JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Radiation Therapist Educator
This form is for highly experienced Radiation Therapists who are interested in supporting the training of radiotherapy clinicians in low- and middle- income countries (LMICs). We really appreciate your generosity in sharing your knowledge, your experience, and your passion. We thank you again for reaching out to Rayos Contra Cancer.
Learn more about us at
rayoscontracancer.org
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
What is your current institution? (Name, City, Country)
*
Your answer
What experience do you have in practice? (briefly describe)
*
Your answer
How many years of experience do you have?
*
Your answer
Are you certified in other modalities?
*
Dosimetry X-ray
CT
MR
None of the Above
Other:
Do you have experience in education? If so, briefly describe.
Your answer
What techniques are you interested in teaching about?
*
I am happy to teach about any technique that is most helpful (can leave rest blank)
Brachytherapy
2D to 3D transition
IMRT
VMAT
IGRT
SBRT
SRS
IORT
Other:
Required
What topics are you interested in teaching?
*
I am happy to teach any topic that is most helpful (can leave rest blank)
Acceptance and Commissioning
Calibration
Computer-based treatment planning
Dose measurement and calculation
Imaging
Quality Assurance
Treatment process
Contrast media in simulations
4D Gating
Other:
Required
What is your preference? (mark all that apply)
Be able to use my existing presentations to teach (they may need to be catered based on time constraints and audience level)
Be able to build or incorporate new presentations that are focused on LMIC settings
Be able to build or work with center specific documents, protocols, checklists, QA, etc. and provide these for permanent use and regional dissemination
Lead a team of radiation therapists for an RCC project (more time commitment involved)
Other:
During one year, how many 1hr educational sessions are you potentially interested in participating in? (as a teacher)
*
1
2 - 3
4 - 6
More than 6
Undecided (at least 1)
None, but I want to be involved in another way
Other:
Are you interested to be a teacher in large group education? (e.g. audience of 30 or more)
*
Yes
No
Maybe
Are you interested to serve on a RCC team for improving the content of educational programs? (e.g. improving powerpoint presentations, handouts, videos, practice questions, interactive assignments, etc.)
*
Yes
No
Maybe
Are you interested to volunteer ad-hoc for one-on-one clinic support?
*
Yes
No
Maybe
What motivates you to share your expertise in developing regions?
*
Your answer
What languages do you speak, and with what fluency?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms