Competency Checklist

COMPETENCY CHECKLIST

DIAGNOSTIC MEDICAL SONOGRAPHY – VASCULAR PROCEDURES
Important: This form must be completed, signed, and submitted by the applicant's direct supervisor or designated clinical lead only.
Instructions for the Supervisor

This checklist is used to validate the applicant's clinical experience and current scope of practice.

A procedure marked Competent indicates that the applicant has demonstrated the ability to perform the procedure independently, following the appropriate sequence of tasks to obtain accurate diagnostic images within a reasonable timeframe and across a variety of patient presentations.

A procedure marked Not Applicable indicates that the procedure is not performed within the employer's clinical practice setting. The applicant may require orientation to this procedure in an Alberta clinical environment.
Instructions for the Applicant
- Request that your supervisor complete, sign, and submit this checklist.
- Once the supervisor has submitted the form, a PDF copy will be emailed to you.
- Download the PDF and upload it to your assessment application.
Important Information
- A separate checklist must be completed by the supervisor for each employer listed on your assessment application.
- All checklists must be fully completed, validated, and signed before submission.
- Your assessment application will remain incomplete until all required checklists have been uploaded.

Rows	Date last performed (mm/dd/yyyy)	Competent	Not Applicable	Supervisor Validation if Competent (To be initialed by supervisor only)
Renal artery stenosis
Pre/post transplants
Portal hypertension

Rows	Date last performed (mm/dd/yyyy)	Competent	Not Applicable	Supervisor Validation if Competent (To be initialed by supervisor only)
Carotid and vertebral arteries (including subclavian and innominate arteries)

Rows	Date last performed (mm/dd/yyyy)	Competent	Not Applicable	Supervisor Validation if Competent (To be initialed by supervisor only)
Lower extremity arteries
Aorta/Iliac arteries
Graft surveillance
Post-angioplasty follow-up
Follow-up of hemodynamically significant stenosis
ABI/TBI
Segmental pressures
Exercise testing
Raynaud's testing

Rows	Date last performed (mm/dd/yyyy)	Competent	Not Applicable	Supervisor Validation if Competent (To be initialed by supervisor only)
Upper extremity arteries
Raynaud’s testing
Thoracic outlet testing

Rows	Date last performed (mm/dd/yyyy)	Competent	Not Applicable	Supervisor Validation if Competent (To be initialed by supervisor only)
DVT
Venous insufficiency
Vein mapping

Rows	Date last performed (mm/dd/yyyy)	Competent	Not Applicable	Supervisor Validation if Competent (To be initialed by supervisor only)
Starts an IV line
Administers contrast agent
Selects correct preset, transducer and frequency
Adjusts instrument controls to optimize image quality
Performs transducer cleaning and reprocessing procedures
Performs related measurements
Annotates images
Formulates technical impressions
Optimizes, analyzes and archives electronic data

DIAGNOSTIC MEDICAL SONOGRAPHY – VASCULAR PROCEDURES