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Payroll Application Medical Inservice Skills Checklists     Mammography Name: Verify ID: Date: Click To Highlight: 1 - No Experience 2 - Minimal 3 - Moderate 4 - Very Experienced A. Mammography 1   2   3   4     ACS Guidelines for Mammo Screen           Breast Self Exam Teaching           Mammographic Appearance of Benign Condition           Mammographic Appearance of Malignant Condition           kVp           mAs           Density Setting           Photocell Positioning           cm of Compression           Magnification Techniques           Evaluation of Image Quaility           Film Processing           Quality Assurance of Processing           Screening           Diagnostic           Magnification Views           Stereotactic Biopsy           Digital           Needle Localization           Implant Displaced           Left CC-MLO Views           Right CC-MLO Views           Craniocaudal           Mediolateral Oblique           90 Degree Mediolateral           90 Degree Lateromedial           Axilary Tail           Tangential           Spot Compression           Lateral Roll           Medial Roll           Caudocranial           Lateromedial Oblique           Superolateral to Inferomedial Oblique           Oblique           Galactigram           Quality Assurance           B. Special Patient Situations 1   2   3   4     Chest Wall Deformities           Irradiated Breast           Reduction mammoplasty           Post-Surgical Breast           Males           Kyphotic Patients           Protruding Abdomen           Pacemaker           Infusa-Port           Implants         C. Interventional Procedures: Assist with     Fine Needle Aspiration           Core Biopsy           Breast Specimen Imaging           Needle Localization           Ductography           Pneumocystography           Universal Precautions         D. Certification ⁄ Registries Date   ARRT Expiration Date   Mammography Expiration Date   BCLS Expiration Date   ACLS Expiration Date   Eligible           Other         E. Age Specific Criteria     School Age (5 to 12 years)           Adolescents (12 to 18 years)           Young Adults (18 to 39 years)           Middle Adults (40 to 64 years)           Older Adults (65 & up)           Pneumocystography           Universal Precautions         F. Facility Setting Years Experience   Small Hospital   Large Hospital   BCLS Outpatient   ACLS Clinic G. Name & Model of Machines Used

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