MRI Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information This field is hidden when viewing the formOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security NumberEmail(Required) This field is hidden when viewing the formDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyAGE OF PATIENTS CARED FORNewborn/Neonate (birth to 30 days)(Required) 1 2 3 4 Infant (1 month to 1 year)(Required) 1 2 3 4 Toddler (1 year to 3 years)(Required) 1 2 3 4 Preschooler (3 years to 5 years)(Required) 1 2 3 4 School Age Child (5 years to 12 years)(Required) 1 2 3 4 Adolescents (12 years to 18 years)(Required) 1 2 3 4 Young Adults (18 years to 39 years)(Required) 1 2 3 4 Middle Adults (39 years to 64 years)(Required) 1 2 3 4 Older Adults (64+ years)(Required) 1 2 3 4 MRI SAFETY REQUIREMENTSScreening Patients, Personnel, & Non-Personnel for MRI Safe, Conditional, & Unsafe Devices & Objects(Required) 1 2 3 4 Identify MRI Safety Zones(Required) 1 2 3 4 Static Field (ex: Pojectiles)(Required) 1 2 3 4 Radiofrequency Field (ex: Thermal Loading, Coil Positioning, & Insulation)(Required) 1 2 3 4 Time-varying Gradient Magnetic Fields (ex: Induced Voltages, Auditory Considerations)(Required) 1 2 3 4 Communication & Monitoring Considerations (ex: Sedated Patients, Verbal & Visual Contact, Vital Signs)(Required) 1 2 3 4 Contrast Media Safety (Ex: NSF, Renal Function)(Required) 1 2 3 4 Other MRI Safety Considerations (Ex: Cryogen Safety, Fire, Medical Emergencies, Laser Alignment Lights)(Required) 1 2 3 4 GENERAL SKILLSVenipuncture/IV Placement(Required) 1 2 3 4 Identification of Patient(Required) 1 2 3 4 Safety Screening & Patient Education Regarding Procedure(Required) 1 2 3 4 Patient Care & Assessment(Required) 1 2 3 4 Preparation of Examination Room(Required) 1 2 3 4 Preparation and/or Administration of Contrast Media(Required) 1 2 3 4 Selection of Optimal Imaging Coil(Required) 1 2 3 4 Patient Positioning(Required) 1 2 3 4 Protocol Positioning(Required) 1 2 3 4 Parameter Selection(Required) 1 2 3 4 Image Display, Filming (If Applicable), Networking, & Archiving(Required) 1 2 3 4 Post-Processing(Required) 1 2 3 4 Documentation of Procedure & Patient Data(Required) 1 2 3 4 Patient Discharge with Post-Procedure Instructions(Required) 1 2 3 4 CDC Standard Precautions(Required) 1 2 3 4 MRI Safety Procedures & Precautions(Required) 1 2 3 4 Head and NeckBrain(Required) 1 2 3 4 IAC(Required) 1 2 3 4 Orbit(Required) 1 2 3 4 Pituitary(Required) 1 2 3 4 Head MRA(Required) 1 2 3 4 Head MRV(Required) 1 2 3 4 Cranial Nerves(Required) 1 2 3 4 Posterior Fossa(Required) 1 2 3 4 Head Trauma(Required) 1 2 3 4 Face/ Soft Tissue Neck(Required) 1 2 3 4 Neck MRA(Required) 1 2 3 4 SpineCervical(Required) 1 2 3 4 Thoracic(Required) 1 2 3 4 Lumbar(Required) 1 2 3 4 Sacrum/ Coccyx(Required) 1 2 3 4 Spinal Trauma(Required) 1 2 3 4 Brachial Plexus(Required) 1 2 3 4 ThoraxChest(Required) 1 2 3 4 Thoracic MRA(Required) 1 2 3 4 Breast(Required) 1 2 3 4 Abdomen and PelvisAbdomen(Required) 1 2 3 4 Pancreas(Required) 1 2 3 4 Kidneys(Required) 1 2 3 4 Adrenals(Required) 1 2 3 4 MRCP(Required) 1 2 3 4 Abdominal MRA(Required) 1 2 3 4 Abdominal MRV(Required) 1 2 3 4 Male Pelvis(Required) 1 2 3 4 Female Pelvis(Required) 1 2 3 4 MusculoskeletalElbow(Required) 1 2 3 4 Hand/ Wrist(Required) 1 2 3 4 Finger/ Thumb(Required) 1 2 3 4 TMJ(Required) 1 2 3 4 MR Arthrography(Required) 1 2 3 4 Finger/ Thumb(Required) 1 2 3 4 Hip/ Bony Pelvis(Required) 1 2 3 4 Ankle(Required) 1 2 3 4 Shoulder(Required) 1 2 3 4 Scapula(Required) 1 2 3 4 Sternum/ SC(Required) 1 2 3 4 Foot(Required) 1 2 3 4 Upper Extremity Long Bones(Required) 1 2 3 4 Lower Extremity Long Bones(Required) 1 2 3 4 Knee(Required) 1 2 3 4 Special Imaging ProceduresImage Post-Processing (Ex: MIP, MPR, ADC Mapping, Subtraction)(Required) 1 2 3 4 Perfusion(Required) 1 2 3 4 Diffusion (Non-Brain)(Required) 1 2 3 4 CINE (Ex: CSF Flow Study)(Required) 1 2 3 4 Peripheral MRA (Iliac, Runoff)(Required) 1 2 3 4 Spectroscopy(Required) 1 2 3 4 Quality ControlSignal to Noise(Required) 1 2 3 4 Center Frequency(Required) 1 2 3 4 Transmitter Gain or Attenuation(Required) 1 2 3 4 Geometric Accuracy(Required) 1 2 3 4 Scanners(Required) 1 2 3 4 EMReClinicalworks(Required) 1 2 3 4 EPIC(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 Care 360(Required) 1 2 3 4 Allscripts(Required) 1 2 3 4 Cerner(Required) 1 2 3 4 Optum Insight(Required) 1 2 3 4 Greenway(Required) 1 2 3 4 PACSAmbra Health(Required) 1 2 3 4 Sectra(Required) 1 2 3 4 Infinitt(Required) 1 2 3 4 IBM Merge(Required) 1 2 3 4 McKesson(Required) 1 2 3 4 Philips(Required) 1 2 3 4 FujiFilm(Required) 1 2 3 4 Impax(Required) 1 2 3 4 Centricity(Required) 1 2 3 4 Carestream Vue(Required) 1 2 3 4 Clarity(Required) 1 2 3 4 eRad PACS(Required) 1 2 3 4 EQUIPMENTTelerad(Required) 1 2 3 4 Nighthawk(Required) 1 2 3 4 Power Injectors(Required) 1 2 3 4 GE Signa1.5T Magnet Strength(Required) 1 2 3 4 3T Magnet Strength(Required) 1 2 3 4 Siemens1.5T Magnet Strength(Required) 1 2 3 4 3T Magnet Strength(Required) 1 2 3 4 Hitachi1.5T Magnet Strength(Required) 1 2 3 4 3T Magnet Strength(Required) 1 2 3 4 Philips1.5T Magnet Strength(Required) 1 2 3 4 3T Magnet Strength(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. 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