CYNET_SYSTEMS_MAIN_LOGO.gif   NUCLEAR MEDICINE TECHNOLOGIST SKILLS CHECKLIST
   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) Procedures 1 2 3 4  
Bone scan  
Whole body  
Dual head  
Triple head  
Renal scan  
Renograms  
Three phase renal scan  
Spleen scan  
Testicular studies  
Thyroid scan  
Parathyroid scan  
Liver scans  
Lung scan  
VQ scan  
Aerosol lung scan  
Cerebral blood flow  
Shunt patency  
Gallium scan/ imaging  
Tumor localization  
I-123 uptake  
I-131 therapy  
MUGA scan  
GI bleeding study  
Radionuclide arteriogram  
Radionuclide Venogram  
SPECT scanning  
Brachytherapy  
CCK-HIDA scan  
RIA (Radio Immuno Assay)  
Myocardial Perfusion  
Persantine infusion  
Thallium stress test  
Dual isotopes  
Adenosine infusion  
Vena Cava imaging  
CCK/ejection fraction  
Gastric emptying  
SPECT (single-photon emission CT) scan  
Brain SPECT  
Brain with Glucoheptonate  
Gated SPECT (post infarct  
Stress Holter monitoring  
NVG stress  
NVG rest  
Hot lab  
Shillings  
Biopsy’s  
Angiography  
Carotid  
Stent placement  
Arteriogram  
CO2 studies  
ERCP (endoscopic retrograde cholangio pancreatography)  
PET (position emission tomography) scanning  
Wipe test  
ALARA (as low as reasonably achievable) standards  
Rating Stars (Click) Equipment 1 2 3 4  
GE Star cam SPECT  
GE Maxi 400 Camera  
GE Star 1 Computer  
ADAC Computer/ Camera  
Centiview  
Hitach  
Siemens Computer  
Siemens Orbiter Camera          
Siemens SPECT          
Elsinct Camera          
Ohio Nuclear          
Ohio Nuclear 410 Camera          
Omega 500          
Omega 500 computer          
Hepatic Hernangloma          
Micro Dot computer          
Phillips          
PhoGamma IV          
Picker          
Technicare Computer          
Technicare Camera          
Picker Prism          
Toshiba 6000  
Sophy Computer  
Summit  
Other (list):  
Doctor’s office  
Hospital          
Mobile Route          
Nuclear Cardiology          
Teaching/ Educational          
Rating Stars (Click) Patient populations 1 2 3 4  
Neonatal  
Pediatrics  
Adolescent  
Adults  
Geriatrics  
Rating Stars (Click) General 1 2 3 4  
Venipuncture techniques  
Vital signs  
Oxygen administration  
Contrast media  
Administration  
Anaphylactic reactions  
Side effects  
Patient positioning  
Shielding  
Obtaining consent  
Code Blue  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
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  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)