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.. PLEASE USE THE ADDRESS BELOW FOR.

FUTURE CORRESPONDENCE AND IN RESPONSE... , ,

' TO THIS APPICATION:- ~

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Wagih M. Shehata, M.D.'

6525 Shawnee RidgeEXHIBIT A Cincinnati, Ohio 45243

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~ , W ,. 0..ma,c,.g sin#u3. NUCLEAn nECULATQnY COMMIS3tCN" " * " ' ' ' * * - "APPt.! CATION FOR MATERIALS LICENSE - TELETHERAPY

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EXHIBIT A (Continued)'

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INFORMATiON REQUIRED FOR ITEMS 10 THROUCN 21

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10. ME3tCAL 150TCPE COMMITTEE 15. SEAM 5TCPS. e.

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11. TRAI,.4G AND EXPERIENCE 17. OPERATING ANO EMERGEPeCY PROCEDURES*

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12. INSTRUMENTATICN echech ne) 18. INSTRUCTION OF PER$QN.sEL (eect .ae,,

,_ . C v . e . X a T, ww- e G.uid.e.-.f or.i.P. ale aration" " r

.-A Ne for Licenseses irm.

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13. CALISR. TION OF iNSTfiUME.eT3 (check .ned 19. LEAK TEITS OF $EALED SOURCES+ .-*

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14. FACILITIES AND EQutPMENT

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,ALAR = r, " Guide..f or f reparation otp X m. oo . .e .ea e. .ad -- .e .=. caw .ad X ." Application for Liceases-A e-

'*!'E*"' E IEOL''T"g ptherapy Programs -

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22. CE RTIFICAYE(TA. Ae. must to a.m.A.,.d &y .me sWac.n,)

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10. -RADIATION ~ SAFETY COMMITTEE

LRadiation_ Safety Program will be under authority of Radiation SafetyCommittee.-

a'. .The Radiation Safety. Committee will review safety aspects of'of present program; keep. records'of committee meetings,. actions,recommendations, and decisions; prepare and disseminate infor-mation pertaining to radiation safety; delegate responsibility:to RS0'for conduct of routine radiation safety programs;maintain: records of receipts, transfers, and-disposal of-

.

radioactive materials and also total possession level;' -

initiate corrective actions as necessary to assure radiationsafety to personnel and to. patients'; review training and. experience of any. individual who.uses radioactive material and .

determine that qualifications are sufficient to' perform duties-safely; determine whether current procedures are maintaining exposureALARA. _

b .' The Committee shall meet quarterly (or more often if deemed'necessary).. The records of these meetings will be kept byW. Shehata, Chairman.

c. The committee includes the following members:

Wagih Shehata, M. D. , Radiation Therapist, ChairmanFarooh Jazy, M. D., Radiation TherapistJohn Frgshcorn,LM.S., Radiologic Physicist, RSOJames G. Kereiakes, Ph.D., Radiologic Physicist (Consultant)

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_ _11. TRAINING AND EXPERIENCE ^~-

Drs. E 'Shehata, F.'Jazy are certified in Radiation Therapy by theAmerican Board of'. Radiology and are presently certified for CobaltTeletherapy Human'Use under NRC License No. .34-00991-03 (GoodSamaritan Hospital, Cincinnati, Ohio).

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12, i-INSTRUMENTATION

On Premise: Eberline'E-120 Survey Meter. Access.to: Texas Nuclear-Model 2592 Ion Chamber Survey MeterIon Chamber - Vict'oreen Instrument Corporation-

~

:100 R Model.621,. Serial #1055R-meter model 570, Serial #1055-~

Ion Chamber -NEL'2571' Serial f448*-

Keit' ley Electrometer'35614, Serial #18058h

.- 13 .' CALIBRATION OF INSTRUMENTS-

' Survey Meters (see attached)' - annually and as needed (following-repair); Leo'ustancy. check performed as instrument used (see 3attached -form);- survey. meters will be calibrated by James G.Kereiakes, Ph.D. , Certified Radiological Physicist (American

~

Board of. Radiology), E555 Medical Sciences Building, University*

of Cincinnati, Cincinnati, OH 45267.

Ion Chamber and R-Meter,

See attached for calib' ration

.14. FA'CILITIES AND EQUIP' MENT

a. drawing of facilities. attached

.The unit.will-b.e placed in a presently existing undergroundarea housing transformers. This area is attached to presentunderground portion of building. .Three walls are outsideunderground walls. Remaining inside~ wall adjoins hallway-and office area; area above is outside ground level.

b. & c~.

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Safety. devices to include thr'following:

-1. . Signal lights on the con' trol panel'will indicate source "off"- (green) and source "on" (red) . Lights above the entrancedoor ~ and head unit will indicate source "on" (red" and source~"off" (White) .

'

'2. A door interlock switch will-turnthe source ."off" of the. treatment room: door is opened. The source will remain "off"until the. treatment roam door is closed and the control-. circuits reset.

' 3 .' Unit will have an emergency . source "off" release on. the head.~

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4. A sign with the radiation symbol and the wording " Caution High_

Radiation Area.- COBALT 60, . Curies, dateCaution Radioactive Material" will be posted on the treatmentroom door.

. 5.' A proper notice ~ bearing the conventional radiation symbol and theEword:

CAUTIONRADI0 ACTIVE MATERIAL

COBALT 60, CURIES, DATE '

will be placed on.the unit.'

'

6. Patient viewing is accomplished by closed circuit TV system and 'i-' -also by combination of lead glass window in entrance door _anda-

convex mirror in maze wall. Patient communications is throughan inter-communication system.

.

'7. . Check of source returning to "off" position at end of presenttime:

At end of 'present -time, room will be entered with G. M = surveyL

. meter to assure source is in "off" position switch then turnedto "on" position (time not reset) and room entered with G. M.

. survey meter to assure source remained "off" position.

- : 8. ' A source "on"Jerror will be measured.~

- .9. Room will have Primalert 10 Monitor installed on wall at end ofmaze .(visible from view window and as personnel enter room);monitor will have battery power pack backup in case ofelectrical failure; check' source will be used daily to checkoperation of monitor.

.10. Source:will be wipe tested' every 6 months..

11._ Commitment to: a) train new employees in emergency procedures as. soon as- they report for duty; and b) conduct " dry runs" of -

emergency procedures at least once every six months.

12. Operating procedures have been developed and will be implantedupon teletherapy operation. These procedures will include as aminimum:

a. . Teletherapy unit, room and console will be secured when.

_unattended

b. Operative procedures indicated that it is the responsibility: of the therapy technologist to ensure ,that only the patient isin the treatment room when the rpimary- beam is turned "on."

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Safety devices will be checked (see-enclosed by whom andc.

frequency). Results will be recorded and prompt correctionsof malfunctions or defects will be made. Commercial supplierwill be called on to correct malfunctions or defects; patientsto be treated at Good Samaritan Hospital.

15. BEAM STOPS:

1. For this unit, the head is mechanically stopped so that itwill not tilt forwards or backwards.

2. Interlocks on head and gantry limit operation of unit to:

When head directed towards floor (beam stopper ina. e-

beam); head rotation limited to + 5 (electrical stop)

b. When head directed towards reception and control area,*(beam stopper in beam); head rotation limited to * 50

(electr!. cal stop).---

c. When head directed towards floor (beam stopper not inbeam); as for treatment of Hodgkin's disease, head andbeam stopper rotated clockwise to 45 angle; head thenrotated 45 counter-clockwise (now directed towards floor);

.

mechanical and electrical stops limit head movement from 70to left of vertical (towards floor) to 50 to right of beam

stopper (beam towards beam, stopper).

d. When head directed towards ceiling (beam stopper inbeam); head limitations are * 50 (electrical stop)

e. When head directed towards outside wall (beam stopperin beam); head rotation limited to * 5 (electrical stop)

16. EVALUATION OF SHIELDING

Room protection data is attached for unit used at 80 cm SSD,30 x 30 en field size with head direction: 1) verticallydown (beam directed against beam stopper); and 2) beam .

stopper at 300 angle to simulate maximum scatter situation).Assumed workload (W) of 40000 R/wk at 100 cm. A completeradiation survey will be performed following unit and sourceinstallation.

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Area * Type Use Distance WUT Present . Recommended. Exposure Exposure.Area . Factor Feet R/wk Shielding. Shielding. per hour per, week- 1

at 1 meter mR/hr mR/hr

Wall cdjoining southeast outside:twall (underground) U 1/16 8 2500 10"c. concrete 18" concrete - - - - - - -

(underground) (extended)Wall tdjoining southwest.outside wall

(underground) U 1 12 ' 40000 - 18" concrete --

Wall.tdjoining northwest outside

f.18" concrete --wmil (underground) U 1 18 40000 --

Wall edjoining stairwell U 1/16 15 2500 10" concrete 18" concrete 0.05- 1.2

Entrance wall U 1 11 40000 10" concrete 15" concrete 0.03 1.2.

Entrance door U 1 12 40000 1/4" lead (Pb) 0.03 1.2

View Window in entrance door - U 1 12 40000 1/4" Pbeq Pb 0,03 1.2glass

Maze wall - 1 - 40000 .24'' concrete

Wall adjoining office area U 1 9 40000 12" concrete 24" concrete 0.04 1.6

Arca below (ground) - 1/2 - --

24" concrete 0.12 4.8Arca above (ground level) U 5/16 13 12500 --

Calling concrete thickness of 24" will be extended for at least two feet below ground level on each outside wall

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Workload = 4000d.R/wk at 1 meter.

= 1000 R/hr at 1 meterr

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Area Above (Ground Level)9

Leakage A'

Head leakage = 0.1% of primary beam. Use Factor (U) = 1 .

I' Occupancy Factor (T) = 1WUT = 1000 R/hr at 1 meter

l' 'distance - 4 meter1000 R/hr

(4)2 = -62.5 R/hr at 4 meters

.001 x 62.5 R/hr,

= 62.5 mR/hr at.4 metersHVL = 6.2 cm concrete24" concrete = 61 cm

; Exposure per hour .06 mR/hrExposure per week = 2.4 mR/ week

Scatter (300)

Use Factor (U) = 5/16Occupancy Factor (T) = 1

WUT = 1000 R/hr at 1 meter *

x 5/16 = 312 R/hr at 1 meter

x (1/4)2 = 19.5 R/hr at 4 meters

x .006 = 117 mR/hr at 4 meters (30 scatter)HVL - 6.1 cm concrete

24" concrete = 61 cmExposure per hour = 0.12 mR/hrExposure per week = 4.8" mR/ week

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' Area' Adjoining Hallway and Office

L'akagee

' Head leakage = 0.1% of primary beam,,.' Use Factor (U) = l-

Occupancy Factor (T) = 1' WUT = 1000 R/he at 1 meter

distance = 2.8 meters

1000 R/hr; (2.8) Z = 128.R/hr at 2.8 meters

.001 x 128'= 128 mR/hr at 2.8 metersHVL - 6.2 cm concrete

24" concrete = 61 cm .',

- Exposure per hour = 0.12Exposure per seek = 4.8 mR/wk

.

Scatter

Use Factor (U) = 1/16Occupancy Factor (T) = 1

"

x 1/16 = 62.5 R/hr at 1 meterx -(2.8) 2. = 8.0 R/hr at 2.8 metersx .006.= 48 mR/hr at 2.8 meters (300 scatter)

HVL = 6.1 cm concrete24" concrete = 61 cmExposure.per hour = 0.045 mR/hrExposure per week = 1.8 mR/wk

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G-M Survey Meter Calibration Procedure

1. G-M survey meter is calibrated annually and following repair orbattery replacement.

2. Calibration is accomplished by taking readings at various pointsfrom the calibration source and adjusting the meter readings towithin i 10% of the calculated exposure rates for those points.The points are chosen so that two readings, which are separatedby at least 50% of the scale, are taken in each scale.

2263. The calibration source used is a 1 mg Ra needle manufactured -.

by the Radium Chemical Com7any, Inc. Filtration is 0.5 mm Ptequivalent and the calibration of the source activity istraceable to NBS standards.

.

4. Calibration is done by James G. Kereiakes, Ph. D., RadiologicalPhysicist, at the University of Cincinnati Medical Center.

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17.- OPERATING AND EMERGENCY PROCEDURES '+

-(see attached)

:19. LEAK TESTS OF SEALED SOURCES - John Freshcorn, M. S.(see attached) Good Samaritan Hospital

!-- Cincinnati, OH 45267

L| 20. QUALIFIED EXPERTS - James. G..Kereiakes, Ph. D.(see attached) John Freshcorn, M. S.

21. ALARA PROGRAM - see attached.

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Ion Chamber Survey Meter Calibration Procedure

' l. Meter is- calibrated annually and calibrated following repair orbattery replacement.

2. : Calibration is accomplished by taking readings at various pointsfrom the calibration source and adjusting the meter readings towithin i 10% of the calculated exposure rates for those points.The points are chosen so that.two readings, which are separatedby at'least 50% of'the scale, are taken in each scale.

3. The calibration source used is an EON Corporation Gamma Survey ;Instrument Calibrator, Model 64-764, Serial Number 123,marketed by Nuclear Associates, Inc. . The calibrator contains100 mci 137Cs and the design and manufacture meet NRCrequirements (cf. enclosure). *

4. Calibration done by James G. Kereiakes, Ph. D. , RadiologicalPhysicist,.at the University of Cincinnati Medical Center.

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SURVEY INSTRlBENT CALIBRATION

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PLACE DATE

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I. CALIBRATED BY:

ATTENTION: - Dr. W. Shehata

Technique: Survey meter placed at sev'eral distances from a calibrationsource of 1 mci Ra226 having 0.5 mm Pt. eq. filtration; 't

gamma-ray constant of 0.825 mR/hr at im per. mci was used;survey meter reading adjusted to calculated exposure ratereading (two calibration points per range). .

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i- -Instrument Range Distance. Exposure Rate Meter Reading(cm) Calculated Adjusted

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SURVEY INSTRUMENT: Eberline Survey Meter Model E-120<

PROCEDURE: Use check source (, ); place sourceup against . front surface of survey meter just below

: front clamp; read range X-10,, reading should be mR/hrand'should be between and mR/hr; if not,notify Mr. John Freshcorn.

.

3

Date- Reading Date Reading Date Reading(X-10 range) (X-10 range) (K-10 range) .

mR/hr mR/hr mR/hr

.

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, . - ___-__-_____ _____ _______-____ _ _

*., Page 4' of 6

Toct No. 84007|

DOSIMETER SYSTEM CALIBRATION

1-16-84*

DATE

ELECTROMETER: Mfgr: Victoreen Submitted by: University of

Model: 570 Cincinnati

SN: 1055 Cincinnati. OH 45267.

i CHAMBER: Mfgr: Victoreen

Model: 621 (100R)$N: x1055 i

Scales, Switch Positions, Conditions:

't .

.

Orientation: model number toward source

.

Polarizing potential: 520.5 V Sy, stem leakage: NA

Beam QualityExposure SCD Calibration

HVT (mm) Al/Cu H.C. KVp Rate R/M (mm) factor Scale Class

.

59.6 740 0.975 R/RDG 50% IIICo-60 - - -

|

Discharge Test Reading (refer to [nstruction manual) 42.6 % of scale.

COMMENTS: Fiber motion is not continuous as "zero set"

wheel is rotated (Fiber drag)

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ACCREDITED DOSIMETRY CALIBRATION LABORATORY

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Calibration Report

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Institution / Facility: University of Date: 1-27-84.

. . ,

Cincinnati Report: 250

Medical Science Building

Cincinnato, OH 45267

|

Instrument: Victoreen 570, SN 1055

Victoreen 621. SN x1055

%

Test No.: 840'70

The responsibility for calibration results provided by K & SAssociates, Inc. and its employees extends only to the timethe instruments leave the K & S laboratory facility. Constancytests are highly recommended., It is the responsibility of theinstrument user to assure himself that his interpretation ofthe information contained herein is consistent with the inter-pretation intended.

..

9

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Page 1 of 6

*

x 1834 Sirlane Drine / Xasboiffe, 9ennetsee 37:10 / (6/J) 443-9760

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CHAMBER: Mfgr: NEL Subinitted by: Good Samaritan Hospital '?

, ' .-lModel: 2571(0.Gm1, graphite) 3217 Clifton Avenue*

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j {, SN: 448 CinQinnati, OH. ' 45220t

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CHARGE CALIBRATION FACTOR: ifhkM)n . e n. . :-num4y (Multiply instrument reading by factor to obtain coulombs.) c . MEq),*,nm.- ..

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OPERATING PROCEDURESb-

h- 60Co Teletherapy Unit

Annually!

Full calibration . Qualified Expert

'-- -Semi Annually '

)60Co source wipe ,

s .. Emergency " dry" run,

Qualified Expert

.Staff

. . . ..

[ Monthly--.

'

lp Output spot. check Qualified Expert .

1 -Timer check "

Source "on" time ~ "

Field congruency "

P Distance markers "

Source "on"-lights "

. Door interlock "

.

'Weekly

~

Technologist-Distance markersDoor. interlock TechnologistEmergency devices Technologist

DailySource "on" lights Technologist

'

. Area monitor Technologist

.

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| EMERGENCY PROCEDURESAECL Cobalt-60 Therapy Unit

.J

H IN THE EVENT OF EQUIPMENT FAILURE )

RESULTING IN SOURCE REMAINING "0N"^

.

A. If patient is ambulatory:.

1. Instruct patient to get off table and leave the room

7

LB. .If patient is not ambulatory:

:: Enter treatment room but avoid exposure to the direct. beam.*

[ Pull treatment table as far away .from direct beam as possible.

i Transfer patient to a stretcher and remove patient from room.

2; C. Then:I-

( l. Close, lock and post treatment room doori 2. Turn off main switch at control panel

f 3. Notify the responsible physician and radiation safety|- officer at onceL - 4. Conspicuously post a sign in the area to warn others

of the problem

W. Shehata, M.D. F. Jazy, M.D.Office: 872-2636 Office: 872-2636

[ Home: 831-4057 - Home:

t' J.G. Kereiakes, Ph.D. J. Freshcorn, M.S.Office: 872-5476 -Office: 872-5476

, Home: 561-4067 Home: 874-6014

AECLCHICAGO OFFICE(312) 593-3242Dan Tigmeyer

-

CAUTION: STAY OUT OF DIRECT BEAM AT ALL TIMES,

9

4

. . . ..:. - ._ _ _ _ .,_ ____ - - - -

-*. - - - . . . - . . .

, .

'

.

.

.

TELETHERAPY SOURCE LEAK TEST REPORT

1. Name and address of licensee:

.

2. License Number:

3. Date of source installation:

4 Source serial number:

'^

5. >bke and model number of teletherapy unit: 2-

6. Date of test for leakage and contamination:

wipe around inside of all of collimator near source -

7. Test technique:

location with moistened cotton applicator

8. Instrumentation: Picker Well Scintillation Counter and Spectroscaler 4;

levels, LL = 0020, UL = 1000. HV = 370 (900 v), Co-60 Efficiency = 25%

MDA = = 2.9 x 10 5 C1 (5 min counting time)'

0.25 x 2.20 x 106 5

9. Instrument reading on wipes:

10. Instrument background reading:

.

A. Instrument reading on wipes minus background:

11. B. Reading on wipes minus background:

12. Electric interlock on door checked 5 times and found to be operatingproperly.

Radiologic Physicist

9

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CURRICULUM VITAE

PERSONAL INFOPJfATION:

NAME: John E. Freshcorn

-ADDRESS: 5810 Gilmore iftveFairfield, Ohic 45014'

TELEPHONE: (513) 874-6014

DATE OF BIRTH: January 20, 1956 -

PLACE OF, BIRTH: Cincinnati, Ohio

SOCIAL SECURITY NUMBER: 301-58-3861.

MARITAL STATUS: Married, Two Children

EDUCATION:i-

9/80 - 6/81 M.S. Radiological ScienceUniversity'of CincinnatiThesis: Measurement of the extrafocal radiation .

component for diagnostic x-ray systems and deter-mination of the'possible significance when*

utilizing rare earth screens.

9/74 - 6/78 B.S., BiologyUniversity of CincinnatiCincinnati, Ohio 45221

,

b POSITION:,

'

2/83.- Instructor in-Radiology, Department of Radiology

University College of Medicine

EXPERIENCE:

-Acceptance Testing of Clinac 6/100 SupervoltageX-Ray units

-Data Acquisition of Clinac 6/100 SupervoltageX-Ray Units

-Calibration of both Supervoltage Photon and ElectronBeams

-Annual and Replacement Source Calibration ofCo-60 Teletherapy Units

-Quality Assurance of Megavoltage Acceleratorsand Simulator

-Quality Assurance of Nuclear Medicine andDiagnostic X-Ray Equipment (including Ultrasoundand Computerized Tomography)

-Computerized Treatment Planning-Brachytherapy Dosimetry Involving Rd.-226, Cs-137,

,,

LAu-198, Ir-192, I-125, and Sr-90

.. .

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~ Curriculum VitaeJohn E. $reshcornPage 2

.

' PROFESSIONAL ACTIVITIES:

American Association of Physicists in Medicine , Member

' TEACHING:

' SUPERVISE AND LECTURER: ..-- :

RADIATION HEALTH I AND II - graduate level course offered inDepartment'of Radiology, University College of Medicine

.

PAPERS :,

" Characteristics of Off-Focal Radiation and its Clinicalsignificance in Pediatric Radiology", presented atRSNA by Dr. Stephen Thomas, Ph,D. in 1981

,

PUBLICATIONS: .

Freshcorn, J. with S.R.' Thomas, K. Krugh,13. Henry, J.G.

Kereiakes and R. Kaufman. Characteristics'of'extrafocalradiation and its potential-significance in pediatric

~

radiology. Radiology 146:793, 1983.

,

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.

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: ;.- . -- C ---- - -.. .

**.. . .

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8' ) .-

PROGRAM-FOR MAINTAINING OCCUPATIONALRADIATION EXPOSURES AT ALARA

. ...

Medical Arts Building,

Cincinnati, Ohio

'-August 13, 1984

I. Management Commitment Date

We, the management of this hospital are committed to a program for:a.~ keeping exposures (individual and collective) as low as reasonably. achievable (ALARA) . In accord with this commitment, we hereby describean administrative organization for radiation safety and will developthe necessary written policy, procedures and instructions to foster *'

the ALARA concept within our institution. The organization will ,4

include a Radiation Safety Committee (RSC) and a Radiation SafetyOfficer (RS0).,

b. We will_ perform a formal annual review of the radiation safety program *

including ALARA considerations.- This shall include reviews ofoperating procedures and past exposure records, inspections, etc., andconsultations with the radiation protection staff or outside consultants.Modification to operating and maintenance procedures and to equipmentc.

and facilities will be made where they will reduce exposures unless thecost, in our judgement, is considered to be unjustified. We will beable to demonstrate, if necessary, that improvements have been sought,

y. that modifications have been considered, and that they have been,

N implemented where reasonable. Where modifications have been recommended - -

|k but not implemented, we will be prepared to describe the reasons for notimplementing them.

d. In addition to maintaining doses to individuals as far below the limitsas is reasonably achievable, the sum of the doses received by all exposedindividuals will also be maintained at the lowest practicable level. Itwould not be desirable, for example, to hold the highest doses toindividuals to some fraction of the applicable limit if this involvedexposing additional people and significantly increasing the sum ofradiation doses received by all involved individuals.

II. Radiation Safety Committee (RSC)

a. Review of Proposed Users and Uses

1. The RSC will thoroughly review the qualifications of each applicantwith respect to the types and quantities of materials and uses forwhich he has applied to assure that the applicant will be able totake appropriate measures to maintain exposure ALARA.

2. When considering a new use of byproduct material, the RSC teill *

review the efforts of the applicant to maintain exposure ALARA.The user should have systematized procedures to ensure ALARA,and shall have incorporated the use of special equipmer.t auch assyringe shicids, rubber gloves, etc., in his proposed use.

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iof the investigation. The details of these-reports'will be recorded in-i the Committee minutes. Committee minutes will be sent to the management1 of this institution for_ review. The minutes, containing details of the1i investigation, will be made availabic to NRC inspectors for review at

the time of the-next inspection.,

d. Re-establishment of an individual occupational worker's InvestigationalLevel II above that tested in Table 1.

In cases where a worker's or a group of worker's exposures need toexceed Investigational Level II, a new, higher Inves-igational Level IImay be established on the basis that it is consistent with good ALARApractices for that individual or group. Justification for a newInvestigational Level II will be documented.

The Radiation Safety Committee will review the justification for, andwill approve, all revisions of Investigational Levels II. In such 2cases, when the exposure equals or exceeds the newly establishedInvestigational Level II, those actions listed in paragraph c above,

will be followed..

.VII. Signature of Certifying Officialu.

I hereby certify that this institution (or private practice), has implementedthe ALARA Program set forth above.

0 kh h 0 $Nu.

Signatu're

dLq b M . %,(hm *

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Name (prifiit or type)

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Title

' Institution Name and Address:S u. A 4, ete d M EdAh_f966 MI

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The individual who is authorized to make cora:iitments for the administrationof the institution (e.g., hospital administrator, etc.).

.

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FOnu NRC 313M-SUPPLEMENT A U.S. NUCLEAR REGULATORY COMMISSION' * - *

TRAINING AND EXPERIENCE \AUTHORIZED USER OR RADIATION SAFETY OFFICER \

1. NAME OF AUTHORIZED USER OR RADIATION SAFETY OFFICER 2. STATE OR TERRITORY INWHICH LICENSED TO

John Frescho'rn, M.S. PRACTICE MEDICINE

3. CERTIFICATIONSPECIALTY BOARD CATE GORY MONTH AND YEAR CERTIFIED

A B C

passed ABR.

_

(Radiologic Physics). .

written exam - 1983

.

4. TRAINING RECEIVED IN BASIC RADIOtSOTOPE HANDLING TECHNIQUES -

TYPE AND LENGTH OF TRAINING-- - ~' ~

LECTURE / SUPERVISEDFIE LD OF TRAINING LOCATION AND DATE(S) OF TRAINING LABORATORY LABORATORYA B COURSES EXPERIENCE

*

(Hours) ' (Hours)credit credR,,1___,.___ _e ,,m_,_.

uuu m y - muumpRad Instrumentation & Engr. 'lla. RAOlATION PHYSICS AND Rad DosimetryINSTRUMENTATIONModern Physic

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.. University of' Cincinnati -

b. hADIATION PROTECTION Radiation Health-2 quarters 4 2,

Rad. Sciences Lab

c. MATHEMATICS PERTAINING To University of Cincinnati ~

THE USE AND MEASUREMENT Rad. Instrumentation' 8 - *

OF RAOlOACTIVITY Rad. Dosimetry

University of Cincinnati~

d. RADIATION 810 LOGY Radiation Biology-3 quarters 6

. University of Cincinnatie. RADIOPHARMACEUTICAL Clinical Nuclear Medicine"'"'''"*

Radiation Health' 4~

5. EXPERIENCE WITH R ADE AT|0N. (Actualuse of Radioisotopes or Equivalent Experience)

ISOTOPE MAXIMUM AMOUNT | WHERE EXPERIENCE WAS OAINED DURATION OF EXPERIENCE TYPE OF USE'

Co- 37 100 + cases | Norfolk General HUspital July 81-Jan. 83 Intracavity\ Dept of Rad. Oncology

''University of Cincinnati Intracavity

Au-198seeds 20 + cases Interstitial

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Ir-192 10 + cases University of Cin'cinnati Sept. 83 - Interstitialg,;'~ seeds Intra- -

P-32 5+ NGH/ Univ. of Cincinnati July 81 - present Pleural & peritoneal-dollodial -- - -I-125 '10 + NCH/ Uni,v. of Cir0!Ellati Interstitial

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Isotope Maximum Amount Where Experience was Gained Duration of E::per. Type of Uses

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applicator.. ~5+ NGH/ Univ. of Cincinnati'+ ;' ': ', July 81-present Pterigium

'"'II-131 L S + - (40-100 - NGH/ Univ.'of Cincinnati LThyroid-mC1)-

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