Appendix E — Clinical Tools & Competency Aids

Purpose

This appendix provides structured tools to support clinical competency development and evaluation. It is designed to help students internalize ARRT expectations, engage in meaningful clinical dialogue, and reflect on their performance through guided self-assessment. These tools promote consistency, critical thinking, and confidence in radiographic practice.

ARRT Competency Expectations

The American Registry of Radiologic Technologists (ARRT) requires students to demonstrate proficiency in:

• Anatomy Identification: Recognizing and labeling key anatomical structures on radiographs.
• Positioning & Setup: Correct patient orientation, CR location, SID, angulation, and use of positioning aids.
• Exposure Technique: Selecting appropriate kVp, mAs, grid use, and breathing instructions.
• Image Evaluation: Assessing coverage, rotation, motion, contrast, and diagnostic quality.
• Clinical Rationale: Understanding the purpose of each projection and adapting for pathology, trauma, or patient condition.
• Safety & Documentation: Applying radiation protection, contrast media protocols, and proper documentation.

How the Clinical Preceptor Reference Guide Supports ARRT Evaluation

The guide is structured to mirror ARRT expectations and provides:

1. Region-Based Organization
   • Follows the same sequence as the textbook (Thorax & Abdomen, Extremities, Spine & Pelvis, GI/GU, Head).
   • Each section includes ARRT-required projections and supplemental views.
2. Standardized Evaluation Criteria
   For every projection, the guide outlines:
   • Anatomy Identification: Specific structures students must demonstrate.
   • Positioning & Setup: Detailed instructions for patient positioning, CR location, SID, and adjustments.
   • Image Evaluation Criteria:
   • Coverage: Required anatomy included.
   • Rotation: Symmetry and alignment.
   • Motion: Sharpness and absence of blur.
   • Technique: Contrast, penetration, and absence of artifacts.
   • Clinical Aim: Diagnostic purpose of the projection.
3. Clinical Rationale Prompts
   “Hows & Whys” sections provide targeted questions to guide student reasoning and reinforce understanding of:
   • Anatomical relationships
   • Positioning choices
   • Technique selection
   • Pathology impact
   • Clinical indications
4. Error Recognition & Correction
   • Tables and charts summarize common positioning and exposure errors, their radiographic appearance, causes, and corrective actions.
   • Supports formative feedback and remediation.
5. Competency Aids & Checklists
   • Designed to help preceptors objectively assess student performance.
   • Aligns with ARRT’s emphasis on reproducibility, safety, and diagnostic adequacy.
6. Adaptation & Clinical Context
   • Includes guidance for modifying procedures based on trauma, pediatric, geriatric, or mobility limitations.
   • Emphasizes clinical applications and real-world relevance of each projection.

Sample Competency Checklist: PA Chest

Clinical Rationale Prompts

Clinical rationale prompts are designed to support meaningful dialogue between students and preceptors during competency evaluations. These questions encourage learners to explain their positioning decisions, technique selections, and anatomical considerations, reinforcing the “why” behind each projection. They align with the Hows & Whys content in the textbook and help students develop critical thinking and clinical confidence. Additional prompts can be found in the Hows & Whys section for each exam type throughout the main textbook chapters.

Student Self-Assessment Tools

Student self-assessment tools are designed to promote reflective learning and support the development of clinical judgment. These tools encourage students to evaluate their own performance, identify strengths and areas for improvement, and connect positioning decisions with image quality outcomes. By using structured checklists and reflection prompts, learners can build confidence and competence in radiographic practice.