ML23346A264

Mat-Su Regional Medical Center Imaging Department Amendment 26 Renew 50-29059-01/030-33011 Mc 635950

ML23346A264
Person / Time
Site:	03033011
Issue date:	12/12/2023
From:	Latischa Hanson NRC Region 4
To:	Mat-Su Regional Medical Ctr
References
635950
Download: ML23346A264 (1)

See also: IR 05000290/1959001

Text

U.S. NUCLEAR REGULATORY COMMISSION

MATERIALS LICENSE

NRC FORM 374

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OF

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3

Amendment No. 26

PAGES

Pursuant to the Atomic Energy Act of 1954, as amended, the Energy Reorganization Act of 1974 (Public Law 93-438), and Title 10, Code of Federal Regulations, Chapter I,

Parts 30, 31, 32, 33, 34, 35, 36, 37, 39, 40, 70 and 71, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued

authorizing the licensee to receive, acquire, possess, and transfer byproduct, source, and special nuclear material designated below; to use such material for the purpose(s)

and at the place(s) designated below; to deliver or transfer such material to persons authorized to receive it in accordance with the regulations of the applicable Part(s). This

license shall be deemed to contain the conditions specified in Section 183 of the Atomic Energy Act of 1954, as amended, and is subject to all applicable rules, regulations, and

orders of the Nuclear Regulatory Commission now or hereafter in effect and to any conditions specified below.

Licensee

Palmer, AK 99645

2. P.O. Box 1687

Imaging Department

1. Mat-Su Regional Medical Center

4. Expiration Date: December 31, 2038

Docket No.:

5.

030-33011

License No.: 50-29059-01 is

renewed in its entirety to read as

follows:

Reference No.:

3.

In accordance with application

dated June 15, 2023.

6.

7.

8.

Byproduct, source,

and/or special nuclear

material

Chemical and/or physical form

Maximum amount that licensee

may possess at any one time

under this license

9.

Authorized use

A.

A.

A.

A.

For use in uptake, dilution and

excretion studies permitted by 10 CFR

35.100.

Any

As Needed

Any byproduct material

permitted by 10 CFR 35.100

B.

B.

B.

B.

For use in imaging and localization

studies permitted by 10 CFR 35.200.

Any

As Needed

Any byproduct material

permitted by 10 CFR 35.200

C.

C.

C.

C.

For any use permitted by 10 CFR

35.300.

Any

400 millicuries total

Any byproduct material

permitted by 10 CFR 35.300

License No.:

Docket or Reference No.:

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 374A

MATERIALS LICENSE

SUPPLEMENTARY SHEET

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OF

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2

50-29059-01

030-33011

Amendment No. 26

CONDITIONS

10. Licensed material shall be used or stored at the licensee's facilities located at 2500 South Woodworth Loop, Palmer, Alaska, 99645.

11. The Radiation Safety Officer (RSO) for this license is Richard R. Gardner, CNMT.

12. Licensed material shall only be used by, or under the supervision of:

A.

Individuals permitted to work as authorized users in accordance with 10 CFR 35.13 and 10 CFR 35.14.

B.

The following individuals are authorized users for the material and medical uses as indicated:

Authorized User (M.D.,D.O.,etc.)

Material and Use

Dirk C. Bringhurst, M.D.

35.100; 35.200; oral administration of sodium iodide I-131 in quantities less than or equal to

33 millicuries

Matthew V. Cronin, M.D.

35.100; 35.200

Chris T. Glenn, M.D.

35.100; 35.200; 35.300

Scott A. Harman, M.D.

35.100; 35.200; 35.300

Julee K. Holyater, M.D.

35.100; 35.200; 35.300

John P. Lubisich, M.D.

35.100; 35.200; oral administration of sodium iodide I-131

Andrew Moran, M.D.

35.100; 35.200

Jason Savikko, D.O.

Oral administration of sodium iodide I-131

Douglas Swank, D.O.

35.100; 35.200

Lawrence P. Wood, M.D.

35.100; 35.200; oral administration of sodium iodide I-131

License No.:

Docket or Reference No.:

U.S. NUCLEAR REGULATORY COMMISSION

NRC FORM 374A

MATERIALS LICENSE

SUPPLEMENTARY SHEET

PAGES

OF

PAGE

3

3

50-29059-01

030-33011

Amendment No. 26

13. Except as specifically provided otherwise in this license, the licensee shall conduct its program in accordance with the statements,

representations, and procedures contained in the documents, including any enclosures, listed below. This license condition applies only to

those statements, representations, and procedures that are required to be submitted in accordance with the regulations. Additionally, this

license condition does not limit the licensee's ability to make changes to the radiation protection program as provided for in 10 CFR 35.26.

The U.S. Nuclear Regulatory Commission's regulations shall govern unless the statements, representations, and procedures in the

licensee's application and correspondence impose on the licensee requirements that are more restrictive than or in addition to the

regulations.

A. Application dated June 15, 2023 (ML23171A939)

FOR THE U.S. NUCLEAR REGULATORY COMMISSION

By:

Date:

Latischa M. Hanson

Region IV

December 12, 2023

Latischa M.

Hanson

Digitally signed by Latischa M.

Hanson

Date: 2023.12.12 18:46:03 -06'00'