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ITEM 5: RADIOACTIVE MATERIAL

ITEM 6: PURPOSE(S) FOR WHICHLICENSED MATERIAL WILL BE USED

10 CFk 35.200 Medical Use of Unsealed Byproduct Material for Imaging and Localization Studiesfor Which a Written Directive is Not Required

,*- . . * . . .. : . . . .. , .

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Ahmad Mossavi,M.D. ATT 7

ITEM 7 - Individual Responsible For Radiation Safety

Dr Ahmad Mossavi ,M.D. is the Radiation Safety Officer for this license. His Certificateof completion of the 200 hr classroom and laboratory training is attached. (ATT 7A) Wewill contract an outside consulting Physicist, who will assist him with his radiation safetyduties, as needed.

Authorized Users Material

Alimad Mossavi, M.D. 10 CFR 35.100, 10 CFR 35.200

Dr. Mossavi was an Authorized User on: NRC License # 29 - 28041 -01Physicians Imaging Center, Inc.INME, Nuclear Cardiology Systems, Inc.

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COOPER HOSPITAL/UNIVERSITY MEDICAL CENTERIJMDNI/ROBERT WOOD JOHNSON MEDICAL SCHOOL AT CAMDEN

AAhmad Mossavi, M.D.

Has successfy completed the course, Basic Scic in re Clinki Prctce ofNuclar Mecine, for 200 hours of classoomand lahbortory tining required by the Nudear Regulatory Commission as set forth in 10 CFR 35.920 from March 19, 1993 toMay 28, 1993.

4 £a Wt 1Paul E. Wallner, D.O., FACRChief, Department of Radiation Oncology

- - -, f

Jefty x( jiegelCourse Director

D.

Cooper Hospital/University Medical Center is accredited by the Accreditation Council for Continuing Medical Education to offercontinuing medical education for physicians.

Cooper Hospital/University Medical Center designates this continuing medical education activity for a maximum of 200 hours inCategory I of the Physician's Recognition Award of the American Medical Association, provided it is completed as designed.

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ASNC

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FULL MEMBERAiljil 1, 16s

Dsr r y_!

Ahmad Mossavi, M.D. Item 8

MODEL PROGRAM For Radiation Safety Training

Personnel will be Instructed:1. Before assuming duties with, or in the vicinity of, radioactive materials.2. During annual refresher training..3. Whenever there is a significant change In duties, regulations, or the terms of the license.

Instruction for individuals In attendance will include the following subjects:1. Applicable regulations and license conditions.2. Areas where radioactive material Is used or stored.3. Potential hazards associated with radioactive material In each area where the employees

will work.4. Appropriate radiation safety procedures.5. Ucensee's In-house work rules.6. Each Individual's obligation to report unsafe conditions to the Radiation Safety Officer.7. Appropriate response to emergencies or unsafe conditions.8. Worker's right to be Informed of occupational radiation exposure and bioassay results.9. Locations where the licensee has posted or made available notices, copies of pertinent

regulations, and copies of pertinent licenses and license conditions (including applicationsand applicable correspondence), as required by 10 CFR Part 19.

10 Question and answer period.

The following will be trained initially, and then annually:

Nuclear Medicine TechsEKG TechsNurses

Ahmad Mossavi, M.D.

ITEM 9

Radiation Monitoring Instruments

(A) Radiation Survey Instruments will be calibrated yearly by a qualified person toperform such calibrations. ( We will send out our meter to ourradiopharmaceutical vendor, who sends it to a calibration laboratory that meetthe requirements in 10 CFR 20.1501 and of 10 CFR 35.61.)

(B) Radiation Well Counter will be calibrated yearly by our consulting physicist, whowill follow nationally recognized standards or the Manufacturersrecommendations.

The Survey meter is a Ludlum 14 with a 44-9 GM Pancake Probe. This unit will be usedfor Daily package surveys of incoming packages, daily area surveys, daily monitoring ofhands and feet, and for monitoring waste prior to disposal.

The Well Counter is a Capintec CRC 15 W with a Capintec Well. This unit will be usedfor daily wiping of Incoming and outgoing radioactive packages, and for weekly areawipe testing for contamination.

We reserve the right to upgrade our survey instruments as necessary as long as they areadequate to measure the type and level of radiation for which they are used.

Dose Calibrator

Equipment used to measure dosages will be calibrated in accordance with nationallyrecognized standards or the manufactures instructions.

Gamma Camera

We will perform all Quality Control and Calibrations that are in accordance withnationally recognized standards and manufacturers recommendations.

- - . . . .. Attachment.; .Facilities and Equipment

Hot Lab:

The hot lab is the location wIe= radiopharmaceuticals are stored, prepared anddispensed. Lead bricks or lead lined storage modules are used to provide shielding where* cessry. The hot lab has an.L" block present. Additional lead shlielding is used around the

'VL" block where.necessary. Absorbent, plastic backed paper is used to line the counter topswhere radioactive material is used.

DOT shipping containers for the transport of. unit doses provide significant shielding.These will be used for storage of patient doses until their use unless a suitable alternative Custs

Storage of Radioactive Material and Waste:

* . : . .Lead lined ( inch) disposal cans are present ia the hot lab ars for the storage of

active waste. Lead lined (t(8 inch), or equivalent, storage modules are present for thestorage of radioactive material.

Additional Safety Equipment:

WM& The folo safety e t is also present for use at the licensees facility and atloiations whre radiophamnceuticals are used.

syringe shields syringe cariersdisposable protective gloves, absorbent pads*remote handling devices lead equivalent Locklead shields.for vial storage lead bricks (as eeded)l lead lined storage modules lab coats

ATT 9 B

Dr. Mossavi will be using a Digirad Cardius 2 Mobile Camera, that he will keep in hisoffice at 3200 Sunset Avenue, Suite 107 Ocean, New Jersey 07712.

One day a week, he will bring this unit to Dr. Shahid Farooqi's Office located at 20White Road Shrewsbury, New Jersey 07702. There will be a Hot Lab at this facility, anda diagram is attached ( ATT. 9D). The Hot Lab equipment will be identical to theequipment found at 3200 Sunset Avenue. The Unit Doses of radiopharmaceuticals willbe delivered to the 20 White Road address on days it will perform imaging there.

The calibration sources for the Imaging Camera and Dose Calibrator will be stored at the3200 Sunset Avenue address, and only transferred with the Digirad Camera on days thatimaging will take place at 20 White Road.( a 10 mCi Co 57 source for Camerauniformity, and a 200 uCi Cs 137 source fro Dose Calibrator constancy) These sourceswill be secured in the van that transfers the camera to and from the site. ( the distance is 7miles between the 2 locations)

NARI Medical-Association, LLCAhmad Mossavi, M.D.3200 Sunset Avenue, Suite 107Ocean, New Jersey 07712

. .--,*. .. _

00

1 Lead Lined L.l3lock2 Radioactive Dose Work Area it3 Lead Lined Radioactive Waste4 Camera5 -Imaging Chair6 Treadmill7 EKG Control8 Table9 Injection Area

A1T 9tDr. Shalid Farooqi, M.D.

20 White RoadShrewsbury, New Jersey 07702

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Lead Lined L-BlockRadioactive Dose Work AreaLead Lined Radioactive WasteCameraImaging ChairTreadmillEKG ControlTableInjection Area

Ahmad MossaviM.D.

Item 10

Occupational Dose

We will provide dosimetry that meets the requirements listed under criteria in NUREG1556, volume 9 " Consolidated Guidance about Materials License: Program SpecificGuidance about Medicla Use Licensees."

Area Surveys

We have developed and will implement and maintain written procedures for area surveysIn accordance with 10 CFR 20.1101 that meet the requirements of 10 CFR 20.1501 and10 CFR 35.70.

Safe Use of Unsealed Licensed Material

We have developed and will implement and maintain procedures for safe use of unsealedbyproduct that meets the requirements of 10 CFR 20.1101 and 10 CFR 20.1301.

Spill Procedure

We have developed and will implement and maintain written procedures for saferesponse to spills of licensed material in accordance with 10 CFR 20.1101.

Item I 1

Waste Management

We have developed and will implement and maintain written waste disposal proceduresfor licensed material in accordance with 10 CFR 20.1101, that also meet the requirementsof the applicable section of Subpart K to 10 CFR Part 20 and 10 CFR 35.92.

This Is to acknowledge the receipt of your letter/application dated

I 1 IAo 5 , and to Inform you that the initial processing whichincludes an administrative review has been performed.

IL LAcre Ap., c4ta C'OZ03(C8kA; )There were no administrative omissions. Your application was assigned to atechnical reviewer. Please note that the technical review may identify additionalomissions or require additional information.

FZ Please provide to this office within 30 days of your receipt of this card

A copy of your action has been forwarded to our License Fee & Accounts ReceivableBranch, who will contact you separately if there is a fee issue involved.

Your action has been assigned Mail Control Number Is3 U3LWhen calling to inquire about this action, please refer to this control number.You may call us on (610) 337-5398, or 337-5260.

NRC FORM 532 (RD Sincerely,(6-96) Licensing Assistance Team Leader

(FOR LFMS USE)INFORMATION FROM LTS

BETWEEN:

License Fee Management Branch, ARM

and

Regional Licensing Sections

: Program Code: 02201: Status Code: 3: Fee Category:: Exp. Date: 0: Fee Comments:

: Decom Fin Assur Reqd: -

LICENSE FEE TRANSMITTAL

A. REGION _

1. APPLICATION ATTACHED

Applicant/Licensee:Received Date:

Docket No:

Control No.:

License No.:

Action Type:

NARI MEDICAL ASSOCIATION, LLC200501193036822

136322

5q *3o9$-olNew Licensee

2. FEE ATTACHED /Amount:

Check No.:

3. COMMENTS

Signed &IXUAe 6ATL-Date l

B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered /_/)

1. Fee Category and Amount:

2. Correct Fee Paid. Application may be processed for:

Amendment

Renewal

License

3. OTHER

SignedDate