CT Scan Technician / Technologist Self-Assessment Skills Checklist

Infant (Birth to 1 year)

1

2

3

4

1

2

3

4

Toddler (1–3 years)

1

2

3

4

1

2

3

4

Pre-school (3–6 years)

1

2

3

4

1

2

3

4

School Age (6–12 years)

1

2

3

4

1

2

3

4

Adolescent (12–18 years)

1

2

3

4

1

2

3

4

Young Adult (18–30 years)

1

2

3

4

1

2

3

4

Mature Adult (30–60 years)

1

2

3

4

1

2

3

4

Elderly (>60 years)

1

2

3

4

1

2

3

4

CT Scan Technician/Technologist

Head without contrast

1

2

3

4

1

2

3

4

Head with contrast

1

2

3

4

1

2

3

4

Head with/without contrast

1

2

3

4

1

2

3

4

Facial Bones

1

2

3

4

1

2

3

4

Orbits

1

2

3

4

1

2

3

4

Temporal bones/IAC's

1

2

3

4

1

2

3

4

Sinuses

1

2

3

4

1

2

3

4

Mastoids

1

2

3

4

1

2

3

4

Soft-tissue neck

1

2

3

4

1

2

3

4

Chest without contrast

1

2

3

4

1

2

3

4

Chest with contrast

1

2

3

4

1

2

3

4

Trauma Chest

1

2

3

4

1

2

3

4

High Resolution Chest

1

2

3

4

1

2

3

4

Cardiac Scoring

1

2

3

4

1

2

3

4

Abdomen with/without contrast

1

2

3

4

1

2

3

4

Adrenals

1

2

3

4

1

2

3

4

Aorta (AAA)/Renal Stone

1

2

3

4

1

2

3

4

CT KUB

1

2

3

4

1

2

3

4

Multi-phase liver/pancreas/renals

1

2

3

4

1

2

3

4

Abdomen/Pelvis with/without contrast

1

2

3

4

1

2

3

4

Trauma Abdomen/Pelvis

1

2

3

4

1

2

3

4

Pelvis

1

2

3

4

1

2

3

4

Bony Pelvis/Hips

1

2

3

4

1

2

3

4

Cervical Spine

1

2

3

4

1

2

3

4

Thoracic Spine

1

2

3

4

1

2

3

4

Lumbar Sacral Spine

1

2

3

4

1

2

3

4

Trauma Spine

1

2

3

4

1

2

3

4

Shoulder/Scapula

1

2

3

4

1

2

3

4

Humerus

1

2

3

4

1

2

3

4

Elbow

1

2

3

4

1

2

3

4

Forearm

1

2

3

4

1

2

3

4

Hand/Wrist

1

2

3

4

1

2

3

4

Femur

1

2

3

4

1

2

3

4

Knee

1

2

3

4

1

2

3

4

Lower Leg

1

2

3

4

1

2

3

4

Foot/Ankle

1

2

3

4

1

2

3

4

CTA Cranials

1

2

3

4

1

2

3

4

CTA Carotids

1

2

3

4

1

2

3

4

CTA Pulmonary Arteries

1

2

3

4

1

2

3

4

CTA Mesenteric

1

2

3

4

1

2

3

4

CTA Thoracic Aorta

1

2

3

4

1

2

3

4

CTA Abdominal Aorta

1

2

3

4

1

2

3

4

CTA Femorals W/ W/O runoff

1

2

3

4

1

2

3

4

CT Guided Paracentesis

1

2

3

4

1

2

3

4

CT Guided Thoracentesis

1

2

3

4

1

2

3

4

Post Myelogram Scans

1

2

3

4

1

2

3

4

Biopsies (various body parts)

1

2

3

4

1

2

3

4

SI Injections

1

2

3

4

1

2

3

4

Special Procedures (artho/venograms)

1

2

3

4

1

2

3

4

Colorectal Studies (rectal contrast)

1

2

3

4

1

2

3

4

Head

1

2

3

4

1

2

3

4

Chest

1

2

3

4

1

2

3

4

Abdomen/Pelvis

1

2

3

4

1

2

3

4

Years Experience in Clinical Specialty :

Most recent facility worked at :

I hereby certify that ALL information I have provided to Clover Health Services, 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.

Proficiency : -	1 = Never Performed	2 = Limited Experience	3 = Comfortable Performing	4 = Proficient
Frequency : -	1 = Never	2 = Sometimes	3 = Often	4 = Always