Gadsden State Community College Radiologic Technology Program Procedures Lab Evaluation Student Name: ____________________________ Procedure: _______________________________

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Dev
eloped
August

2008
; revised 10/2008


Gadsden State Community College

Radiologic Technology Program

Procedures Lab Evaluation

S
tudent Name
: __________________
__________


Procedure: ____
___________________________


1.

check patient identification



2.

introduce self


3.

properly prepared patient
for procedure


4.

had proper supplies prepared


5.

checked for possible pregnancy


6.

proper patient identification on image


7.

part positioned properly


8.

CR / Part / IR centering


9.

used proper collimation


10.

proper marker / proper marker placement




Projections

AP

LAT

RPO

LPO

OM

Total

11.

shielded patient when possible

20/20

20/20

17/20

19/20

20/20

16/20

12.

explained the procedure to the patient







13.

used proper SID







14.

grid / bucky / tablet
op used properly







15.

appropriate cassette size / orientation







16.

part positioned properly







17.

CR aligned to IR and part correctly







18.

CR angled correctly







19.

appropriate collimation







20.

proper marker (R, L, etc.) / proper marker
plac
ement







21.

gave proper breathing instructions







22.

provided for patient comfort







23.

anatomy identification








#of items possible

#of items correct








Evaluator Signature:

_____________________________ Dat
e: _____
_________



Score: _____ / _____

= _____
# of GEs = _____



DD
=

yes

no


GE = 10 point deduction off final score

DD = 5 point deduction for not having dosimeter


_____ (Score)
-

_____ (GE)
-

_____ (DD) = _____ Final
Grade

C
-
Spine

SLO #1

Assessment #
2

Class of 2012

2011
-
2012

Page 1of 2

Dev
eloped
August

2008
; revised 10/2008



Gads
den State Community College

Radiologic Technology Program

Procedures Lab Evaluation

S
tudent Name
: __________________
__________


Procedure: _______________________________


1.

check patient identification



2.

introduce self


3.

properly prepared patient for pr
ocedure


4.

had proper supplies prepared


5.

checked for possible pregnancy


6.

proper patient identification on image


7.

part positioned properly


8.

CR / Part / IR centering


9.

used proper collimation


10.

proper marker / proper marker placement





Projections

Caldwell

Waters

Lateral

Total



11.

shielded patient when possible

20/20

20/20

19/20

19/20



12.

explained the procedure to the patient







13.

used proper SID







14.

grid / bucky / tabletop used p
roperly







15.

appropriate cassette size / orientation







16.

part positioned properly







17.

CR aligned to IR and part correctly







18.

CR angled correctly







19.

appropriate collimation







20.

proper marker (R, L, etc.) / proper marker
placement







21.

gave proper breathing instructions







22.

provided for patient comfort







23.

anatomy identification








#of items possible

#of items correct








Evaluator Signature: _____________________________ Date: ______
________



Score: _____ / _____ = _____ # of GEs = _____


DD =

yes

no


GE = 10 point deduction off final score

DD = 5 point deduction for not having dosimeter


_____ (Score)
-

_____ (GE)
-

_____ (DD) = _____ Final
Grade

Sinuses

SLO #1

Assessment #
2

Class of 2012

2011
-
2012

Page 2 of 2