ML20033F205

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Voided Matls Licensing Action for Jersey City Nuclear Diagnostic Ctr LP.Control:110902
ML20033F205
Person / Time
Issue date: 07/21/1989
From:
NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I)
To:
NRC OFFICE OF THE CONTROLLER
References
110902, NUDOCS 9003160477
Download: ML20033F205 (18)
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SUBJECT:

VOIDED APPLICATION

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Control Number:

110902-

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Applicant:-

Jersey City Nuclear Diaa. Ctr. L.P.

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.Date. Voided:.

July 21.1989

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- Reason-for Void:- Action reauested is under another license. The other licenie must be-terminated before allowina this action to occur. '(SEE TELEPHONE CONVERSATION)'

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Attachment:

~ 0fficial. Record Copy of

. Voided Action-FOR LFMB USE-ONLY

Final Review of VOID Completed:

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030- 30623 JERSEY Cl1Y NUCLEAR DIAGNOSTIC CENTER, LP.1 9

y 550 SUMMIT AVENUE. SUITE 202, JERSEY CRY, NEW JERSEY 07306 June 20, 1989

-Mr. Gene Gessick U.S. Nuclear' Regulatory Commission Region # 1 475-Allendale Road King of Prussia, Pennsylvania 19406 RE:

LICEN REEE # 29-28-223-01

Dear Mr. Gessick,

Enclosed please find Application 5or Amendment to our present License,# 29-28-223-01 submitted in duplicate.-

Said application

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requests authorization to use said licenses at an additional location, namely

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NORTH JERSEY IMAGING CENTER-1 307 - 60TH STREET-WEST NEW YORK, N.J.

07093 We will : follow all instructions in the Regulatory Guide 10.8,

-including the following which are-attached hereto:

  1. 7,-#8A, #8B, #10A, #10B, #13, #14. #15, #16, #17, #18, and #21.

We will implement specific protocols for #12, (Training-Program).,

Please see: enclosed #9 and #11.

For #13, also-see #18 dese.ribing receipt of unit doses.

- We are enclosing our check in the amount of $40.00 in payment f-

'the amendment fee.

j very truly yours, Ay a

aldonado$M.6.

do RB mcd

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UI License fgS Information Enclosures /

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g.sw w 110902 JUN 231989 0FFICIAL RECORD COPY gjg I

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Nhc PORM 313M U.6, NUCLE AR te:ULATORY COMMIE 000N Approved by OMS M'

APPLICATION FOR MATERIALS LICENSE - MEDICAL

~ais0m 10 CFR 35 INSTRUCTIONS - c ase s t mogh N #sws a en hiemtowessden w en spencetion ser on t era sann. un emea msnmish==

anee assessery, tema N must he conpesand en eat ma==.== and sqnsd ReesM one sepy. Submit erminalandone copy of ensnm me ceaan so t Doucesr, Othee e/ Nusdner esseriet Sedery and $sdspasrek, DJ Nurs.or Aapuineory '" - -

Washinpron. D.C.

r 2nus. LAnen espreeelof she ophastian, she epicent newosemiee a Meenriek License An NAC Mosernsk insener is issued an accord.

eue uneh she enneet oneudrensne conmnand k ne 10. Cee of feere!.% Y : ; Ases 30. end she Licenser a en6 rect se hter 10.

com et Festrai Assudseens. Aars f#. Mand N and she disoner ise prevision of Tisie 80. Com et Federet Aapudeoens. Aert i/A The econs Aus sesspory shouM As sessed h issa N and she sproprism ise encAssad 1.a. NAME AND MAILING ADDRES OF APPLICANT (insarar#en, 1.tk STREET ADDRESSIES) AT WHICH RADIOACTIVC MATERIAL

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(irm, e#ade,physiche, etc) INC LUDE ZIP CODE WILL SE USED III A/4 dent kam f.A/ INCLUDE ZIP CODE I

RICARDO BALD 0NADO, M.D.

NORTH JERSEY IMAGING: CENTER 550 SUMMIT AVE.

307 60TH ST.

JERSEY CITY, N.J.

07306 WEST NEW YORK, N.J.

07093 TELEPHONE NO AREA CODEI I'

2. MRSON TO CONTACT R50ARDING THIS APPLICATION 1 THlS 18 AN APPLICATION FORI Enset,4penpstee tem /

t Q NEW UCENSE J. WARMUND, M.S.

th 29-28-223-01 g @ AMENDMENT,TO UCENSE NO.

RENEWAL OF UCENSE NO.

- TELEPHONE NO 4 AREA CODE 2123 588 7000 X668

-j 4, INDIVIDUAL USERS Mieme inselduals who w#t um er direcWy B6 RADIATION SAFETY OFFICER (RSO)(Name e/persen esipiend eupowin une of radioaction meertel. Camphe suppsoments A enef 8 flereas4 kHfwidual./

en tenietsen ennety otheer. 11eeher araan indr,Mantuser, eeneisen onsw.

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me of areining andeamenens as in Suppdunser A) -

1 RICARDO BALD 0NADO M.D.

(RS0)

SAME AS IN LICENSE

-JOSEPH WARMUND (DEPUTY RS0)'.

6.a RADIOACTIVE MATERIAL FOR MEDICAL USE MAXIMUM MARK MAXIMUM RADIOACTIVE MATERIAL EO 8

ADDITIONAL ITEMS:

Dg'iggo SSam g

yg LISTED int x

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Roe osunieuries) 10 CFR 31.11 FOR IN VITRO STUDIES IOOINE.131 AS lODIDE FOR TREATMENT OF HYPERTHYROIDISM 10 CFR 36.100, SCHEDULE A, GROUP 1 AS NEEDED PHOSPHORUS 32 AS SOLUBLE PHOSPHATE FOR TREATMENT OF POLYCYTHEMIA VERA. LEUKEMIA AND BONE METASTASES 10 CFR 36.100, SCHEDULE A, GROUP 11 AS NEEDED PHOSPHORUS 32 AS COLLOIDAL CHROMIC PHOSPHATE FOR INTRACAVITARY TREAT.

l 10 CFR 35.100, SCHEDULE A GROUP 111 MENT OF MALIGN ANT E FFUSIONS.

t GOLD.19B AS COLLOlD FOR INTRA.

CAVITARY TREATMENT OF MALIGNANT 10 CFR 36.100, SCHEDULE A, GRQUP IV AS NEE DED EF FUSIONS.

IODINE.131 AS lODIDE FOR TREATMENT 10 CFR 3.100. SCHEDULE A, GROUP V AS NEEDED OF THYROID CARCINOMA XENON.133 AS GAS OR GASIN SALINE FOR 10 CFR 3.100. SCHEDULE A, GROUP V BLOOO FLOW STUDIES AND PULMONARY FUNCTION STUDIES.

6.b. RADIOACTIVE MATERIAL FOR USES NOT LISTED IN ITEM 6.a. ISmeedsources uo mamCiusedrw cohbretion and reference standards are authorned under Secoon 36.1did),10 CFR Port 36. and NEED NO T BE LISTEDJ CHEMICAL MAXIMUM NUM8E R ELEMENT AND MASS NUMBER PHYSyC L FORM OF M

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Fee CatcEc Type of Fee.__ __ A.d h. ____

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4 INFORMATION '.UUIRED FIR ITEMS 7 THROUGH.23 For items 7 theough 23, check the approprl:te box (es) and submit a untailed description cf all the requested informati:n. Begin sech item on a separate sheet. Identify the item number and the date of the application in the lower right corner of each pag{

you indicate that en appendix to the medical licensing guide will be followed, do not submit the pages, but spoolfy the revhion i

number and date of the referenced guide: Reguletory Guide 10.8

. Rev.

Date:

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7. MEDICAL ISOTOPES COMMITTEE
16. GENERAL RULES FOR THE SAFE USE OF RADIOACTIVE MATERIAL / Check Onel Nemes and Spooletties Atteched; and '

X Appendix G Rules Followed;or Duties as in Appendix 8;or Equivalent Rules Attached X

Equivalent Duties Attached

16. EMERGENCY PROCEDURES (Check One)
8. TRAINING AND EXPERIENCE X

Appendix H Procedures Followed;or Supplements A 8: B Attached for Each Individuol User; i

and Equivalent Procedures Attedied X

Supplement A Attached for RSO.

17. AREA SURVEY PROCEDURES (Check Onel
9. INSTRUMENTATION (Check One)

X Appendix 1 Proceeures Followed;or X

Appendix C Form Attached;or Equivalent Procedures Attached List by Name and Model Number

18. WASTE, DISPOSAL (Check One)
10. Call 8 RATION OF INSTRUMENTS Appendix J Form Attached;or

.X Appends D Womes FoHow fw Sm I"'"**""

x Equivalent information Attached (Check Onel Equivalent Procedures Attached;and

19. THERAPEUTIC USE OF RADIOPHARMACEUTICALS (Check Onel X

Appendix D Procedures Followed for Dose Calibretor;or Appendix K Procedures Followed;or (check One)

Equivalent Procedures Attached Equivalent Procedures Attached

11. FACILITIES AND. EQUIPMENT
20. THERAPEUTIC USE OF SEALED SOURCES X

Desalpdon and Disgram Attached Detailed Information Attached;and

12. PERSONNEL TRAINING PROGRAM Appendix L r rocedures Followed;or a

X (Check Onel Description of Training Attached Equivalent Proadures Attached -

13. PROCEDURES FOR ORDERING AND RECEIVING PROCEDURES AND PRECAUTIONS FOR USE OF RADIOACTIVE MATERIAL
21. RADIOACTIVE GASES (e.g.. Xenon - 133)

.X Detailed Information Attached X

Detailed Information Atteched PROCEDURES FOR SAFELY OPENING PACKAGES 14.

CONTAINING RADIOACTIVE MATERIALS

22. RADIOACTIVE MATERIAL IN ANIMALS i (Check One)

DetailedInformation Attached X

Appendix F Procedures Followed;or 23 RADIOACTIVE MATERIAL SPECIFIED IN ITEM 6.b Equivalent Procedures Attached Detailed information Attached' IWnC PCnM 313M te4tl Page 2

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24. PERSONNEL MONITORING DEVICES TVPE IUPPLIIR EXCHANGE PRE 00ENCY Imece appropries bonJ X

PiLM LANDAUER MONTHLY s.WHOLE 80DY TLD 0THE R ispee/4)

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25. FOR PRIVATE PRACTICE APPLICANTS ONLY
e. HOSPITAL AGREEING TO ACCEPT PATIENTS CONTAINING RADIOACTIVE M ATE RI AL

- NAME OF HO6PITAL h ATTACH A COPY OF THE AGREEMENT LETTER hg.

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c. WHEN REQUESTING THERAPY PROCEDURES.

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Cl ATTACH A COPY OF RADIATION SAFETY PRECAU-STATE ZIP CODE TIONS TO BE TAKEN AND LIST AVAILABLE Q, g e {

RADIATION DETECTION INSTRUMENTS.

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26. CERTIFICATE IThis hem must be completed by applicant)

. The applicent and any officiel executing this certificate o'n behalf of the applicent named in item f e rir if y that this application is prepared in conformity with Title 10, Code of Federal Regulations. Ports 30 and 35, and that allinformation tcc ned herein, including any suppioments atteched hereto,is true and correct to the best of our knowledge and Delief.

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ta APPLICA OR C RTIFY GOFF4 IA gmears)

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. a. LICENSE FEE REQUIRED IS** Section 17MI,10 C(_M 170) g,g n,y, gyg,,g,,,,

RICARDO BALD 0NADO, M.D.

(1) UCENSE FEE CATEGORY:

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~ RADIOLOGIST (2) LICENSE FEE ENCLOSED: s 40.00 JUNE 19, 1989 NRC FORM 313M (9-81)

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PRIVACY ACT STATEMENT Pursuant to 5 U.S.C. 552atell3), enacted into law by section 3 of the Privacy Act of 1974 (Public Law 93 579), the following statement is furnished to individuals who supply information to the Nuclear Regulatory Commission on NRC Form 313M.

This information is maintained in a system of records designated as NRC 3 and described at 40 Federal Register 45334 (October 1,1976),

1. AUTHORITY Sections 81 and 161(b) of the Atomic Energy Act of 1964, as amended (42 U.S.C. 2111 and 2201(b)).
2. PRINCIPAL PURPOSE (S) The information is evaluated by the NRC staff pursuant to the criteria set forth in 10 CFR Perts 30 36 to determine whether the application meets the requirements of the Atomic Energy Act of 1954,as amended,

, and the Commission's regulations, for the issuance of a radioactive mater lal license or amendment thereof..

3. ROUTfNE USES The information may be used: (a) to provide records to State health departments for their information and use; and (b) to provide information to Federal, State, and local health officials and other persons in the event of inch dent or exposure, for their information, investigation, and protection of the public health and safety. The information may also be disclosed to appropriate Federal, State, and local agencies in the event that the information indicates a violation or potential violation of law and in the course of an administrative or judicial proceeding. In addition, this in-formation may be transferred to an appropriate Federal, State, or local agency to the extent relevant and necessary for a NRC decision or to an appropriate Federal agency to the extent relevant and necessary for that agency's decision about

,1 you. A copy of the license issued will routinely be placed in the NRC's Public Document Room,1717 H Street, N.W.,

Washington, D.C.

4. WHETHER DISCLOSURE 18 MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING

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lNFORMATION Disclosure of the requested information is voluntary. If the requested information is not furnished, however, the appilcation for radioactive material license, or amendment thereof, will not be processed.

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5. SYSTEM MANAGER (S) AND ADDRESS Director,61 vision of Fuel Cycle and Material Safety, Office of Nucleat Mate-rial Safety and Safeguards, U.S. Nuclear Regujetory Commission, Washington, D.C. 20556.

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NRC FORM 313Idl SUPPLEinENT A U.S. NUCLEAR REGULATcRY COMMISSION W

TRAINING AND EXPERIENCE AUTHORIZED USER OR RADIATION SAFETY OFFICER

1. NAME OF AUTHORIZED USER OR RADIATION 5APETY OFFICER
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JOSEPH WARMUND M.S. (DEPUTY R.S.O.)-

WHICH LICENSED TO 3

PRACTICE MEDICINE t

3. CERTIFICATION FECIALTY BOARD CATEGORY MONTH AND YEAR CERTIFIED A

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AMERICAN BOARD OF RADIOLOGY RADIOLOGIC PHYSICS JUNE 1972 i

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4. TRAINING RECEIVED IN BASIC RADIOlSOTOPE HANDLING TECHNIQUES TYPE AND LENGTH OF TRAINING LECTURE /

SUPERVISED FIF.LD OF TRAINING LOCATION AND DATEISI OF TRAINING LABORATORY LABORATORY A

B COURSES EXPERIENCE (Nowd (Nows) d C

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PHYSICIANS & SURGEONS 1 YEAR 1 YEAR s.' RADIATION PHYSICS AND W MENTATION COLUMBIA UNIVERSITY MASTER OF SCIENCE IN naulutuvAv retzsics

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-xw WD E ",.

,13;1l GUIDANCE FOR ORDERING, AND. PECEIVING RADIDACTIVE _ MATERI AL- ' ~ W[P y, 4 +

n

~

3.,

t_

k pc

w ag
9 m+

__c p.q

-We Wil'l> establish and11mplement.the_ model ~ gui' dance for

  • 4 N

p&g

~orderingisnd recel'ving-r'adioactive$ material thatcwas'

- ( f@,

g' publ'ishedpin, Appendix:E MbW

?

i

+ a.

4 J'

j_

U._

[

' i

'f 3 xl.

,ik L

T$

d 114.. TRQGfipyEC; FOR @AFELY" OPENING PACKAGE % CONTAINING c,

' ;s+,e M,

'IsBAQ.lOACTIVE MATERIAltz's

n. -

. t'

~

[6 s

r-m

,y.,

s

._s r

e.

.g

, 77 y o pg g% jp j "We will(establluh,.gcandfimplement;the}model-procedure for

=qmj l

l opening; packages 1thatiwas pub.lished-in' Appendix-F qy Q 4

~

> w ;;;e j

. w:

5 RADIOPHARMACEUTICALS' 7V 1-

-15.

RULES FOR JAFE-UT 0

  • /

9

~

. der will dEstabl'ish dirid.. A mplementT the; mo'dels safe,ty, rules g,

M,,

~

'7

<publisheddin Appendi"x.G' '

l s.

a-6, 4-e s.

x.

4i 4

l 7@

ml6?G EMERGENE PRDCEDURES j

n, w m: _

, q n; a v

N ~ g^ e We will est,ablish andUimplemetyt the model.spil.1 proEep i

dtIres(publ'istied ; ih Appendi w Hj "f_.'

7 j,/

7

c, w "
,-

cy y4

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4 y

C,1,

  • 2 [74 2 PROCEDUREIFORJAREA SURVEYS 1

E t

. ~

^

pu v

6 f J. s

,f We 'willL-entablish and~ Amplement the model' procedure for,

-40

$ydI

[gs,[areadsufveys'thate was;publ"ished i ln=AppendixTI-p, t

l

.vj:

.g e +

1

~

v a

18. ~ PROCEDURE;FOR WASTE. DISPOSAL'

-(:

c i%

f.

t' a

\\

B.y.ncorN Sradiopharmaceuticals areiutilized.in thi.s, s

  1. qjt W

m

-Department.

Allor.adioactivlty'Is, ordered,through_this%

'?

m

@7 Compahy.) When thes siyr;inges Lcome l'nedaily they'are sur-i V

4

+

'veYediand a% ipe?testlig p erjfo rmed. -These'results are'

~ ' '

% y' storedJin'thel nuclear. ledger books..

k y

l t-.

t

_q, L

s..

s, Q 1' Thejunused syringes go back to'Syncor for disposal along UVy "with< unused iodine capsules.

\\

W...

i.

+

+.,,

n-( >

,r.,

W OThe. vials that'are'uned tosmake up kits-also are sent.

m p((-

/,

backIfor: dispon'al the same day-that ~ they are made up; b,

13 *, k

_": M. M,', a a.

v,..y

  • +

RECORDS' pf RADIDACTIVE MATERT ALTUSE e^ A.ag_

,7 RECORD pf UNET DO' SAGE USE.

w.

L i

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r C.c

~

We will_ establish and-implement a procedure for ~

a'unib dosage record systeme th

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m

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w.y+m,n

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yp m W 3 ;

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3 u4 the~ modelfprocedure 'for calculati t.

3 C,

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a y 3 s

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E,..

l.-

s APPEN0lX C 9

INSTRUMENTATION I.

Survey meters a.

Manufacturer's name:

Manufacturer's model number :

TMYAC III SERIAL-# 1749 Number of instruments availshie :

Minimum range:

mR/hr to mR/hr i

0.2 Maximum range:

mR/hr to 200 mR/hr b.

Manufacturer's name :

Manufacturer's model number:

Number of instruments available :

Minimum range :

mR/hr to mR/hr Maximum range; mR/hr to mR/hr 2.

Dose calibrator uci Manufacturer's name

  • i i

Manufacturer's model number:

Number of instruments available ;

e 1

3.

Instr iments used for dia6nostic procedures Manufacturer's Type of Instrument Name Model No.

I GAMMA CAMERA MEDEX t

1 THYROID PROBE CATOMIC PRODUCTS.)LUDLUM 261 SER #1004 4

Other fe.g., liquid scintillation counter, area monitor, velometer)

I-10.8 21 i

C

4 s-4, 9 '

~

S

'212-588-7000'X668 J0m MU2. MA 718-428-6754 I

connocampusanomuxuontenvens1r 313 3033W AVENUE GAVuos.NEWTORK 11300 11 PREVI OUS----

A.J. Swyer, M.D.

+

9 Radiation Protection Survey of Radioactive Material Storage Area.-

[

.Date:

At lead shielding the maximum reading was mR/hr.

At 1 meter tho reading was-mR/hr.

i J. Warmund M.S.

t f

e f

f OTg

)

  • MIS %DR sR tc et k ocg c LM e boQ

. Xcec g X " d A ^/.

y Pdocse,rog DOOR doog C D R Rt Dok

~

T 0

6 i

i

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(

':j ;.i 3

3 g

9

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c l- :

.pngqq pi,

  • q.:

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., I J !

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ith

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il'

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t e

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r i..:

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r.

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~~:

c.

j)

, p, }.4 8 e e., '

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4

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5.

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.=

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s (

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4 1

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1 gf 4

t 6

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'I s ).

4i NORTH JERSEY IMAGING CENTER Professonal Services Provided by

)-

DIAGNOSTIC IMAGING ASSOCIATES, P.A.

307 00th STREET-.

g West New York, New Jersey 07003 3,

(201) 064 1200 4

s

  • 0uality Control o

1.

Cameras A.

Daily Plooda - to check consistency of photomultiplier tubes.

B.

Barchantom - performed once a week, to-check linearity and accuracy of photomultiplier tubes.

2.

Survey Meter A.

Daily surveys - performed in area where patients are injected and radiopharmouticals are kept.

Daily surveys are also done on any radiopharmaceuticals that are j---

brought into the Nuclear Medicine Laboratory.

I I

B..

Weekly surveys - performed in different areas arc.3nd the Nuclear Medicine Room.

+

l

3. ' Dose Calibrator A.-

Daily tests are done using CO Ba 133 and C 137 sources, this is done tocheckthefunctioningofth' systems.

3 B.

Linearity tests are done (4 times a year) to check to see if-results of this study are within NRC standards.

j 1

C.

Accuracy tests are done (annually), this is done to check j,

accuracy of system. -

l-D.

Geometry tests are done only if required.

l All information is logged in the Nuclear Medicine ledger books.

'l 110802

+

0FflCIAl. RECORD COPY gj$

~

~~~

^

7-

.+

A 1 TR (201)6%$050 -

Fod, Uc. p29-2822341 :

NJW Nd 20337 -

For (201)6S3009 ;

p JERSEY CITY NUCLEAR DIAGNOSTIC CENTER, LP.

1 ll ll.

~ 550 SUMMIT AVENUE SUITE 202. JERSEY CITY. NEW JERSEY 07306.-

t June.28, 1989 w

L U.S. Nuclear Regulatory Commission Washington, D.C.

20555 httention:

Ms. Kimberly, License Fee Management. Branch l'

l RE:

License # 29-28-223-01 3

Dear Ms. Kimberly our physicist, Mr. Joseph Warnund, has advised me - of his I

conversation with you today concerning my application for amendment j

to. the above ' license.

In accordance with your instruction, i

enclosed please -find. check- #1141 of Jersey city Nuclear Diagnostic Center,. signed by myself, in the amount of $80.00 representing-the q

fee required in addition.to.the $40.00 previously submitted with i

-application for amendment.

I a

At the time of-telephone conversation today, no control number has-been' assigned to this matter.

Your assistance in expediting our application for amendment is sincerely appreciated.

l Thanking you.

4 Ve r truly yours, W

Ri cardo Baldonado, M.D.

RBracd

/

Enclosures /

~

d ip

P

^

1 o~

3

.g i1 (FOR LFMS:USE)

INFORMATION FROM LTS LO "S'*EE":

~~~~~~~~~-~~~~~~~~~~

l LICENSTi FCi M AN AGEMENT M ANCH, AU1 PPOGkAM CODE: 02200 O

S"5 C

E-

~ ^ "

REGIDHAL LIC E NSING S ECT 1085 FEE C ATEGORY:

.Exp. DATF: 19930930 FEE C MMENTS: _,,,,,,,,,,,,,,,,,,

TO'.

_p LICENSE #EE'TRAH5MITTtt A.

P, E GIO N 40

.1.

- APPLIC ATIcu ATT ACHED.

l.P PLI C ANT / LICE N5 f E :

JERSEY CITY NUCLEAR DIAG. CTR.

L.P.

"'C'I v 5 3^Tt:

3' 623 O-00CKET NO:

-30306E3 1

CONTROL NO.:

110902 1

'"SE ":

9-23223-C' O

~L ACTION TYPE:

AMENOMENT

.2.

FEE ATTACHE 0

'-E AhDlJNT:

kheh.

case m.:

nR._.

?O

-3.

COMMEN T$

SIGNED D AT E

~~ $*h N

[

~

p 8..LICEHi.E ME MANAGEM NT BRANCH (CHECA WHEN HILESTONE 03 I; ENTERED /_ I

- 1.

FEE Cle TE GORY A ND Ah0UNT:

,,,,,,,,,,,,_,,,,,,,,,,,,,,[r,$d....

.OL 2.

Coue C1 n; n.,s,N,,gLtcA11cN MAy u nocessen gox:

AnENutuT "ENERAL LICENSE lQ 3=.

OTHER 5'

O oATt

..........-7<

f.............

LO!

,o; 0

10 B'

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