S E N T A R A. -, I-;/ !?: 45IRC FORM 313A U.S. NUCLEAR REGULATORY COMMISSION 020051 MEDICAL USE TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued) 6a. WORK OR PRACTICAL

- - y p ' T ]

- , ! I-;/ !?: 45

- , a , ~

c Sentara CarePlex Hospital 3000 Coliseum Drive Hampton Virginia 23666

www sentara com

-,..,- . e . . S E N T A R A.

December 6,2005

Mr. Mike Perkins Licensing Assistant U.S. Nuclear Regulatory Commission Division of Nuclear Materials Safety Region I 475 Allendale Road King of Prussia, PA 19406

9 7 1 I Reference: Radioactive Materials License No. 45-09087-0 1 31, f , -I 0 0 2 3 -)

Dear Mr. Perkins:

We would like to request our radioactive materials license be amended to make the following changes:

1. We would like to change the Radiation Safety Officer fiom David Weimer, M.S. to Sandy Wolff, M.S. Ms. Wolff is already listed as RSO on our Sentara Hospitals, Southside NRC license, No. 45-001 3 1 - 02. Please reference this license for documentation of training and experience.

2. We would like to add Dr. Michael Miller to our list of authorized users for byproduct material as specified under 10 CFR 35.300 and 35.400. Please reference the attached NRC Form 3 13A and related documentation.

3. We would like to remove Dr. Adedamola Omogbehin, M.D. fiom our list of authorized users.

We would appreciate it if the processing and approval of this application could be expedited. With Dr. Omogbehin taking a position in the D.C. area and Dr. Williams being transferred to cover another Sentara facility, Dr. Miller will be the only authorized user readily available for therapies involving byproduct material.

If you should have any questions or comments regarding any of the information, please do not hesitate to contact David E. Weimer, M.S., at (757) 827-2444.

Sincerely,

Tamika Jefferson Director, Facilities and Patient Care Services

Irfii, 7 3 NMSSlRGNl MATERIALS-002

3C FORM 313A US. NUCLEAR REGULATORY COMMISSION '-2005)

MEDICAL USE TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION

1

PART I -- TRAINING AND EXPERIENCE

APPROVED BY OMB: NO. 3150-012( EXPIRES: 1013112008

ofe: Descriptions of training and experience must contain sufficient detail to match the training and experience criteria in the applicable regulation (10 CFR Part 35)

Name of Individual, Proposed Authorization (e.g., Radiation Safety Officer), and Applicable Training Requirements (e.g., 10 CFR 35.50)

p y , r &FAA)

For Physicians, Podiatrists, Dentists, Pharmacists -- State or Terrltory Where Licensed

G R G Lv5& 3. CERTIFICATION

Provide a copy of the board certification. (Stop here if applying under IO CFR Part 35, Subpart J or 35.590fa); continue if applying under other subparts.) Provide documentation in appropriate items 4 through 10 of training or clinical case work required by 35.50(e); 35.51 (c); 35.290(c)( l)(ii)(G) for AU seeking 35.200 authorization; 35.390(b)(l Xii)(G); 35.396(d)(l) and 35.396(d)(2); 35.590(c); or 35.690(c). Provide completed Part II Preceptor Attestation, Items 1 l a through 1 Id . Stop here after completing items 3a, 3b, and 3c when using board certification to meet 10 CFR Part 35 training and experience requirements.

4. INDIVIDUALS IDENTIFIED ON A LICENSE OR PERMIT AS RADIATION SAFETY OFFICERS (RSO), AUTHORIZED USERS (AU), AUTHORIZED MEDICAL PHYSICISTS (AMP), OR

AUTHORIZED NUCLEAR PHARMACISTS (ANP) SEEKING ADDITIONAL AUTHORIZATIONS Provide a copy of the license or broadscope permit listing the current authorization and (b) or (c)

Complete items 6c (and 10 when training is provided by an RSO, AMP, ANP, or AU) and preceptor items 11 b through 1 I d to meet requirements for: RSO in 35.50(~)(2) or 35.50(e); or AU in 35.290(c)(l)(ii)(G) or 35.390(b)(l)(ii)(G) or 35.590(c) or 35.690(c); or AMP under 35.51(c).

Complete items 5, 6a, 6b, 10, and Preceptor items I l a through 1 I d to meet AU requirements in 35.396(a)

5. DIDACTIC OR CLASSROOM AND LABORATORY TRAINING (optional for Medical Physicists)

Description of Training

adiation Physics and strumentation

adiation Protection

athematics Pertaining to the Use id Measurement of Radioactivity

adiation Biology

iemistry of Byproduct Material for edical Use

THER

C FORM 313A (10-2005) PRINTED ON RECYCLED PAPER PAGE 1

IRC FORM 313A U.S. NUCLEAR REGULATORY COMMISSION

MEDICAL USE TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued) 020051

6a. WORK OR PRACTICAL EXPERIENCE WITH RADIATION Location and

Corresponding Name of ' Materials License Description of Experience Supervising

Individual(s) Number

M- 0. IJiS-O013\ v o p c w.wt = f t f i Jn-x&b, !hqc\L 5I1Adt5, 5 d w

Dates andlor Clock

Hours of Experience

7 I I l O l - 6 - 3 ; - 05

I (

6b. SUPERVISED CLINICAL CASE EXPERIENCE (describe experience elements in sa) Location and Dates andlor Name of

Individual Number Experience

Corresponding Clock No. of Cases,

Involving Personal

Particbation Supervising Materials License Hours of Radionuclide Type of Use

RC FORM 313A 1-2005)

U.S. NUCLEAR REGULATORY COMMISSION

MEDICAL USE TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

6c. TRAINING FOR SECTIONS 35.50(e), 35.51 (c), 35.590(c), or 35.690(c)

Training Element Type of Training * Location and Dates

2/ .) J3 j 7 - i - JHf r*u+src,'4A t/(;n/fyJ IZ 7 / 4 0 I lifi.+wy QLt*y

NOrsl-.C-lC L. l,:n/LfwL I%&+@

7. FORMAL TRAINING Physicians (for uses under 35.400 and 35.600) and Medical Physicists

Name of Organization that Approved the Program

(e.g., Accreditation Council for Graduate Medical Education)

and the Applicable Regulation (e.g., 10 CFR 35.490)

Name of Program and Location with

License Number

Degree, Area of Study or Corresponding Dates

Residency Program Materials

- A j r E w EVMJ '7/1/3 I RLLflL ~ L C . S ~ ~ I + m e , o m C 5 F\3 G t 4 -

SClt-A? L. 1 a- 0.) 95 - go(31- 2 4/+' 2 &)\ HI ilbJ 0 h ) C C ) L o G Y

8. RADIATION SAFETY OFFICER (RSO) -- ONE-YEAR FULL-TIME EXPERIENCE

7 YES

&/A of the RSO for License No

Completed 1 year of full-time radiation safety experience (in areas identified in item sa) under supervison

9. MEDICAL PHYSICIST -- ONE-YEAR FULL-TIME TRAlNlNGMlORK EXPERIENCE

Completed 1 year of full-time training (for areas identified in item 6a) in therapeutic radiological physics

who is a medical physicist (35.961) or meets requirements for Authorized Medical Physicists (35.51);

gAs (35.961) or medical physics (35.51) under the supervision of

and

3 YES

dN,A Completed 1 year of full-time work experience (at location providing radiation therapy services described and for topics identified in item 6a) for (specify use or device)

under the supervision of who is a medical physicist (35.961) or meets

requirements for Authorized Medical Physicists (35.51) (specify use or device)

NRC FORM 313A U.S. NUCLEAR REGULATORY COMMISSION (10-2005)

MEDICAL USE TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

I I O . SUPERVISING INDIVIDUAL - IDENTIFICATION AND QUALIFICATIONS

The training and experience indicated above was obtained under the supervision of (if more than one supervising individual is needed to meet requirements in IO CFR Part 35, provide the followng information for each) :

I

A. Name of Supervisor

_ & r n s H A !!EL!Y.!D d h o r i z e d User Authorized Medical Physicist

C. Supervisor meets requirements of Part 35, Section(s)

D. Address E. Materials License Number

B. Supervisor is:

c] Radiation Safety Officer 0 Authorized Nuclear Pharmacist

~ ~ ~ 3 QQ, qqo ,-&qe ~ _ ~ _ -

for medical uses in Part 35, Section@) 30 0 b o & --+ 43 . _. .

Sentara Norfolk General Hospital 600 Gresham Drive Norfolk, VA 23507 ~ 4 5 - G O l 3 l r 0 2 -

Note: This part must be completed by the individual's preceptor. If more than one preceptor is necessary to document experience, obtain a separate prece tor statement from each. This part is not required to meet training requirements in 35.590 or Part 35. &bDart J lexceot 35.980).

rHn I 11 -- rnebcr I un n I rESTATlON

I attest the individual named in Item 1:

has satisfactorily completed the requirements in Part 35, Section(s) and Paragmph(s) 3C-Q -f -b. 'i 0 1

as documented in section(@ q-, (p -, 7 of this form. Ltq 0 - .................................................................................................................

meets the requirements in 35.50(e) 35.51(c) &5.390(b)(l)(ii)(G) &5.690(c) for - h 0 NIA types of use, as documented in section@) 5) 6 ~ 7 ofthis form. ........................................................................................................................ 1 IC.

0 has achieved a level of competency sufficient to independently operate a nuclear pharmacy (for 35.980); Or

has achieved a level of competency sufficient to function independently as an authorized M 5 c ?h s i CI u ,for 311 p . v+ u h ' ~ uses (or units); Or

has achieved a level of radiation safety knowledge sufficient to function independently as a Radiation Safety Officer for a medical use licensee ; Or n NIA

1 Id .

0 d I meet the requirements of 3 9 0 y 9 0 b 9 0

I am an Authorized Nuclear Pharmacist; Or 0 I am a Radiation Safety Officer; Or

section@) of 10 CFR Part 35 ----. ~-~ ~

or equivalent Agreement State requirements to be a preceptor

for the following byproduct material uses (or units): -&, f,fq e cLb c - a \ \ or 0 AMP

~~ .~~ . -~ ~ . ............. .............................................................. A. Address Sentara Norfolk General Hospital B. Materials License Number

600 Gresham Drive Norfolk, VA 23507

Q, L

t,

Q,

k’ V

1

1

ei

Radiation Oncology Resident Record Report

Program ID: 43051 11 105 Program Name: Eastern Virginia Medical School Program at All Institutes

Michael L. Miller

For All Types in Brachytherapy - Intracavi area Done Between 7/1/2001 And 6/30/2005

For Procedures in All Years For All Resident Roles

Resident Name: Miller, Michael L. Current Year: 3

Procedure Date: 1/9/2002 Resident Year: 2 Role: Performed Institution: Sentara Norfolk General Hospital

Case ID: 41 1643284

Radiation Oncology - Area IYE Q ~ Y Brachytherapy - Intracavitary Cerv i f l te rus - Low Dose Rate 1

I *


Case ID: 02/004

Radiation Oncology Area IYE Q ~ Y Brachytherapy - Intracavitary Endobronchial - High Dose Rate 1

I *


Case ID: 01/374

Radiation Oncology Area DE Q ~ Y Brachytherapy - Intracavitary Endobronchial - High Dose Rate 1 Brachytherapy - Intracavitary Endobronchial - High Dose Rate I

2 *

I 1 Procedure Date: 1/16/2002 Resident Year: 1 Role: Performed

Institution: Sentara Norfolk General Hospital Case ID: 02/004/2

I I Radiation Oncology - Area IYJK Q ~ Y Brachytherapy - Intracavitary Endobronchial - High Dose Rate 1

1 *

10:11:32Ahl 11/29/2005 1

Radiation Oncology Resident Record Report Program ID: 43051 1 I105 Program Name: Eastern Virginia Medical School Program

at All Institutes Michael L. Miller

For All Types in Brachytherapy - lntracavi area Done Between 7/1/2001 And 6/30/2005



Procedure Date: 1/23/2002 Resident Year: 1 Role: Performed Case ID: 02/004/3 Institution: Sentara Norfolk General Hospital

I 1 Radiation Oncology - Area IYE Q ~ Y Brachytherapy - Intracavitary Endobronchial - High Dose Rate 1

I *


Case ID: 02/018/1

Radiation Oncology Area Brachytherapy - Intracavitary

XYES CervixNterus - High Dose Rate

Q ~ Y 1 1 '


Case ID: 002/218/2

Radiation Oncology Area XYES Q ~ Y Brachytherapy - Intracavitary CervixNterus - High Dose Rate 1

I *

I Procedure Date: 3/4/2002 Resident Year: 1 Role: Performed

Institution: Sentara Norfolk General Hospital Case ID: 02/018/3

Radiation Oncology - Area Brachytherapy - Intracavitary

IYE CervixlCIterus - High Dose Rate

Q ~ Y I I *


Case ID: 26491231 1

Radiation Oncology Area EiE Q ~ Y Brachytherapy - Intracavitary CervixNterus - Low Dose Rate 1

I *

1O:l I:32AM 11/29/2005 2



Michael L. Miller




Procedure Date: 3/26/2002 Resident Year: I Role: Performed Institution: Sentara Norfolk General Hospital

Case ID: 02/155/2

I I

Radiation Oncology - Area DE Q ~ Y Brachytherapy - Intracavitary Cervix/Uterus - High Dose Rate 1

I *


Case ID: 55304162811

I I

Radiation Oncology - Area w Q ~ Y Brachytherapy - Intracavitary CervixNterus - Low Dose Rate 1

I *

Procedure Date: 4/2/2002 Resident Year: 1 Role: Performed Case ID: 021155 Institution: Sentara Norfolk General Hospital


DIE CervixLJterus - High Dose Rate

Q ~ Y I 1 *


Case ID: 55304162812

I I

Radiation Oncology - Area DE Q ~ Y Brachytherapy - Intracavitary CervixAJterus - Low Dose Rate 1

I *

. Procedure Date: 7/29/2002 Resident Year: 2 Role: Observed

Institution: Sentara Norfolk General Hospital Case ID: 400583000obs

I I

Area DE Q ~ Y Brachytherapy - Intracavitary Cervix/Uterus - Low Dose Rate 1

Radiation Oncology

I *

1O:l I:32AM Il/29/2005 3

Radiation Oncology Resident Record Report Program ID: 43051 11 105 Program Name: Eastern Virginia Medical School Program





Procedure Date: 8/21/2002 Resident Year: 2 Role: Observed Institution: Sentara Norfolk General Hospital

Case ID: 021471

I I

Radiation Oncology - Area Q ~ Y Brachytherapy - Intracavitary Bile Duct - High Dose Rate 1

I *

I I Procedure Date: 8/27/2002 Resident Year: 2 Role: Performed

Institution: Sentara Norfolk General Hospital Case ID: 01/619brachy

I 1 Radiation Oncology - Area DIE Q ~ Y Brachytherapy - Intracavitary Esophagus - High Dose Rate 1

I *


Case ID: 02/644/b

1 I

Radiation Oncology - Area DIE Q ~ Y Brachytherapy - Intracavitary CervixAJterus - High Dose Rate I Brachytherapy - Intracavitary CervixNterus - High Dose Rate 1

2 *

Procedure Date: 12/31/2002 Resident Year: 2 Role: Performed Case ID: 0211 128 Institution: Sentara Norfolk General Hospital


IYJs CervixAJterus - High Dose Rate

Q ~ Y 1 I *

10:11:32AM lll29/2o(M 4



Michael L. Miller




Case ID: 04/465


Case ID: 99/074

Area Brachytherapy - Intracavitary

xYE!s CervixAJterus - High Dose Rate

Q ~ Y 1 I *

Procedure Date: 6/16/2003 Resident Year: 2 Role: Performed Case ID: 03/483 Institution: Sentara Norfolk General Hospital

Radiation Oncology -- Area Brachytherapy - Intracavitary

IYE Esophagus - High Dose Rate

Q ~ Y 1


Radiation Oncology Area IYE Q ~ Y Brachytherapy - Intracavitary Cervix/Uterus - High Dose Rate 1

I *

IO:II:3tA.M llR9R005 5


I

Procedure Date: 12/22/2003 Resident Year: 3 Role: Observed Case ID: 03745 Institution: Sentara Norfolk General Hospital

Program ID: 43051 1 1 105 Program Name: Eastern Virginia Medical School Program at All Institutes

Michael L. Miller




Procedure Date: 12/8/2003 Resident Year: 3 Role: Observed Case ID: 03745 Institution: Sentara Norfolk General Hospital


IYE CervixAJterus - Low Dose Rate

Q ~ Y 1 I *


Case ID: 03909

I I

Radiation Oncology - Area DIE Q ~ Y Brachytherapy - Intracavitary CervixNterus - Low Dose Rate I

I *

Radiation Oncology Area Brachytherapy - Intracavitary - IYE

CervixAJterus - Low Dose Rate Q ~ Y

I I *


Case ID: 04/302

I I

Radiation Oncology - Area IYE Q ~ Y Brachytherapy - Intracavitary Cervix/Uterus - High Dose Rate 1

I *


Radiation Oncology Area Brachytherapy - Intracavitary - IYE

CervixAJterus - High Dose Rate Q ~ Y

I I *

6

Radiation Program ID: 43051 1

Oncology Resident Record Report 105 Program Name: Eastern Virginia Medical School Program





Procedure Date: 5/19/2004 Resident Year: 3 Role: Observed Case ID: 01/074 Institution: Sentara Norfolk General Hospital


ZYJs Other - High Dose Rate

Q ~ Y 1 I *


Case ID: 02/289

I

- Area ZYJs Q ~ Y Brachytherapy - Intracavitary Other - High Dose Rate 1

Radiation Oncology

I *


Case ID: SC9571

I

Radiation Oncology Area IYls Q ~ Y Brachytherapy - Intracavitary CervixKJterus - High Dose Rate 1

I *


Case ID: LD3789

I Radiation Oncology - Area IYls Q ~ Y Brachytherapy - Intracavitary CervixRJterus - High Dose Rate 1 Brachytherapy - Intracavitary Cervix/Uterus - High Dose Rate 1

2 *

10:11:32Ahl 11/29/2005 7



Michael L. Miller




Procedure Date: 2/1/2005 Resident Year: 4 Role: Performed Case ID: BH8468 Institution: Sentara Norfolk General Hospital

Radiation Oncology - Area DE Q ~ Y Brachytherapy - Intracavitary Cervix/Uterus - High Dose Rate 1

I *

Number of Procedures for Resident: 37

Grand Total: 37

1 0 1 1:32AM 11/29/2005 8



For AI1 Types in Endovascular Insertions area Done Between 7/1/2001 And 6/30/2005


Resident Name: Miller, Michael L. Current Year: 3 I


Case ID: 01/515

L Radiation Oncology - Area I!@ Q ~ Y Endovascular Insertions Endovascular Insertions 1

I *


Case ID: 01/574

1 I

Radiation Oncology - Area I!@ Q ~ Y Endovascular Insertions Endovascular Insertions 1

I *

I 1 Procedure Date: 1/8/2002 Resident Year: 1 Role: Observed

Institution: Sentara Norfolk General Hospital Case ID: 02/021

Radiation Oncology - Area Endovascular Insertions

IYE Endovascular Insertions

Q ~ Y 1 1 *


Case ID: 021023

I I

Radiation Oncology - Area IYE Q ~ Y Endovascular Insertions Endovascular Insertions 1

I *


Case ID: 02/045

Radiation Oncology - Area Endovascular Insertions

IYE Endovascular Insertions

Q ~ Y 1 I *

10:12:15AM 31/29/2005 1



For All Types in Endovascular Insertions area Done Between 7/1/2001 And 6/30/2005



Procedure Date: 1/15/2002 Resident Year: I Role: Observed Institution: Sentara Norfolk General Hospital

Case ID: 02/048

Radiation Oncology - Area ZYE Q ~ Y Endovascular Insertions Endovascular Insertions 1

1 *


Case ID: 02/057

I I

Radiation Oncology Area Endovascular Insertions - ZYE

Endovascular Insertions Q ~ Y

1 I *

Procedure Date: 2/1/2002 Resident Year: I Role: Observed Case ID: 02/106 Institution: Sentara Norfolk General Hospital

L Radiation Oncology - Area IYIs Q ~ Y Endovascular Insertions Endovascular Insertions 1

1 *


Case ID: 02/123

1 I

Radiation Oncology - Area DIE Q ~ Y Endovascular Insertions Endovascular Insertions 1

1 *

I Procedure Date: 2/7/2002 Resident Year: I Role: Performed Case ID: 021203 I Institution: Sentara Norfolk General Hospital

Radiation Oncology Area Endovascular 1 nsertions - DE


I I *

IO: 12: I5.4M I 1/29/2oot( 2

Radiation Oncology Resident Record Report Program ID: 43051 1 1 105 Program Name: Eastern Virginia Medical School Program






Case ID: 02/205

I I Radiation Oncology - Area I Y E ? Q ~ Y Endovascular Insertions Endovascular Insertions 1

I *

I I


Case ID: 02/201

I J Radiation Oncology - Area XYfS Q ~ Y Endovascular Insertions Endovascular Insertions 1

1 '


Case ID: 02/732

I

Radiation Oncology - Area I Y E Q ~ Y Endovascular Insertions Endovascular Insertions 1

I *


Institution: Sentara Norfolk General Hospital Case ID: 031347

1 J Radiation Oncology - Area IYIE Q ~ Y Endovascular Insertions Endovascular Insertions I

I *


Case ID: 031376

I Radiation Oncology Area DJE Q ~ Y Endovascular Insertions Endovascu la r Insertions 1

I *

10: 12: 1 SAM I 1/29/2OO5 3







Radiation Oncology - Area m Q ~ Y Endovascular Insertions Endovascular Insertions 1

1 *


Case ID: 03/435

I

Radiation Oncology - Area IYE Q ~ Y Endovascular Insertions Endovascular Insertions 1

I *


Radiation Oncology

Endovascular Insertions Endovascular Insertions 1 - Area m Q ~ Y

I *


Case ID: 03/469

I I Radiation Oncology

Endovascular Insertions Endovascular Insertions 1 - Area I Y r E Q ~ Y

1 *


Radiation Oncology

Endovascular Insertions Endovascular Insertions 1 - Area IYE Q ~ Y

I *

IO: 12:lSAM 11/29/2005 4

Radiation Oncology Resident Record Report Program ID: 43051 11 IO5 Program Name: Eastern Virginia Medical School Program






Case ID: 03/470

Radiation Oncology -.

- Area Endovascular Insertions

n!E Endovascular Insertions

Q ~ Y 1


Case ID: 031473

Radiation Oncology Area n!E Q ~ Y Endovascular Insertions Endovascular Insertions I

I *


Case ID: 03/524

Radiation Oncology Area Endovascular Insertions - I!iE


1 I *


Case ID: 04239

Radiation Oncology Area E ndovascu la r Insertions - ZYIE


1 I *


Case ID: 04/366

Radiation Oncology - Area IYIE Q ~ Y Endovascular Insertions Endovascular Insertions I

I *

1 0 12: 1 SAM 1 1/29/2OO5 5

Radiation Oncology Resident Record Report Program ID: 430511 1105 Program Name: Eastern Virginia Medical School Program






Radiation Oncology

Endovascular Insertions Endovascular Insertions 1 - Area DIE Q ~ Y

I *


Grand Total: 26

10: It: l5AM 1 l/29/2OOS 6



For All Types in Unsealed Sources area Done Between 7/1/2001 And 6/30/2005




~~

Case ID: 011402

I Radiation Oncology - Area m Qtr Unsealed Sources 1-131 Oral I

I *


Case ID: 01/471

Radiation Oncology - Area IYE Q ~ Y Unsealed Sources 1-131 Oral 1

I *


Case ID: 011393

I Radiation Oncology Area IYE Q ~ Y Unsealed Sources 1-131 Oral 1

I *


Case ID: 011503

1

Radiation Oncology - Area Unsealed Sources

m 1-131 Oral

Q ~ Y 1 I *


Institution: Sentara Norfolk General Hospital Case ID: 021902

I I Radiation Oncology - Area IuE Q ~ Y Unsealed Sources SR-89 1

I *

I


Program ID: 43051 11 IO5 Program Name: Eastern Virginia Medical School Program at All Institutes

Michael L. Miller





Case ID: 02/1057


I!UE 1-131 Oral

Q ~ Y 1 I *


Case ID: 02/1132


IYJE 1-131 Oral

Q ~ Y I I *



I I

Radiation Oncology - Area DE Q ~ Y Unsealed Sources SR-89 1

I *


Radiation Oncology Area Unsealed Sources - I!m

1-131 Oral Q ~ Y

1 I *



I I

Radiation Oncology - Area BE Q ~ Y Unsealed Sources 1-13] Oral 1

I *

10:I3:06AM 11/29/2005 2





Resident Name: Miller, Michael L. Current Year: 3 r 1


Case ID: 04/427

I I Radiation Oncology - Area I Y E Q ~ Y Unsealed Sources 1-131 Oral 1

I *


Case ID: 04/400

I I

Radiation Oncology Area Unsealed Sources - I Y E

1-131 Oral Q ~ Y

I 1 *

Procedure Date: 3/9/2005 Resident Year: 4 Role: Performed Institution: Virginia Beach General Hospital

Case ID: SO5099

Radiation Oncology - Area IYN Q ~ Y Unsealed Sources 1-131 Oral I

I *

Procedure Date: 3/9/2005 Resident Year: 4 Role: Performed Institution: Virginia Beach General Hospital

Case ID: M05023

Radiation Oncology Area Unsealed Sources -

Radiolabeled Drugs Q ~ Y

1 I *


Institution: Virginia Beach General Hospital Case ID: PO5175

I I Radiation Oncology - Area 3!.E Q ~ Y Unsealed Sources Radiolabeled Drugs 1

I *

10:13:06AM 31/29/2005 3



Michael L. Miller




Grand Total: 15

10:13:06AM I1129/2005 4

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

, and to inform you that the initial processing which includes an administrative review has been performed.

/+li\xu 3 %l,t - F W ~ 7-6 I Is) There were no a ministrative omissions. Your application was assigned to a technical reviewer. Please note that the technical review may identify additional omissions or require additional information.

Please provide to this ofice within 30 days of your receipt of this card

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

Your action has been assigned Mail Control Number [ <,$073 When 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 (RI)

(6-w)

Sincerely, Licensing Assistance Team Leader

S E N T A R A. -, I-;/ !?: 45IRC FORM 313A U.S. NUCLEAR REGULATORY COMMISSION 020051 MEDICAL USE TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued) 6a. WORK OR PRACTICAL

Documents