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CYNET_SYSTEMS_MAIN_LOGO.gif   MRI Tech Skills
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.  
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.  
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

  
       
Rating Stars (Click) WORK SETTINGS 1 2 3 4  
0
 Adult Acute Care  
0
 Adult Outpatient  
0
 Pediatric Acute Care  
0
 Pediatric Outpatient  
0
 Trauma  
0
 Outpatient Clinica/Free-Standing clinic  
0
 Mobile  
0
 Supervisory/Management Experience  
Rating Stars (Click) ANGIO STUDIES 1 2 3 4  
0
 Abdominal Aorta  
0
 Chest/Arch  
0
 Circle of Willis  
0
 Upper & Lower Extremities  
0
 Carotids/Neck  
0
 Renal Arteries  
0
 Subclavian  
Rating Stars (Click) VENOGRAM STUDIES 1 2 3 4  
0
 Carotids/Neck  
0
 Renal Arteries  
0
 Pelvis  
0
 Upper & Lower Extremities  
Rating Stars (Click) MR STUDIES 1 2 3 4  
0
 Cardiac MRI  
0
 Head/Neck  
0
 Brain/Head w-w/o Contrast  
0
 Face w-w/o Contrast  
0
 Pituitary w-w/o Contrast  
0
 Soft Tissue Neck w-w/o Contrast  
0
 TMJ w-w/o Contrast  
Rating Stars (Click) ABDOMEN/PELVIS 1 2 3 4  
0
 Abdomen w-w/o Contrast  
0
 Adrenals w-w/o Contrast  
0
 Cholangiogram  
0
 Pelvis w-w/o Contrast  
0
 Sacroiliac Joint w-w/o Contrast  
0
 Renal w-w/o Contrast  
Rating Stars (Click) CHEST 1 2 3 4  
0
 Brachial Plexus  
0
 Breast w-w/o Contrast  
0
 Chest w-w/o Contrast  
0
 Myocardium w-w/o Contrast  
0
 Sternum w-w/o Contrast  
Rating Stars (Click) SPINE 1 2 3 4  
0
 Cervical Spine w-w/o Contrast  
0
 Thoracic Spine w-w/o Contrast  
0
 Lumbar Spine w-w/o Contrast  
0
 Sacrum w-w/o Contrast  
Rating Stars (Click) UPPER EXTREMITIES 1 2 3 4  
0
 Scapula w-w/o Contrast  
0
 Shoulder w-w/o Contrast  
0
 Arthogram Shoulder  
0
 Elbow/Wrist w-w/o Contrast  
0
 Hand/Finger w-w/o Contrast  
0
 Humerus w-w/o Contrast  
Rating Stars (Click) LOWER EXTREMITIES 1 2 3 4  
0
 Hip w-w/o Contrast  
0
 Knee w-w/o Contrast  
0
 Foot/Ankle w-w/o Contrast  
0
 Femur/Tibia w-w/o Contrast  
Rating Stars (Click) PHASE ARRAY 1 2 3 4  
0
 Head  
0
 Neurovascular  
0
 Spine  
0
 Torso  
Rating Stars (Click) SURFACE COILS 1 2 3 4  
0
 Extremity  
0
 Shoulder  
0
 TMJ  
Rating Stars (Click) IMAGES 1 2 3 4  
0
 Echo Planar Imaging - EPI  
0
 Gradient Echo Imaging  
0
 Multiplanar Reconstruction/MRA  
0
 Spin Echo Images  
0
 T-1 weighted  
0
 T-2 weighted  
0
 Inversion Recovery  
0
 Fat Supression  
0
 Fiesta  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 1 2 3 4  
0
 National Patient Safety Goals  
0
 Computerized Charting  
0
 Venipuncture  
0
 Contrast Administration  
0
 Imaging a Patient with Conscious Sedation  
0
 Imaging a Patient under Anesthesia  
0
 Patient Isolation/Infection Prevention  
Rating Stars (Click) MRI IMAGING SYSTEMS  
  GE Signa    
  1.5T Magnet Strength
   
  3T Magnet Strength
   
  Model (List):  
  Siemens  
  1.5T Magnet Strength
   
  3T Magnet Strength
   
  Model (List):  
  Hitachi  
  1.5T Magnet Strength
   
  3T Magnet Strength
   
  Model (List):  
  Phillips  
  1.5T Magnet Strength
   
  3T Magnet Strength
   
  Model (List):  
  Other  
  1.5T Magnet Strength
   
  3T Magnet Strength
   
  Model (List):  
Rating Stars (Click) CERTIFICATIONS/LICENSURES/REGISTRATIONS  
  EMR Conversion
   
  ARRT
   
  ARRT (MR) (National Certification)
   
Rating Stars (Click) State Licenses:  
  State (List)  
  Other  
Rating Stars (Click) EMR 1 2 3 4  
0
 Epic  
0
 Cerner  
0
 Eclipsys  
0
 McKesson  
0
 Meditech  
0
 Other Computerized System  
0
 Computerized Physician Order Entry  
0
 Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1    
COMMUNITY ER    
RURAL ER    
Rating Stars (Click) AGE APPROPRIATE CARE 1 2 3 4  
0
 Newborn/Neonatal (birth – 30 days)          
0
 Infant (30 days-1 year)          
0
 Toddler (1-3 years)          
0
 Preschool (3-5 years)          
0
 School Age Children (5-12 years)          
0
 Adolescent (12-17 years)          
0
 Young Adults (18-44 years)          
0
 Middle Adults (45-64 years)          
0
 Older Adults (>65 years)