Ultrasound Skills Checklist

Ultrasound

1 = No theory and/or experience 2 = Limited Experience 3 = Experienced/minimal support needed to perform 4 = Proficient

Experience with Patients by Age
Newborn (birth – 30 days)*
- 1
- 2
- 3
- 4
Infant (30 days – 1 year)*
- 1
- 2
- 3
- 4
Toddler (1 – 3 years)*
- 1
- 2
- 3
- 4
Preschooler (3 – 5 years)*
- 1
- 2
- 3
- 4
School Age (5 – 12 years)*
- 1
- 2
- 3
- 4
Adolescents (12 – 18 years)*
- 1
- 2
- 3
- 4
Young Adults (18 – 39 years)*
- 1
- 2
- 3
- 4
Middle Adults (39 – 64 years)*
- 1
- 2
- 3
- 4
Older Adults (64+ years)*
- 1
- 2
- 3
- 4
GENERAL SKILLS
Preparation of Examination Room*
- 1
- 2
- 3
- 4
Identification of Patient*
- 1
- 2
- 3
- 4
Patient Assessment & Education Regarding Procedure*
- 1
- 2
- 3
- 4
Patient Positioning*
- 1
- 2
- 3
- 4
Image Optimization (Ex: Transducer Selection, Focal Zone, FOV)*
- 1
- 2
- 3
- 4
Protocol Selection*
- 1
- 2
- 3
- 4
Image Archiving*
- 1
- 2
- 3
- 4
Documentation of Procedure and Patient Data*
- 1
- 2
- 3
- 4
CDC Standard Precautions*
- 1
- 2
- 3
- 4
Correlation of Adjunct Imaging Studies to Breast Sonogram*
- 1
- 2
- 3
- 4
Doppler Mode Selection*
- 1
- 2
- 3
- 4
Work Setting
Adult Acute Care*
- 1
- 2
- 3
- 4
Adult Outpatient*
- 1
- 2
- 3
- 4
Pediatric Acute Care*
- 1
- 2
- 3
- 4
Pediatric Outpatient*
- 1
- 2
- 3
- 4
Sonography
Liver*
- 1
- 2
- 3
- 4
Biliary Tract/ Gallbladder / CBD*
- 1
- 2
- 3
- 4
Pancreas*
- 1
- 2
- 3
- 4
Spleen*
- 1
- 2
- 3
- 4
GI Tract*
- 1
- 2
- 3
- 4
Kidneys*
- 1
- 2
- 3
- 4
Adrenals*
- 1
- 2
- 3
- 4
Bladder*
- 1
- 2
- 3
- 4
Lymph Nodes*
- 1
- 2
- 3
- 4
Prostate*
- 1
- 2
- 3
- 4
Aorta/ Great Vessels*
- 1
- 2
- 3
- 4
Inferior Vena Cava*
- 1
- 2
- 3
- 4
Vasculature*
- 1
- 2
- 3
- 4
SUPERFICIAL STRUCTURES STUDIES
Abdominal wall*
- 1
- 2
- 3
- 4
Scrotum & Testis*
- 1
- 2
- 3
- 4
Musculoskeletal*
- 1
- 2
- 3
- 4
Superficial masses*
- 1
- 2
- 3
- 4
Thyroid*
- 1
- 2
- 3
- 4
GYNECOLOGICAL STUDIES
Uterus*
- 1
- 2
- 3
- 4
Adnexa*
- 1
- 2
- 3
- 4
Transvaginal Probe*
- 1
- 2
- 3
- 4
Obstetrics
1st Trimester*
- 1
- 2
- 3
- 4
2nd / 3rd Trimester*
- 1
- 2
- 3
- 4
High Risk OB*
- 1
- 2
- 3
- 4
Fetal Biophysical Profile*
- 1
- 2
- 3
- 4
Amniocentesis*
- 1
- 2
- 3
- 4
Fetal Abnormalities*
- 1
- 2
- 3
- 4
UGR Protocols*
- 1
- 2
- 3
- 4
Interventional Procedures
Biopsy*
- 1
- 2
- 3
- 4
Aspiration*
- 1
- 2
- 3
- 4
Drainage Procedures*
- 1
- 2
- 3
- 4
Thoracentesis*
- 1
- 2
- 3
- 4
Paracentesis*
- 1
- 2
- 3
- 4
Sterile Techniques*
- 1
- 2
- 3
- 4
Pediatric Studies*
- 1
- 2
- 3
- 4
General Echo Skills
Venipuncture / IV Placement*
- 1
- 2
- 3
- 4
Standard Precautions*
- 1
- 2
- 3
- 4
Isolation Precautions*
- 1
- 2
- 3
- 4
Pediatric Respiratory / Cardiac Arrest*
- 1
- 2
- 3
- 4
Adult Respiratory / Cardiac Arrest*
- 1
- 2
- 3
- 4
Crash Carts*
- 1
- 2
- 3
- 4
Defibrillators*
- 1
- 2
- 3
- 4
12 Lead EKG*
- 1
- 2
- 3
- 4
Stress Testing*
- 1
- 2
- 3
- 4
Holter Monitoring*
- 1
- 2
- 3
- 4
Adult Echo
Routine*
- 1
- 2
- 3
- 4
3-D Echo*
- 1
- 2
- 3
- 4
Pedoff Probe*
- 1
- 2
- 3
- 4
Transesophageal Echo*
- 1
- 2
- 3
- 4
Stress Echo*
- 1
- 2
- 3
- 4
Pharmacological Stress Echo*
- 1
- 2
- 3
- 4
Post-Cath Echo*
- 1
- 2
- 3
- 4
Post-Surgical Echo*
- 1
- 2
- 3
- 4
Imaging with Contrast Agents*
- 1
- 2
- 3
- 4
Sterilization Procedures*
- 1
- 2
- 3
- 4
2-Dimensional*
- 1
- 2
- 3
- 4
M-Mode*
- 1
- 2
- 3
- 4
PW Doppler*
- 1
- 2
- 3
- 4
CW Doppler*
- 1
- 2
- 3
- 4
Color Doppler*
- 1
- 2
- 3
- 4
Parasternal Long Axis View*
- 1
- 2
- 3
- 4
Right Ventricular Inflow Tract (RVIT)*
- 1
- 2
- 3
- 4
Right Ventricular Outflow Tract (RVOT)*
- 1
- 2
- 3
- 4
4-Chamber View*
- 1
- 2
- 3
- 4
2-Chamber View*
- 1
- 2
- 3
- 4
Diastolic Dysfunction Evaluation*
- 1
- 2
- 3
- 4
Subcostal View*
- 1
- 2
- 3
- 4
Special Views
Pulmonary Veins*
- 1
- 2
- 3
- 4
Hepatic Veins*
- 1
- 2
- 3
- 4
Suprasternal Notch*
- 1
- 2
- 3
- 4
Calculations
Simpson's Rule*
- 1
- 2
- 3
- 4
Proximal Isovelocity Surface Area*
- 1
- 2
- 3
- 4
Distology with TDI*
- 1
- 2
- 3
- 4
LV Strain / LV Volume*
- 1
- 2
- 3
- 4
Pediatric Echo
Routine*
- 1
- 2
- 3
- 4
3-D Echo*
- 1
- 2
- 3
- 4
Pedoff Probe*
- 1
- 2
- 3
- 4
Transesophageal Echo*
- 1
- 2
- 3
- 4
Pediatric Anomalies
Aortic Arch Abnormalities / Vascular Ring*
- 1
- 2
- 3
- 4
Arch Sidedness*
- 1
- 2
- 3
- 4
Coarctation of the Aorta*
- 1
- 2
- 3
- 4
Coronary Artery Anomalies*
- 1
- 2
- 3
- 4
Double Outlet Ventricle*
- 1
- 2
- 3
- 4
Hypoplastic Heart Syndrome*
- 1
- 2
- 3
- 4
Pulmonary Venous Return Anomalies*
- 1
- 2
- 3
- 4
Tetralogy of Fallot*
- 1
- 2
- 3
- 4
Transposition of the Great Vessels*
- 1
- 2
- 3
- 4
Tricuspid and Pulmonary Atresia*
- 1
- 2
- 3
- 4
Truncus Arteriosus*
- 1
- 2
- 3
- 4
Univentricular Heart Anomalies*
- 1
- 2
- 3
- 4
Pediatric Post-Surgical Scans
Arterial Switch*
- 1
- 2
- 3
- 4
Blalock-Taussig*
- 1
- 2
- 3
- 4
Damus-Kaye-Stansel*
- 1
- 2
- 3
- 4
Fontan*
- 1
- 2
- 3
- 4
Glenn*
- 1
- 2
- 3
- 4
Konno*
- 1
- 2
- 3
- 4
Mustard*
- 1
- 2
- 3
- 4
Norwood*
- 1
- 2
- 3
- 4
Rastelli*
- 1
- 2
- 3
- 4
Sano*
- 1
- 2
- 3
- 4
Sennig*
- 1
- 2
- 3
- 4
VASCULAR SONOGRAPHY
Arterial – Aorta*
- 1
- 2
- 3
- 4
Arterial/Venous – Superior Mesenteric*
- 1
- 2
- 3
- 4
Arterial/Venous – Inferior Mesenteric*
- 1
- 2
- 3
- 4
Arterial – Celiac*
- 1
- 2
- 3
- 4
Arterial / Venous – Hepatic*
- 1
- 2
- 3
- 4
Arterial / Venous – Common Iliac*
- 1
- 2
- 3
- 4
Arterial / Venous – Internal Iliac*
- 1
- 2
- 3
- 4
Arterial / Venous – External Iliac*
- 1
- 2
- 3
- 4
Arterial / Venous – Renal*
- 1
- 2
- 3
- 4
Arterial / Venous – Splenic*
- 1
- 2
- 3
- 4
Venous – Inferior Vena Cava*
- 1
- 2
- 3
- 4
Venous – Portal*
- 1
- 2
- 3
- 4
Transplants – Liver*
- 1
- 2
- 3
- 4
Transplants – Renal*
- 1
- 2
- 3
- 4
ARTERIAL PERIPHERAL
Subclavian*
- 1
- 2
- 3
- 4
Axillary*
- 1
- 2
- 3
- 4
Brachial*
- 1
- 2
- 3
- 4
Radial*
- 1
- 2
- 3
- 4
Ulnar*
- 1
- 2
- 3
- 4
Digital*
- 1
- 2
- 3
- 4
Common Femoral*
- 1
- 2
- 3
- 4
Superficial Femoral*
- 1
- 2
- 3
- 4
Deep Femoral*
- 1
- 2
- 3
- 4
Popliteal*
- 1
- 2
- 3
- 4
Tibioperoneal Trunk*
- 1
- 2
- 3
- 4
Posterior Tibial or Anterior Tibial or Peroneal*
- 1
- 2
- 3
- 4
Segmental Pressure-Upper Extremities*
- 1
- 2
- 3
- 4
ABI or Segmental Pressure-Lower Ext*
- 1
- 2
- 3
- 4
PVR (Pulse Volume Recording)*
- 1
- 2
- 3
- 4
Digital Pressure*
- 1
- 2
- 3
- 4
Post-Exercise Testing*
- 1
- 2
- 3
- 4
VENOUS PERIPHERAL
Internal Jugular*
- 1
- 2
- 3
- 4
Subclavian*
- 1
- 2
- 3
- 4
Axillary*
- 1
- 2
- 3
- 4
Brachial*
- 1
- 2
- 3
- 4
Cephalic*
- 1
- 2
- 3
- 4
Basilic*
- 1
- 2
- 3
- 4
Radial*
- 1
- 2
- 3
- 4
Ulnar*
- 1
- 2
- 3
- 4
Vein Mapping*
- 1
- 2
- 3
- 4
Common Femoral*
- 1
- 2
- 3
- 4
Femoral*
- 1
- 2
- 3
- 4
Deep Femoral*
- 1
- 2
- 3
- 4
Popliteal*
- 1
- 2
- 3
- 4
Great Saphenous*
- 1
- 2
- 3
- 4
Small Saphenous*
- 1
- 2
- 3
- 4
Calf Veins*
- 1
- 2
- 3
- 4
Vein Mapping*
- 1
- 2
- 3
- 4
Reflux Assessment*
- 1
- 2
- 3
- 4
Carotid Artery*
- 1
- 2
- 3
- 4
Vertebral Artery*
- 1
- 2
- 3
- 4
Subclavian Artery*
- 1
- 2
- 3
- 4
POST INTERVENTION PROCEDURES
Bypass Grafts*
- 1
- 2
- 3
- 4
Post Catheterization Complications*
- 1
- 2
- 3
- 4
Endografts*
- 1
- 2
- 3
- 4
Dialysis Access Grafts/ Fistulae*
- 1
- 2
- 3
- 4
Stents*
- 1
- 2
- 3
- 4
Angioplasty*
- 1
- 2
- 3
- 4
TIPS*
- 1
- 2
- 3
- 4
BREAST SONOGRAPHY
Fluid Aspiration*
- 1
- 2
- 3
- 4
Fine Needle Aspiration*
- 1
- 2
- 3
- 4
Core Biopsy*
- 1
- 2
- 3
- 4
Vacuum – Assisted Biopsy*
- 1
- 2
- 3
- 4
Clip Placement*
- 1
- 2
- 3
- 4
Needle Localization*
- 1
- 2
- 3
- 4
PACS
Ambra Health*
- 1
- 2
- 3
- 4
Sectra*
- 1
- 2
- 3
- 4
Infinitt*
- 1
- 2
- 3
- 4
IBM Merge*
- 1
- 2
- 3
- 4
McKesson*
- 1
- 2
- 3
- 4
Philips*
- 1
- 2
- 3
- 4
FujiFilm*
- 1
- 2
- 3
- 4
Impax*
- 1
- 2
- 3
- 4
Centricity*
- 1
- 2
- 3
- 4
Carestream Vue*
- 1
- 2
- 3
- 4
Clarity*
- 1
- 2
- 3
- 4
eRad PACS*
- 1
- 2
- 3
- 4
Syngo*
- 1
- 2
- 3
- 4
Intellaviewer*
- 1
- 2
- 3
- 4
Epic Radiant*
- 1
- 2
- 3
- 4
Novo Rad*
- 1
- 2
- 3
- 4
Equipment
Acuson*
- 1
- 2
- 3
- 4
Aspen*
- 1
- 2
- 3
- 4
Cypress*
- 1
- 2
- 3
- 4
Sequoia*
- 1
- 2
- 3
- 4
128XP10*
- 1
- 2
- 3
- 4
Philips/ ATL*
- 1
- 2
- 3
- 4
HDI 1000*
- 1
- 2
- 3
- 4
HDI 3000*
- 1
- 2
- 3
- 4
HDI 4000*
- 1
- 2
- 3
- 4
HDI 5000*
- 1
- 2
- 3
- 4
UM9 HDI*
- 1
- 2
- 3
- 4
Philips P*
- 1
- 2
- 3
- 4
Sonos 1000*
- 1
- 2
- 3
- 4
Sonos 2000/ 2500*
- 1
- 2
- 3
- 4
Sonos 5500*
- 1
- 2
- 3
- 4
Imagepoint*
- 1
- 2
- 3
- 4
Imagepoint HX*
- 1
- 2
- 3
- 4
GE*
- 1
- 2
- 3
- 4
Logiq 500 PRO*
- 1
- 2
- 3
- 4
Logiq 7*
- 1
- 2
- 3
- 4
Logiq 700*
- 1
- 2
- 3
- 4
Logiq 500MD*
- 1
- 2
- 3
- 4
Logiq 9*
- 1
- 2
- 3
- 4
Vivid 5*
- 1
- 2
- 3
- 4
Vivid 7*
- 1
- 2
- 3
- 4
Volusion 730*
- 1
- 2
- 3
- 4
Siemens*
- 1
- 2
- 3
- 4
Elegra*
- 1
- 2
- 3
- 4
Prima*
- 1
- 2
- 3
- 4
Toshiba*
- 1
- 2
- 3
- 4
SSH-140*
- 1
- 2
- 3
- 4
Powervision 8000*
- 1
- 2
- 3
- 4
Konica Minolta*
- 1
- 2
- 3
- 4
Please list the EMR systems you have used*
*
I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.*
*
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Ultrasound Skills Checklist

Ultrasound

Experience with Patients by Age

GENERAL SKILLS

Work Setting

Sonography

SUPERFICIAL STRUCTURES STUDIES

GYNECOLOGICAL STUDIES

Obstetrics

Interventional Procedures

General Echo Skills

Adult Echo

Special Views

Calculations

Pediatric Echo

Pediatric Anomalies

Pediatric Post-Surgical Scans

VASCULAR SONOGRAPHY

ARTERIAL PERIPHERAL

VENOUS PERIPHERAL

POST INTERVENTION PROCEDURES

BREAST SONOGRAPHY

PACS

Equipment

Traveler

Travel Jobs

Facilities

CrossMed

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