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Ultrasound
Radiology: Sonographer
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
General Ultrasound
No Experience
Limited Experience
Experienced
Highly Skilled
Abdominal - Limited
Abdominal - Complete
Pediatric Abdomen
Paracentesis
Thoracentesis
Biopsy Guidance of the above
Color/doppler of the above
Intraoperative experience
Small Parts
No Experience
Limited Experience
Experienced
Highly Skilled
Breasts
Superficial masses
Testicles
Thyroid
Fine needle aspiration
Biopsy guidance of the above
Color/doppler of the above
Vascular Technology
No Experience
Limited Experience
Experienced
Highly Skilled
Continuous wave doppler
Pulse wave doppler
Color doppler
Digital acquisition systems
Carotids
TCD
Abdominal aorta, IVC
Hepatic/splenic/SMA/celiac
Renal artery duplex
Upper extremity arterials
Upper extremity venous
Arterial graft studies
Lower extremity arterials
Lower extremity venous
Plethysmography for finger, toes, TOS
Use PW/CW to determine % stenosis
Diameter for % stenosis
Area for % stenosis
OB/GYN
No Experience
Limited Experience
Experienced
Highly Skilled
Fetal position/presentation
Fetal anatomical survey
Biometry
CRL
Four chamber view
Cerebellum, ventricles
Diaphragm
Stomach
Renal/bladder
AFI and BPP
Atria and cisterna magnum
Bone lengths
Fingers, toes
Inter and intraorbital measurements
Nose and lips
Outflow fracts
IUGR protocols
Nuchal translucency screen
Twin/multiples protocols
Umbilical cord doppler
Mid-cerebral artery doppler
Transvaginal exam
Cervical length
Amniocentesis assistance
Chorionic villi sampling assistance
Renal/Pelvis
No Experience
Limited Experience
Experienced
Highly Skilled
Renal/bladder
Post-void residual
Renal artery doppler
Adnexa
Ovaries
Uterus
Transabdominal view
Transperineal view
Transvaginal view
Follicle study
Assist with sonohystogram
Assist with ovarian cyst aspiration
Hernia
Prostate (Transabdominal)
Prostate (Transrectal)
Color/doppler of the above
Neonatal
No Experience
Limited Experience
Experienced
Highly Skilled
Head
Hips
Spine
Abdomen/pelvis
Renal/bladder
Duodenal atresia
Equipment
No Experience
Limited Experience
Experienced
Highly Skilled
Phillips
Siemens
Toshiba
Hitachi
GE
Accuson
Work Settings
No Experience
Limited Experience
Experienced
Highly Skilled
Adult acute care/hospital
Adult outpatient
Pediatric acute care
Pediatric outpatient/clinic
High risk OB
Neonatal
Management
Mobile routes
Physician's office
Age Specific Experience
No Experience
Limited Experience
Experienced
Highly Skilled
Newborn/neonate (Birth-30 days)
Infant (1mo-1yr)
Toddler (1-3yrs)
Preschooler (3-5 yrs)
School age child (5-12 yrs)
Adolescents (12-18 yrs)
Young adults (18-39 yrs)
Middle adults (39-64 yrs)
Geriatric adults (65+ yrs)
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