X 9/19/13-SLD X X X Mandatory Elective Date/Int 4/2/13-JN X 6/14/13-NM X

Comp /Date Completed 4/3/13 7/23/13 6/20/13 6/20/13 Score 100 100 100 100

Verified By Nelson Buerkel Mossing g Mossing

Spot Check Date/ P or F

5/29/13 5/29/13

100 100

Carpenter C t Carpenter

6/20/13

100

Mossing

10/30/13

100

Mossing

9/26/13 11/1/13

100 100

VanSuch Mossing

Trial ENDOCRINE Primary (Pituitary, Thyroid, Adrenal) BREAST Tangents Only Tangents Only with Supraclav Tangents g p Tangents with Supraclav Tangents with Supraclav and Posterior Axilla Tangents with Supraclav and Internal Mammary ABDOMEN AP/PA 3 or More Fields or IMRT 3 or More Fields or IMRT Para-Aortic PELVIS AP/PA (ie, boost) IMRT/ Multi-field Pelvis (Supine) IMRT/ Multi-field Pelvis (Supine) IMRT/ Multi-field Pelvis (Cone Beam) IMRT/ Multi-field Pelvis (Prone) Inguinal (Photons or Electrons) X 2/6/13-JD X X X X X 5/31/13-AC X X 4/19/13-SB X 9/5/13- CP X X X Mandatory Elective Date/Int X

Date Completed 1/24/14 Score 100

Verified By Rohrer

Spot Check Date/ P or F

9/4/13 9/5/13 1/27/14

100 100 100

Griffin Parsels Parsels

2/18/14 9/16/13 11/4/13

100 100 100

Day Heuser Rivera

2/12/13 4/1/13 4/3/13 7/26/13 5/30/13 2/12/13

100 100 100 100 100 100

Wooden Troullos Pick Buerkel Carpenter Wooden

Trial SKELETAL Spine Spine Extremity Pelvic (ie. Hip, Sacrum or Iliacs) ELECTRON FIELDS Single Field Single Field Abutting fields (Photon & e- or e- with e-) LOW VOLUME, HIGH RISK PROC. Mantle Craniospinal Axis Total Body (assist) Total Skin (assist) VERIFICATION & NEW STARTS Treatment Verification Procedure Treatment Verification Procedure h&n rapid arc Treatment Verification Procedure New Start Patient w/o prior verification New Start Patient w/o prior verification New Start Patient w/o prior verification New Start Patient w/o prior verification Treatment Accessory Devices Bolus Patient Transfer X X X X X X X X X X X X X 4/19/13-SB X X Mandatory Elective Date/Int 5/31/13-AC 5/31/13 AC X 1/22/14-SJ X

Date Completed 2/12/14 2/12/14 1/30/14 5/22/13 Score 100 100 100 100

Verified By Day Day Day Rhorer

Spot Check Date/ P or F

5/31/13 6/14/13 1/27/14

100 100 100

Carpenter Mossing Parsels

5/31/13 7/10/13

100 100

Troullos Pick

2/4-2/6/14 3/4-3/5/14

100 100

Barhorst Collins

2/6/14 2/10/14

90

Barhorst VanSuch

4/3/13 4/2/13

Pass Pass

Nelson Carpenter

** Multi-field is defined as three or more fields on the same target volume or the same site of interest with different target volumes
R:Admin/Clin Therapist/Word as of 6/12