CT Technologist Skills Checklist Personal InformationName(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) Date MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyCT Technologist SkillsAbdominal 1 2 3 4 Pancreas 1 2 3 4 Liver 1 2 3 4 Pelvis 1 2 3 4 Temporomandibular 1 2 3 4 Adrenal 1 2 3 4 Aorta 1 2 3 4 Thorax 1 2 3 4 Brain CT Scans Contrast Non-contrast 1 2 3 4 Chest 1 2 3 4 Orbit 1 2 3 4 Pulmonary embolism 1 2 3 4 Internal Auditory canal 1 2 3 4 Facial Bone 1 2 3 4 Sinus 1 2 3 4 Mastoid Scan 1 2 3 4 Neck Scans 1 2 3 4 Thoracic Scans 1 2 3 4 Cervical Spines 1 2 3 4 Lumbar/Sacral Spine Scans 1 2 3 4 Post Myelogram scans 1 2 3 4 Trauma Spinal scans 1 2 3 4 Upper extremity scans 1 2 3 4 Lower extremity scans 1 2 3 4 Renal CT Renal cyst puncture 1 2 3 4 Spin-echo images 1 2 3 4 Surface coils 1 2 3 4 Biopsy procedures 1 2 3 4 Gradient Echo imaging 1 2 3 4 CT guided Thoracic drainage’s, abdominal drainages 1 2 3 4 Pediatric Head CT Scans 1 2 3 4 Pediatric thoracic and abdominal CT Scans 1 2 3 4 Quality improvement studies/participation 1 2 3 4 Equipment UsageGeneral Electric 1 2 3 4 Hitachi 1 2 3 4 Kodak Processor 1 2 3 4 Siemens 1 2 3 4 Phillips 1 2 3 4 High speed Advantage 1 2 3 4 Radiation badge/ PPE 1 2 3 4 Hewlett Packard 1 2 3 4 Other EquipmentAge Specific CompetenciesInfant (Birth - 1 year) 1 2 3 4 Preschooler (ages 2-5 years) 1 2 3 4 Childhood (ages 6-12 years) 1 2 3 4 Adolescents (ages 13-21 years) 1 2 3 4 Young Adults (ages 22-39 years) 1 2 3 4 Adults (ages 40-64 years) 1 2 3 4 Older Adults (ages 65-79 years) 1 2 3 4 Elderly (ages 80+ years) 1 2 3 4 AuthorizationsSignature(Required)The information I have given is true and accurate to the best of my knowledge. I hereby authorize Hired by Matrix, Inc. to release this CT Technologist Skills Checklist to Client facilities of Hired by Matrix, Inc. in consideration of my assignment to work at those facilities.
