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Dosimetrist
Dosimetry
Name
First
Last
Date
MM slash DD slash YYYY
Self-Assessment Rating Scale
No Experience
Theory or observation only during the past 12 months
Limited Experience
Performed less than 12 times within the past 12 months and may need a review
Experienced
Performed at least once per month within the past 12 months and may need minimal assistance
Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient
Treatment Planning Systems
No Experience
Limited Experience
Experienced
Highly Skilled
Acuplan
Adac
Adac IMRT
Cad Plan
CMS Focus
CMS Focus IMRT
CMS XiO
CMS XiO IMRT
Corvus IMRT
Eclipse
Eclipse IMRT
GE
Helios
Plato
Prowess
Radionics
RAHD
Render Plan
ROCS
Siemens IMFAST
Theraplan
Theraplan IMRT
Treatment Planning 3D
No Experience
Limited Experience
Experienced
Highly Skilled
CT Simulations
Breasts
Prostates
Lung
Head and Neck
Pelvis
Mantle
Fusions
MLC
Dynamic Wedges
Treatment Planning 2D
No Experience
Limited Experience
Experienced
Highly Skilled
Irregular Fields
Contours
Record and Verify
No Experience
Limited Experience
Experienced
Highly Skilled
Impac
Varis
ARIA
Lantis
Portal Vision
HDR
No Experience
Limited Experience
Experienced
Highly Skilled
Varian
Nucleton Plato
Gamma Med
Age Specific Care
No Experience
Limited Experience
Experienced
Highly Skilled
Newborn/neonate (Birth - 30 days)
Infant (30 days - 1 yr)
Toddler (1 - 3 yrs)
Preschooler (3 - 5 yrs)
School age children (5 - 12 yrs)
Adolescents (12 - 18 yrs)
Young adults (18 - 39 yrs)
Middle adults (39 - 64 yrs)
Older adults (64+ yrs)
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