ML20054A454
| ML20054A454 | |
| Person / Time | |
|---|---|
| Issue date: | 10/16/1973 |
| From: | Book H, North H NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION V) |
| To: | |
| Shared Package | |
| ML20049A151 | List:
|
| References | |
| FOIA-82-11 NUDOCS 8204150467 | |
| Download: ML20054A454 (33) | |
Text
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- l 11RAIT INSPl.:(: TION REPORT FORM _
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Name and nddreno,of licenace 2.
Date of Innpcction 9/28/73 ll Veterans Administration Hospitql NWilshireandSawtelleBoulevards 3.
Type of Innpoction h$
ion
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llLos Angeles, California 90073
- 4. ". License nimiber(s), docket um..In r (n). ninober nnd date of 'last amendnien t i
M. or cach licenso.
Cater,ory noil Prlorit.y of each licennec.
g04-00181-04, Amendment No. 61, March 20,1973, G(1),11 i-..
-S i 'i.Date of. previous innpection February 3, 1972
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- 6. ' Propricenry information None i
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iicopu of innpection if other Ihan routino Routine '
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.t ' 8 '. Participanen (Licenneu reprenentativen and tic 1co, State '
Irap*rcuentativen, etc.)
j Mr..L. Wettereau, Physicist, Nuclear Medicine Service, RSO i
9.
linnor,einen t Interview (Inform.n. ion reepii. red for N/C canen)
W.' 11. Blahd, M.D.
- Chief,' Nuclear Medicine Service Mr. L. Wettereau, RSO i
- I 10.
Actinn and Date:
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.Sep_tember 28, 1973 AKt:- 5'l l n/t:
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Attnchinent to :;eet line into 8204150467 820216 PDR FOIA NELSON 82-11 PDR
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t Veterans Administration Hospital Los Angeles, California 90073 License No.
04-00181-04 13.
Inspection Summary
**?d The inspection of September 28, 1973 disclosed no items of non-compliance or health and safety significance. The inspector did observe that the licensee is operating under difficult conditions due to space limitations resulting from the closure of Wadsworth Hospital. At the time of the inspection, Wadsworth Hospital had been razed, and excavations are in progress for a new 800-bed hospital. The inspection was concluded with the issuance of a Form AEC-591 reficcting no items of noncompliance. The previous inspection disclosed no items of noncompliance and resulted in the issuance of a clear AEC-591.
.wec 14.
Summary of Licensed Program The licensee operates, under a broad license, a program of nuclear medicine diagnosis and therapy with najor activities in various fields of research. A nuclear pharmacy is presently active.
Summaries of the licensee's Nuclear Medicine Service are contained t
' ~~ 9 in the Nuclear Medicine Service Report for Fiscal Year 1973, which -
is attached to this draf t report as Appendix A.
This report notes that a total of 7,434 procedures were performed which included approximately 1,800 in-vitro tests. The licensee also treated
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ly Ob ten cases of hyperthyroidism and one case of thyroid using iodine-131 and made therapeutic use of phosphorus-32 in five cases. The personnel associated with the use of licensed materials in the Nuclear Medicine Service are described on Page 7 of Appendix A of this report. In addition, the Research Service has staffs that operate in various laboratories under the direct supervision of specifically authori::ed supervising individuals.
The licensee estimated that procurement of licensed material by the hospital is in the range of approximately 25 curies per year, mostly technetium-99m. The licensee is currently using no generators and is buying all technetium in precalibrated form.
On the basis of disgussion with the licensee and as a result of i
- he examination of records, it appeared that the use of materials was as authorized by the license.
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Organization and Administration 4
The current hospital Director is Mr. John Cox, who at the time of the inspection was a patient in the hospital. The Assistant Director, Joseph Burmingham, was acting for Mr. Cox. PM tk... A L.
to the Director as the, Administrative Service is Doctor Ed Wright, Chief of Staff. Reporting to Dr. Wright are various medical services, plus the Research Service, who use radioactive material in medical and biological resca ch.
Also reporting to Dr. Wright M.---_.
a t
, is Dr. Blahd as the Chief of the Nuclear Medicine Service.
Mr. Wettereau, RSO, reports to Dr. Blahd.
Mr. Wettereau of the Nuclear Medicine Service is identified on Page 7 of Appendix A.
The VA Hospital is continuing a program of residency and technician c.c.
training, and this program is described on Page 11 of Appendix A.
Mr. Wettereau, as RSO, provides training for users of radioactive materials on a continuing basis. This activity requires approximately 5% of his time. The training course repeats quarterly, and attendance uam. t.
may be a prerequisite to these licensed materials based on the decision of the Isotopes Committee. Attendance at the course is i
open to users of licensed materials i
s for refresher training.
In addition to the training program described, Mr. Wettereau devotes approximately 10% of his time to the training of resident physicians and nuclear medicine technologists.
It is noted that the principal user of licensed material at this facility, based on curies or quantity of materials handled, is the Nuclear Medicine Service. The Research Service, which encompasses a much larger number of individuals, actually uses relatively small quantities of materials in the form of tracer activity.
Mr. Wettereau's duties include supervision of receipt, possession and use of licensed
-tr w.-.Q materials and has authority to cheek-on activities in the case of radiation safety problems.
The licensee has a Radioisotopes Committee that consists of the individuals named in an attachment to the licensee's application of January 21, 1965, with the exception of Dr. James Davis who has been replaced by Dr. Otis H. True, Chief,
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- Radiotherapy Radiology Service.
Mr. Wettereau is not a member of the Committee but is in an advisory capacity through Dr. Blahd.
The licensee has in fact two separate Committees, the Radioisotope
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Committee and the Human Use Committee, both of which must evaluate proposals for use of materials in humans. The Radioisotope Committee also approves use of materials in connection with research activities, which do not involve human use. The licensee maintains well documented files reviewing Committee actions on proposed uses and users.
It appeared that the Committee is actively carrying out its responsibilities as described in the Radioisotcpe Committee Administrative Procedures attachment to t > application of b
January 21, 1965.
16.
Facilities v.ae s.
The licensee's clinical facilities consist of two clinical areas,,
on the hospital grounds which provide spac>e,administrit'ibnfaEd ~~.\\udq tp.
patient counting facilit,' a nucicar pharmacy and the old hot lab in Building 114, which is used to handle iodine-131.
In addition, I
the licensee maintains one thyroid clinic as a part of the Nuclear Medicine Service. The licensee has approximately 24 laboratories I
using small quantities of materials in in-vitro.and small animal s
research. These activities are located in Buildings 114, 115 and I
l T85.
During the inspection, the inspector toured the Radioisotope
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_5 Research Laboratories in Building 114, where the licensee uas using Efi'
-e v y liquid scintillation counting systems for analysis oflowlevelsamples,andelabeledorganicsandbiologicalmaterials
-3; were stored in two different refrigerators or freezers. The whole 1
LuA l.
body counter is in a small building adjacent to Building 114, which is presently equipped with 5 x 8 inch b$h.lI detector and a I
Nucicar Data 512 Channel Analyzer. The Nuclear Medici,ne, Service te yta*r Aw facilities in Building 213 include] dual probe and'electrolinear scanner and uptake equipment in addition to the scintillation camera n
and Clianicon Computer. The facility also has a dual opposed three-l v
i-inch
- f. }c~15 scintillation detector, "I O BD J2, counter scaler i
and apparatus to perform xenon-133 pulmonary studies. The licensee maintains control of access to locations where licensed materials are stored or used by means of personal surveillance or lock and key.
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.2 17.
Equipment A listing of the equipment available to the Nuclear Medicine Service is contained in Appendix A, Page 8, under " Equipment, Present Inventory." In addition, the licensee has a number of freezers and
- re; refrigerators used for storage of licensed materials in the research i
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,g;g programs, as well as liquid scintillation counting equipment. At i
the time of the inspection, the licensee's inventory was stated to be as reported in the document dated September 28, 1973, which is l
attached as Appendix B.
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1 18.
Radiological Safety Procedures The licensee's procedures remain as identified in Paragraphs 21 and 23 of the license. The procedures had not been changed without c,
prior approval of DOL.
1k. Wettereau stated that when an individual first receives approval to use licensed materials they are required to complete a Form AEC-4, at which time they are provided with a copy of the procedures and invited to attend the Health Physics i
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Radiation Safety Training Course. Attendance at this course may be a prerequisite to receiving permission to utilize materials unless j
the Radioisotopes Committee is satisfied concerning the level of training and proficiency of the individual. It was noted that Forms AEC-3 were posted at all facilities visited during the inspection. The licensee had attached to each AEC-3 a small type-l written notice informing the readers that copies of the AEC license
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and the licensTds procedures were available for review as were the i
AEC's regulations in compliance with 10 CFR 19 at a specified i
I location. The location was Mr. Wettereau's office, and his name and office location were provided.
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19.
Personnel Monitoring and Exposure to External Radiation m
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The licensee uses monthly film badges supplied by Radiation Detection Company. The licensee maintains records of exposure in terns of dose per month and per quarter. Information i
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~7-equivalent to Forms AEC-5 are maintained. Finger rings are used by individuals who are likely to receive high extremity exposures, principally due to handling technetium. Pocket dosimeters'are
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available but are not routinely used. During 1972, the high quarterly whole body exposure was 480 millirem, and the finger ring measured high exposure was 1560 millirem.
During 1973 through August, the maximum quarterly whole body exposure was 225 millirem.
The maximum finger ring measured exposure was 1850 millirem. The average exposure ranges from approximately 25 to 50 millirem per month.
s The licensee has a requirement placed by Condition 18 which requires the performance of bioassays on individuals using at one f
time more than 100 millicuries of tritium in an uncontained form.
The licensee stated that no such use of tritium had occurred, and no bioassays had been performed for tritium. The licensee does perform spot check bioassays on radioisotope technicians, however, the results of the spot checks have been negative.
20.
Exposure of Employees to Airborne Radioactive Materials The caly significant potential for exposure to airborne activities would be in the case where patients are administered xenon-133 for pulmonary studies.
Mr. Wettereau stated that a gas is administered l
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. i in a saline solution by injection and that the patient's exhaled breath is collected in a Douglass bag and vented through a chemical fume hood in one of the counting facility laboratories.
21.
Effluents to Unrestricted Areas j
This licensee makes no intentional sewer disposals of radioactive materials. Some small disposal probably occurs during washing of glassware. This licensee has in the past buried waste at their facility. There have been no recent burials. Waste is disposed by transfer to California Salvage Company.
Since the last inspection, the licensee has disposed of a total of 53,55-gallon barrels of waste which contained 629.8 millicuries of activity. The licensee
'L maintains records of disposal in the form of disposal company.ttetoft sepply records.
..:..e 22.
Miscellaneous Surveys, Evaluations and Records
.'il Mr. Wettereau stated that he performs surveys for record,of f
activitfusinglicensedmaterialsatthisfacility. He stated i
that he also instructs and advises users of materials to contact him in the event of any problems. !!r. Wettereau maintains a log-book which records the results of surveys and problems. These records include the date, dose rates or measured naximum contamina-s,m a.v tion, the results of. sewer tests, with space for remarks. The
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4 frequency of visits to the laboratories varies from weekly to 1
i approximately every few month depending upon the use of materials l
at that facility. Most of the surveys indicate no significant levels. Wettereau makes a particular point o'f conducting thorough
..a ;A surveys of vacated facilities including plumbing and records the results for future reference. The survey records indicated that foisr surveys had been performed and were well documented.
1 23.
Special License Conditions i
None.
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b 24.
Posting and labeling A tour of the licensce's facilities disclosed t. hat locations of use
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and storage were posted in accordance with Regulatory requirements.
A spot check of materials-in storage disclosed that containers were labeled in accordance with Regulatory requirements. Forms AEC-3 l
and notices relating to Part 19 requirements were posted in each i
facility or laboratory where licensed materials were used.
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Independent Ifeasurements I
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Operations observed None.
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Incidents, Overexposures, Theft or Loss. Equipment Malfunction Mr. Wettereau maintains a log of problems and unusual occurrences.
From this record, the following items of interest were noted:
A shipment from Cambridge Nuclear Pharmaceutical Corporation, P. O. Box 528, Princeton, New Jersey ~3540 -- A packing slip
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from this supplier dated March 21, 1972, identified the shipment
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as sodium chlorider:24, Nacl-24, at 2.2 millicuries per milliliter containing two milliliters with the activity shipped as 0.4 6 : h' millicuries. The licensee's receipt analysis showed that the shipment contained 22 millicuries of sodium-24. A telephone call by Wettereau to Cambridge Muclear did not result in an appropriate response according to Wettereau.
In a second case, a shipment from Isomed was stated to contain 50 t -,
~l millicuries technetium-99 and was labeled as of April 5, 1972; 4
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however, the material was actually shipped April 17, 1972 and on that date contained 47.9 millicuries.
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_11 Mr. tiettereau noted one occurrence on April 19, 1973, in which a residentphysicianpreparingtodoapolusI.V.injectionof15 mil 11 curies technetium-99 pertechnetate inserted the needle in the patient's arm after having applied a tourniquet above the injection site, verified th'e presence of veinous blood, removed the tourniquet, removed the hypodermic from the patient's arm and ejected the contents of the hypodermic on the patient rather than injecting the material into the vein as intended. Mr. Uettereau stated that the particular resident physician in question was a pathologist who he sected apparently had had insufficient contact m
with living patients. Ucttereau was notified and, with the assistance x
of the physician and the nu_rsing, staff, the patient was decontaminated.
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The resident physician terminatedLhis training program without completion.
..c, On September 10, 1973, a sink overflowed in a carbon-14 lab resulting in incalized flooding. Wettereau participated in the cleanup of the facility and sur9 eyed the floor and made certain that it was decontaminatedico background levels.
1 Mr. Wettereau s'tated that there had been no unreported incidents or unusual occurrences which he felt were necessary to report to q
-N the Commission.
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Other Information or Continuation From Previous Paracraphs Addition to Paragraph 23 -
The licensee has two sealed sources, a Model R-30 cobalt-60 source
- esav4y, and a Model RA-1A strontium-90 Medical Applicator. The-licensee performs leak. tests at regular. intervals.
Records of leak tests are maintained. Leak tests have been performed at the required intervals, and the records disclosed no evidence of leakage.
Attachments:
1.
Appendix A 2.
Appendix B g
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.- RCS 10-108-z
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r NUCLEAR MEDICINE SERVICE REPORT VA UADSWORTil 110 SPITAL CENTER, Los Angeles, Calif. 90073 CIIIEF '
William !!. Blahd, M. D.
FISCAL YEAR 1973 up DUE 10 working days af ter receipt of this form TOTAL-TOTAL j
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DIAG"OSIS_
NO. OF NO. OF DOSAGE PTS.
PROCEDUni FORM PURPOSE RANGE VISITS OR SC7WS-i-
l Ev-product Material J31-Iodine i.
1.1 Iodide Thyroid function 2-10 oci 625 206 (uptako)
I 1.2 Iodide Thyroid scan 100-500 pc_i 101 101 l.3 IIISA Plasma' volume 10-15 nci 392 196 1.4 IIISA Cardiac _ scan-output
, 1.5 IllSA Cisternography 100 oci til 37 1.6 MAA Lung scan 1.7 MAA Liver scan 1.8 Rose Bengal Liver function 250 cci 1
1 1.9 Ilippuran Kidney fuliction,
250 pCi 74 74 1.10 IIippuran Kidney scan 250 pCi 73 73 1.11 Fats / Fatty Acids GI absorption 1.12 T-3 In vitro l'
l.13' T-4 In vitro l
1.14 Iodide Thyroid function -life' 2-5 pC1 108 18 l
1.15 Iodide Thyroid & chest scan 5 mci 38 19 imm 1.16 1.17
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f I:0. OF
- 0. OF DOSAGE PTS.
PRCCEDURES
, FORM
_PURPOSU R7d:GE VISITS
_OR SCAI:S 12 5-Iod i n_e_
2.1 Iodide Thyroid function (uptake) 2.2 Iodide Thyroid scan 2.3 IIISA Plasma' volume 2.4 T-3 In vitro In vitro 1451 W+:. 2. 5 T-4 In vitro In vitro 241 2.6 Digoxin In vitro In vitro 11R 2.7 Insulin In vitro 2.8 Renin In vitro 2.9 Australian Antigen In vitro 2.10 RISA Blood Volume 5 uCi 15 15 2.11 2.12
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99m Technetium 3.1 Pertechnetate Brain scan 15-20 mci 1454_
1454 3.2 Pertechnetate Thyroid scan 1-6 mci a
6 3.3 Pertechnetate Thyroid uptake 3.4 Pertechnetate Cerebral blood flow 15-20 mci 953 953 3.5 Pertechnctate Renal blood fl'ow 3.6 Pertechnetate Joint scan 3.7 Pertechnetate Cardiac scan "iP!3. 8 Pertechnetate Arterial flood flow 3.9 Pertechnetate Cardiac blood flow 3.10 Pertechnetate Brain blood flow 3.11 Portechnetate Parotid scan 10 mci 1
1 3.12 Sulphur Colloid Liver scan 500 pci-2.5 mci 862 862 3.13 Sulphur Colloid Spleen scan 500 pCi-2.5 mci 50 50 3.14 Sulphur Colloid Bonc marrow scan 10 mci 10 10 3.15 ' Sulphur Colloid Cardiac scan 8 mci 4
4 3.16 Sulphur Colloid Lymphangiogram 3.17 Sulphur Colloid Stomach & Duodcum
-3.18 Albumin Cardiac scan 3.19 Albumin Cysternogram 3.20 Iluman Serum Lung scan 3 mci 424 424
.s Albumin Microophores 3.21 An tin ony-sulphu r Aerosol lung scan Colloid 3.22 Sulfur Colloid Vena C.wa 2-4 ir.Ci 42 42 3.23 Tc DIPA Kidney Scan 1-3 mci 63 63 3.21 Sulfur Colloid ::A Vena; ram 2 r.:Ci 1
1 3.25 Tco, ::cckle's Diver ticul en 10 oct 2
2 Tc-POP borc 15 r.Ci 2/9 2h Tc-DI P bonn 15 i..Ci 10 10
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o-t 12 0. OF HO. OF DOSisGE PTS.
PHOC1:Dt' PORM PURPOSE RIWGE VISITS OR Scla 51-Chromi_tg 4.1 Sodium Chroma te RDC Survival
_7_5_- 150 oCi 117 18 4.2 Sodiu:a Chromate Spleen nean 4.3 Sodium Chrer.uit e REC volume
_50-75 oci 72 24 4.4 Soditr.1 Chromato Spleen nequestration 33_JJ0 oCi 150 15 4.5 Sodium Chremate G.I.
bleeding W
4.6 Sodium Chrc:aate Liver / Spleen ratio 4.7 Sodium Chrcmate Platelet curvival 4.8 Albumin GI protein loss 4.9 4.10
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4.11 59-Tron 5.1 Chloride Iron turnover 5.2 Chloride Body distribution, external countc 5.3 Citrate Iron turnover
( 20utJ 90 6
5.4 Citrate Plasma clearance o m gj on_
6 5.5 Sulphate Iron absorption 5.6 Amomonium Citrate In vitro Iron binding capacity 5.7
_ 5.8
.-w 3,9 5.10 1
197 or 203-Mercurv 6.1 Chlornerodrin Kidnc;y 6.2 Chlormerodrin Brain scan G.3 6.4 "W9 198-Gol d 7.1 Colloid Liver scan 7.2 Colloid Lymph node ccan 7 J3 7.4 7.5
s NO. OF 11 0. OF DOSAGE PTS.
PROCEDU FOpi
_PUJIPOSE RAUGE
_ VISITS Oil SCA:
lil-Indium 8.1 Trnnsferin Lymph node scans 8.2 DTPA Cisternogram 500 uCi 204 68 8.3 8.4 113"-Ind.ium 9.1 Colloid Liver scan 9.2 Colloid Lung scan 9.3 Colloid Cardiac scan-output 9.4 9.5 57-Cobalt 10.1 Vit. B12 Absorption (P.A.)
0.5-1 un 114 57 10.2 Vit. B12 Ab:icrption (G.I.)
l'O. 3 Vit. B12 Scrum binding capacity 10.4
- 10.5 58 or 60-Cobalt 11.1 Vit. B12 Absorption (P.A.)
11.2 Vit. B12 Absorption (G.I.)
11.3 11.4 11.5 85-Strontium 12.1 Hitrate Bonc scan 12.2 Chloride Bonc scan 12.3 12.4 12.5
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NO. OF NO. OF DOSAGE PTS.
PROCEDURES FORM PURPOSE RANGE VISITS OR SCAMS' 18-Pluorine L3.1 Sodium fluoride Bone scan 1-5 nCi 39 30
-++-Tr>L 3 2 L3.3 133-Xenon L4.1 Gas Cardiac studies L4.2 Gas Pulmonary studies 5-10 nCi 2
2 L4. 3 Saline Muscle blood flow 2-10 mci 72 72 L4.4 Saline Cerebral blood flow
- L4.5 JL4.6 L4. 7 5
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3-II Tritium L5.1 Digoxin In vitro LS.2 Other
- W ML6.1 Methionine Se 75 Pancreas Scan 250 pCi 30 30-L6.2 Ilydrogen 3 (Tritium) Total Body Waters 150-200 pCi 28 14-L7.1 Bromine 82 Extracellular Water 25 pCi 28 14 L7.2 Sodium 24 Exchangeabic Sodium 150-200 pCi 28 14 31 31 L 7.' 3 K 40 Total Body Potassium
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L7.4 Callium 67 Callium 4-5 mci 342 114 168 168 Ultrasound l
TSil studies 10 units 45 15 l
L8.1 L8.2 Thyroid Followup 61
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T]!J'!;A PY 170, OF NO. OF DOSAGE PTS.
PROC!2r F.Cil'_1 PURPOSE
_nAI'CE VISITS On f;Cg
_ 31-Iodi.no
]
20.1 Iodide Ilyperthyroidism 2_20 mgi_
q_g 39
. 20.2 Iodide Thyroid CA
_50-150 mci 1
1 GQ; 20.3 Iodide IIcart Discane 398-Gold 21.1 Colloid Intercavitary CA 21.2 Colloid Interstitial CA 32-Phonnhorous 22.1 Phosphate Polyc' themia Vera y
22.2 Phosphate Leukciain 22.3 Phosphate Bone CA 22.4 Colloidal chromic Intercavitary CA 22.5 Phosphate Interstitial CA
_10-50 rCi 1
1 Phosphate Interstitial (Artliritis)-
500 pCi 24 4
b o
n N"P WW l
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III.
Scope of Services 1
Coverage:
40' hrs per week, plus. emergency callback capability 2.
Sites: There are 38 locations within our hospital where radioactive materials were used for any purpose.
IV.
Cost 1.
Personnel (Name, Position Title, Grade, State Licensure,
'A +5 Certification or Registration)
,i-W. H. Blahd, M. D.
Chief, Nuclear Medicine Service (DM&S 15)
California license Certified in Nuc1 car Medicine, and Internal _ Medicine Fellow, American College of Physicians M. A. Winston, M. D.
Assistant Chief, Nuclear Medicine Service (DM&S 14)
California license Certified in Nuclear Medicine, and Internal Medicine.
G. T. Krishnamurthy, M. D.
Staff Physician, Nuclear Medicine Service (DM&S 14)
Licensed in California and Washington Certified in Nuclear Medicine Fellow, American College of Physicians J. H. Pritchard, M. D.
Staff Physician, Nuclear Medicine Service (DM&S 14)
California license
-"<6e^
Certified in Nuclear Medicine L. W. Wetterau, B.
A., Physicist, GS-12 Manuel Tubis, Ph. D., C'linical Radioblochemist, GS-15 Panchita,_B. Thomas, B.
S.,
Biologist, GS-ll Robert J. Huebotter, B. A., Biologist, GS-ll Jerome J. Gambino, Ph. D., Biologist (Instructor), GS-13 Carol F. Walsh, Health Technician (Instructor), GS-9, ARRT(RT Nucl Med)
Billie Jean Kinney, Health Technician, GS-9 Shirley N. Stichler, Health Technician GS-7, ARRT (RT Nucl Med)
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IV.
Cost 1
Personnel (continued)
Vacancy to be filled - Health Tech i i n c an, GS-7 Kazuko Endow, Secretary-Steno
, GS-6 Ruth V. Adams, Dictation Machine T TOTAL SALARY COST:
ranscriber, GS-4
$ 237,112 2.
Supplies:
$ 60,000 3.
Equipment 3.1 Purchase cos t:
$ 59,998 3.2 Repair cost:
8,300 V.
Special Items 1
Personnel needs:j GS-4 Clerk-typi t (
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new position) 2 Equipment 2.1 Present inventory 2.1.1 Imacing coulpment Model HP, 1972 Nuclear-Chicago, Pho/ Gamma Scintill ation Camera System, l
System, Model 6403, 1969 Nuclear-Chicago, Pho/ Ga ntillation Camera Searle Nucicar-Chicago, Clincom
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, Model PDS-3, 1973 Radx, 70 mm camera, Model M-600
, 1972 2.1.2.
Scanners Picker Nuclear, Magnascanner II 1964 i
, 3" crystal, Model 6184-D, Picker Nuclear, Magnascanner 500 1970
, 3" crystal, Model 2806-K, Picker Nuclear, Magnascanner Ill 1972
, 5" crys tal, Model 2852,
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Special Items 2.
Equipment 2.1.2.
Scanners (continued)
Picker Nuclear Magnascanner 500, 5" crystal, Model 500, 1969 Nuclear-Chicago, Pho/ Dot V, 5" crystal, Model 1775, 1973 2.1.3.
Probes Nuclear-Chicago Probe-Scaler Assembly, Model 820582, 1970 Nuclear-Chicago Probe-Scaler Assembly, Model 8725, 1971 2.1.4.
Other equipment i
Picker Renogram Assembly Dual Analyzer /Ratemeter, Model 620-085, 1966 Nucicar-Chicago Auto / Gamma Spec trometer, Model 1085, 1971 Packard Tri/Carb Liquid Scintillation Spectrometer, Model 3320, 1971' Kodak X-Omat Dry Film Processor, Model M6A-N, 1970 Kodak X-Omat Dry Film Processor, Model M6A-N, 1972 Picker Nuclear Ultrasonoscope, Model lQ20-2, 1972 Olivetti Desk Programmer, Model 101, 1969 Whole-Body Counter (constructed in 1959) 5" steel chamber 4" x 8" crystal Nuclear Data 512-Channel Analyzer System, Series 2200, 1971,
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V. ^Special Items 2.
Equipment (continued) 2.2.
Needs 2.2.1.
Initial cauipment Nuclear Chicago 2-channel, 3" Automatic Gamma i
Counter with eye-level control, Model 1185D
$ 14,500 mwn Nuclear Chicago Model 09009 Dual Isotope p-Analysis Display for H.P. Camera 4,500 Nuclear Chicago Whole-body Scanning Tabic 22,000 Refrigerated Centrifuge - International PR-J with 8-place head 2,544 i
Van Waters & Rogers, Sterilizer, Steri Quick,
- 58626-007 650 Van Waters % Rogers, Waterbath, Shaker, #13300-007 with Tray, 1#13301-065 770 k
$ 44,964 Total Cost
.2.2.2.
Replacement equipment 04-6493 Scanner, Ser. #196 - replacement requested is Ohio Nucledr Dual $ Scanner,
$ 33,000 M.C. price
- ests'
.j 18-0614 Camera, Osc. Trace - replacement requested is Riverside Bio Engineering 70 mm camera M-800 1,795 04-2214 Counter Prop Gas Flow Ser. #569 - replace-ment requested is Nuclear Chicago Model 8725 3,000 04-2240 Counter, Well Scintillation - replacement requested is Baird Atomic M-98810C 1,450 18-0470 Camera and Video Monitor - replacement requested is Shibaden HV-14 & Shiba VM-903
'738 Total Cost
$ 39,983 J
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s V.
Special Items 2.
Equipment (continued) 2.3.
Repairs 2.3.1.
24 repair service calls 2.3.2.
Down time, inpatient-hours / week:
I hr/ wee'k
~
2.3.3.
Service is readily available 2.3.4.
Scrvice is not by VA personnel.
3.
No untoward reactions to any clinical procedures.
4.
Space used for clinical activities:
4.1.
Total space in square feet:
4,000 sq ft 4.2 Number of rooms:
20 4.3.
, ervice is not situated in one geographic area S
5.
Training and Education Activities The Nuclear Medicine Service offers training at three icvels:
physician, radiopharmacist, and technologist. _ Physicians seeking eligibility for certification by the American Board o'f Nuclear Medicine take a two-year
~
program.
During this time, resident. physicians receive instruction in the theoretical and practical aspects of diagnostic and therapeutic nuci, ear medicine.
Didactic and laboratory instruction is provided in relevant basic sciences, including medical nuclear physics, radiation biology, radiation protection, instrumentation, radiopharmaceuticals, and statis tics.
In the second year of training, emphasis is on independent investigation, and the residents' responsibility in the nuclear medicine clinics is progressively increased.
The program is structured so as to provide balanced training in the clinical and research applications of radio-nuclides.
~
The radiopharmacist training program provides one' year of training to qualified licensed pharmacists. Trainees attend the University of Southern California for two academic semesters, receiving didactic and laboratory training.
Upon completion of the academic portion of the program, trainees intern for a three-month period at VA Wadsworth Hospital Center. Their internship provides practical experience in the Nucicar Medicine Service Radiopharmacy Laboratory where they participate in the preparation of radiopharmaceuticals used in routine clinic procedures, observe the performance of clinical procedures, and also participate in developmental research in radiopharmaceuticals.
During this period, the trainees attend many of the same lectures and seminars attended by physicians in training.
, m
('
V.
Special Items 5.
Training and Education Activities (continued)
The Technologist Training Program offers one year of training, including both theory. and practice. Trainees attend and participate in many of the same lectures,. laboratories, conferences, and seminars that the physicians in training attend.
In addition, the technologists receive ample practical experience under the supervision'of the training staff in the Nuclear Medicine Clinics and in vitro laboratories.
~6:a The Training Program in,Nucicar Medicine at Wadsworth Hospital Center s"
was impicmented in May of 1969.
During the period of time the Program has been in effect, a total of 10 physicians, 10 technologists, and 8 radiopharmacists have been or are being trained.
6.
Research Activities - title of research project and investigator (s)
Treatment of Thyrotoxicosis in Graves' Disease (W.H. Blahd and M. A. Winston)
A Comparison of Radioiron and Indium 111 Chloride (W.H. Blahd, H.G. Berger)
Radiolabeled Anti-CEA for External Detection of GI Tumors (W.H. Blahd, J.H. Pritchard, M. Tubis, and J.J. Gambino) i
~
Body Composition Changes in Radiation Therapy of Malignancy (W.H. Blahd and J.J. Gambino) l Urecholine, Glucagon, to Aid Pancreatic' Scans l
A6 (M.A. Winston) f P Chromic ~ Phosphate for Recurring Synovial Effusions 32 (M.A. Winston and R. Bluestone) i 57 Detection of Increased Iron Absorption Using CO (M.A. Winston and P. Guth) f Technetium 99m-Penicillamine for Cholescintigraphy l
(G.T. Krishnamurthy, M. Tubis, W.H. Blahd, and J.S. Endow)
Kinetics of Technetium-Labeled Skeletal Rad'ionuclides (G.T. Krishnamurthy, W.H._Blahd,.and M. Tubis)
"~~~
Gamma Camera Study of Venacaval Obstruction without Syndrome (G.T. Krishnamurthy, M.D. Kehr, Z. Piotrkowicz, and W.H. Blahd)
Tc 99m and I 131-Labeled Metronidazole for Liver Imaging (M. Tubis, W.H. Blahd, G.T. Krishnamurthy, and R. Suwanik) 9 !
s;, b.
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Special Items 6.
Research Activit'ics (continued)
I Indium 113m Sulfide Macroaggregate for Lung Scanning (M. Tubis, M. B. Cohen, and C. D. Gilliam)
Technetium 99m-Penicillamine-Acetazolamide for Scanning (M. Tubis and W.11. Blahd)
Indium 111 Colloid for Lymph Node Imaging (H. G. Berger and W. II. Blahd) 7.
Notabic advance made in Nuclear Medicine Service within the past year 3
7.1 The Nucicar Medicine Service has recently acquired a Clincom system that will become an integral part of one of our scintillation cameras.
It is anticipai.ed that this dedicated computer system will provide. improved diagnostic services and new avenues for clinical investigation.
l
- 7. 2.. Ultrasound b mode scanning has been used extensively during the past yhar as a compicmentary modality to nuclear medicine imaging procedures.
It has greatly augmented our diagnostic capabilitics and it is hoped that this technique will have even greater application during the coming year.
7.3.
Two new radiopharmaceuticals have been devised during
'the past year.
One of these, I 131 labeled-metronidazole, will be used for th'c detection of amebic a,bscesses of the
^
liver. A second radiopharmaceutical, Tc.99m' penicillamine,
~
has been developed for imaging of the gallbladder.
7.4.
A technique has been developed to improve imaging of the pancreas, involving the use of urecholine and pancrea-zymin.
Early results using this technique have been encour-l aging.
l 7.5.
The metabolism and distribution of a new radioisotope tracer, Indium 111, has been investigated.
Preliminary studies suggest that this tracer may be extremely useful for bone marrow imaging, and for the evaluation of patients with
-. ~.
l hematologic disease associated with disordered bone marrow l
function.
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VI.
Significant Administrative Problems and Future Plans 1.
Administrative Problems 1.1.
One important problem has, developed as a result of the earthquake of 1971 necessitating the relocation of the Nuclear Medicine Service into two clinical areas.
It has been impossible to obtain through Administration, clerical help in one of these clinical areas. As a re'sult, the efficiency of the Servi.cc operation in this ' area has been greatly u
hampered since Nuc1 car Medicine technicians have been required to perform clerical and secretarial work.
1.2.
As a result of the increas~ed workload and expanding activities of the Nuclear Medicine Service during the past several years requiring the handling and preparation of numerous and large quantities of radiopharmaceuticals, there has developed an urgent need for a radiopharmacist.
Despite numerous appeals, it has not been feasible.to obtain the services of such an individual despite the fact that he would play a major role' in increasing the efficiency and productivity of Service operations.
I 1.3.
The Servicejoperates a scintillation camera in each of its two clinical areas.
In one area an older camera is in use that urgently requires overhauling and upgrading, such that its performance will be comparable to the current standards of scintillation camera operation. The cost to upgrade the above instrument is approximately $12,000 Funds have been
. requested for this project but have not been forthcoming.
1.4.
The Nuclear Medicine Service has need pf replacement l
equipment funding as indicated above, and in particular, the need of a dual probe system to replace an existing recti-linear scanning instrument that would also improve and extend l
the efficiency and productivity of Service operations.
2.
Future Plans The Nuclear Medicine Service is impicmenting an In Vitro Laboratory for the' performance of radioimmunoassay procedures. The Laboratory was i
constructed largely from surplus laboratory furniture and equipment,and i
is nearing completion.
It is anticipated that the Laboratory will be igrj functional within the next 30 days. According to present plans, a number of procedures will be immediately available, including T3, T4, 3,,2 and Digoxin analyses.
Future plans include performance of other tech-l niques, such as HAA, Vitamin B-12, TSH, and angiotensin.
A major problem regarding this activity is the lack of adequate personnel.
At the present time the Service has one high-level person who is assigned to this area on a part-time basis, who has available primarily the assistance of one or two technicians in training.
Further personnel support for this Laboratory is urgently needed.
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VETERANS ADMINISTRATION WADSWORTH HOSPITAt. CENTER i
WIL3NIRE AND S AWTELLE BOULEV ARDS Los ANGELES, CALIFORNI A 90073 IN RENY September 28, 1973 McrtR to:
691/172A Mr. Ilarry North U. S. Atomic Energy Commission SUBJ: Radioisotope inventory as of 9-28-73 License 04-00181-04 Millicuries 3H as Labeled Compounds 158.520 14C as Labeled Compounds 18.127 35S as Labeled Compounds 0.675 45Ca as Labeled Compounds 0.495 51Cr as Labeled Compounds 2.100 59Fe as Labeled Compounds 0.138 57Co as Labeled Compounds 0.040 63Ni as Labeled Compounds 9.800 67Ca as Labeled Compounds 6.000 75
'f?,
Se as Labeled Compounds 1.500 "Tc as Pertechnetate 400.000 99"Tc as Labeled Compounds 20.000 111 In as Labeled Compounds 4.500 ll4 In as Labeled Compounds 0.030 125 1 as Labeled Compounds 26.500 I
as Nal 27.970
~~
131 1 as Labeled Compounds 5.200 133 1
Xe as Gas in Saline 25.000 137Cs as Labeled Compounds 0.138 l
SIow retersn's fsli name, l'1 fle number, and social security nsmber on all corregonience. -
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Mr. liarry North U. S. Atomic Energy Commission Sept. 28, 1973 Millicuries 3H as Scaled Source-Varian Gas Chroma-tograph Model 02-0645 detector cell 199.000 60C as Scaled Source - Tracerlab Model R-30 0.060
.rM5~.
90Sr as Scaled Source - eye therapy -
Tracerlab Model RA-1A 24.900 TOTAL 923.693 millicuries
/
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~$
L. W. WETTERAU Radiation Safety Officer W
Net $
-