THE OHIO STATE UNIVERSITY

RADIATION SCIENCES AND THERAPY PROGRAM

RADIATION THERAPY PROGRAM
CLINICAL COMPETENCY EVALUATIONS

Clinical competency evaluations begin during the second semester. It is highly recommended
that comps are practiced as such prior to the trial comp. Students must complete a trial on each
of the competency sites except those designated with an X. The trial must be completed on a
different patient other than the actual comp. A comp form will need to be completed for the trial.
A completed comp form will not be accepted with out the trial being completed. Students will
be required to satisfactorily complete (70%) all competencies. Students will have three chances
to pass the competency. All attempts must be turned into the clinical coordinator or program
director. Scores on the competency are as follows.

1st Attempt - 100%

2nd Attempt - 90%
3rd Attempt - 80%

If the comp is not achieved in the first three attempts, remedial work will be done with the
clinical coordinator or program director and the student will then have one more chance to pass
the competency with a 70%.

After the comp is achieved, the clinical instructor, clinical supervisor, clinical coordinator or
program director may review the students comp list and request a spot check on any completed
comp. If a spot check is failed, the student must redo the comp site from the beginning, starting
with the trial. The grade on the comp would then start as if the previous passed comp was failed.
 THE OHIO STATE UNIVERSITY
RADIATION THERAPY
CLINICAL COMPETENCY EVALUATIONS
Class of 2016 - 2018

All 31 of the mandatory treatment competencies and 8 of the elective competencies must be completed. 1 Comp on 5th and 6th rotations, 2 each on 7th –
9th, 5 each on 10th - 14th and 3 each on the 15th and 16th rotations. 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 Comp /Date Verified Spot Check

NERVOUS SYSTEM Mandatory Elective Score
Date/Int Completed By Date/ P or F
Primary Brain Tumor 
Primary Brain Tumor 
Metastatic Brain 
Metastatic Brain 
HEAD AND NECK
Wedge Pair (ie. Sinus, Parotid, Larynx, Orbit) 
IMRT to include supraclav 
IMRT to include supraclav 
IMRT to include supraclav 
3 Field* (ie. Bilateral Neck or IMRT with
separate AP Supraclav) 
Laterals only 
CHEST
AP/PA 
3 or More Fields or IMRT 

3 or More Fields or IMRT 

 Trial Date Verified Spot Check
ENDOCRINE Mandatory Elective Score
Date/Int Completed By Date/ P or F
Primary (Pituitary, Thyroid, Adrenal) 
BREAST

Tangents Only 
Tangents Only 
Tangents Only - Prone 

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) 

 Trial Date Verified Spot Check
SKELETAL Mandatory Elective Score
Date/Int Completed By Date/ P or F
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 
Treatment Verification Procedure 
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 
* Multi-field is defined as three or more fields on the same target volume or the same site of interest with different target volumes
** AP/PA Abdomen and AP/PA Pelvis does not include treatments for metastatic spine disease
R:Admin/Clin Therapist/Word as of 8/
 THE OHIO STATE UNIVERSITY
RADIATION THERAPY
CT SIMULATION COMPETENCY EVALUATIONS
Class of 2016-2018
Students are required to complete 13 simulation competencies. Students must complete Sim Comps 2 on 2nd, 4 each on
3rd - 4th, 3 on 5th.
(The student will demonstrate their skill on the patients of their choice.) 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.

Date
Required Simulation Sites Score Verfied By
Completed
Breast
Breast
Head and Neck
Head and Neck
Chest
Chest
Pelvis
Pelvis
Abdomen (Pancreas, Para Aortic, Lymphoma etc)
Brain
Brain
Spinal Field (Prone or Supine)
Extremity Field (Long bones, shoulders or hips)

Treatment Accessory Devices

Vac Bag – Thorax

Vac Bag – Pelvis
Aquaplast mask
Electron Block
R:Admin/Clin Therapist/Word as of 6/12
 THE OHIO STATE UNIVERSITY
RADIATION SCIENCES AND THERAPY PROGRAM
ACCELERATOR COMPETENCY EVALUATION

Procedure must be completed on each accelerator rotation.

Student Name: _______________________________________________ Date:___________________________

Name of Accelerator:______________________________________ Clinical Site:__________________________

Machine Energy(s):_____________________ Treatment Unit:________________

The student must demonstrate efficiency in the following:

YES NO N/A
1. Manually sets gantry angle.

2. Manually sets collimator angle.

3. Manually sets field size.

4. Manually sets independent jaws.

5. Smoothly manipulates couch movements in all directions.

6. Identifies the purpose for each of the lasers in treatment room.

7. Identifies correct location to place reticle, BB Tray, electron cones and blocks.

8. Explains purpose and locations for circuit breaker, emergency offs, and motion stops.

.9. Defines the use of door interlock and Rad off.

10. Identifies the ODI and can set the table to 100 SSD

11. Localizes the set up instructions for patient in electronic chart.

Evaluator Comments:

Evaluators Signature:_____________________________________________ Score: ____________________

Students Signature:__________________________________________________
 THE OHIO STATE UNIVERSITY
RADIATION THERAPY PROGRAM
MACHINE CLINICAL COMPETENCY EVALUATION

Trial Attempt: ( 1st 2nd 3rd ) Spot Check

Student Name: _______________________________________________ Date:___________________________

Anatomical Site:___________________________ Procedure:____________________________________

Patient RT #:_________________________________ Mandatory:___________ Elective:___________

New Start w/o verification: Yes_______ No________ Verification: Yes________ No_______

Diagnosis:_________________________________________________________Stage/Grade: __________________
(If Metastatic, indicate primary as well as metastatic site)

Critical Structures and Tolerance Dose to each: List Possible Side Effects with this site:

Patient Positioning and Immobilization Devices:

Prescription Total:_______________________ Current Dose:_________________ Daily Dose______________

Machine Energy:_______________ Treatment Unit:________________ Custom Blocks/MLC’s: Yes_____ No_____

Wedges: Yes______ No_____ Bolus: Yes______ No_______

**The top of this sheet must be completed by the student prior to performing the procedure.

The student must demonstrate efficiency in the following:

YES NO N/A
1. Reviews chart and DRR’s (new patient) prior to preparing patient for treatment.

2. Checks prescription with total dose currently delivered.

3. Prepares treatment room with appropriate equipment.

4. Greets and assists patient to and from the treatment area (Confirms patient identity).

5. Explains procedure if new to the patient and confirms patients' understanding.

6. Assist patient into treatment position.____Ambulatory, ____Wheel chair ____Cart

7. Positions patient to reproduce setup indicated in treatment chart.

8. Immobilizes patient and assures patient comfort.

 YES NO N/A
9. Sets treatment parameters to reproduce setup as indicated in chart or EMR(field size,
aligns field, gantry angle, collimator angle, etc.)
10. Selects and places correct blocks, wedges, bolus, etc. Student fabricated Bolus ______

11. Rechecks set-up with set-up indicated in the chart and DRR’s.

12. Indicates to patient that treatment is to begin.

13. Sets appropriate controls on treatment machine console

14. Performs verbal “timeout”.

15. Performs IGRT and aligns the patient appropriately.

_____ Cone beam _____ OBI _____ Exact Trac _____ Vision RT
16. Activates machine to deliver prescribed dose.

17. Monitors patient during treatment.

_____
18. Monitors treatment unit function during treatment delivery.

19. Verifies (EMR) or records (paper chart) technical data was documented in patient chart.
(MU’s, dose, port films)
20. Records patient data in treatment chart.
(Bolus, SSD’s, patient checklists, etc.)
21. Sets up opposing/additional portals correctly.

22. Utilizes all treatment equipment safely.

23. Assists patient from treatment table.

24. Answers patient questions.

25. Answers therapist questions relevant to the procedure.

26. Attends to additional patient care details.(blood work, to see physician, schd. sim, etc.).

27. Displays ethical standards and maintains a level of professionalism.

Evaluator Comments:

Evaluators Signature:_____________________________________________ Score: ____________________

Students Comments:

Students Signature:__________________________________________________
 THE OHIO STATE UNIVERSITY
RADIATION THERAPY PROGRAM
CT SIM CLINICAL COMPETENCY EVALUATION

Attempt: ( 1st 2nd 3rd )

Student Name:________________________________________________________ Date:_______________________

Anatomic Site: ________________________Procedure:_____________________________ Contrast ____Yes ____No

Patient RT#: ________ Diagnosis/Histology: _________________________________Stage or Grade: ______

Describe patient positioning & immobilization devices used:

Critical Structures and the Tolerance Dose to each:

**The above information must be completed by the student prior to the sim.

The student must demonstrate efficiency in the following:

YES NO N/A
1. Reviews chart, planning sheet and diagnostic imaging prior to preparing patient for
simulation.

2. Prepares treatment chart and simulation materials

3. Checks for signed consent and follows through if not signed.

4. Prepare simulation room with appropriate equipment.

5. Greets and assists patient to and from the treatment area (confirms patient identity).

6. Explains procedure to the patient and confirms patient's understanding.

7. Assist patient into simulation position.____Ambulatory, ____Wheel chair ____Cart

8. Prepares and/or fabricates immobilization devices to align patient.

_____ Aquaplast _____ Vac Bag _____ Bite Block

9. Prepares contrast and/or loads the injector adequately.

10. Administers and monitors patient for adverse reactions.

11. Obtains CT images by utilizing preset protocols.

 YES NO N/A

12. Adjust image parameters to obtain scan (slice level, FOV, etc.)

13. Utilize all simulation equipment safely.

14. Sets appropriate mA and kV on console.

15. Monitor patient during CT scan

16. Mark patient’s isocenter and field parameters.

17. Records data of setup and completes all paperwork.

18. Schedules the patient and distributes material to the appropriate areas.

19. Assists patient from treatment table.

20. Answer patient's questions appropriately or directs questions to appropriate personnel

21. Displays ethical standards and maintains a level of professionalism.

22. Follows radiation protection principles to assure safety of therapist and patient.

EVALUATOR COMMENTS:

Evaluators Signature:_____________________________________________ Score: ____________________

Students Comments:

Students Signature:__________________________________________________