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PHI LI PS Philips Medical Systems
June 5,2007 N m - d t
Licensing Assistance Section Nuclear Medicine Safety Branch Division of Radiation Safety and Safetguards U.S. Nuclear Regulatory Commission, Region I 475 Allendale Road King of Prussia, PA 19406-1 41 5
RE: License Number: 3d-31170-01
Philips Medical Systems Termination of License & Close Out Survey
7 L’if 3+ $03
Amendment Request ‘W
Dear License Reviewer:
We request the above referenced byproduct material license be terminated. A “Close-Out Survey” of the vacated hot lab was completed on May 25,2007. Summary results reveals that ambient exposure rates and removable contamination results were measured at background radiation levels. Please refer to the Attachment Section for details.
Radioactive waste was allowed to decay for ten half lives and monitored at the time of disposal.
Sealed sources used for instrument calibration were transferred to our corporate facility located in Cleveland, Ohio. The Sealed Source Inventory and last leak test report has been enclosed in the sleeve section of this report. Please refer to this section for details.
If you have additional questions, please contact me.
We thank you in advance for your assistance with this licensing request.
S inye ly , ,,(
Gjegory Breznai Radiation Safety Officer Philips Medical Systems 595 Miner Road Highland Heights, OH 44143 (440) 483-2222
Philips Medical Systems (Cleveland), Inc. 595 Miner Road Cleveland, OH 44 I43 Tel: (440) 483 3000
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/+o 62-1
NMSS/RGN 1 MATER I ALS-002 . ,
w.medical.philips.com
Attachment A
SEALED SOURCE INVENTORY
FACILITY: Philips Medical Systems
LOCATION: Philadelphia, PA
Nuclide:
Type:
Location:
Assay: (Date)
Mgr:
Serial No.:
Model:
Cs-137
Vial
Hot Lab
204.1 uCi 1 1 IO 1 12002
I PL (Syncor)
935-62-6
RV-137.20011
CS-I 37
Rod
Hot Lab
5.0 mCi 10102/2002
IPL
CZ-290
HEG-0096
CS-137
Rod
Hot Lab
20.0 rnCi 0311 512001
IPL
CZ-714
HEG-137-M
CS-1 37
Rod
Hot Lab
5.0 mCi 611 12000
IPL
DEPARTMENT: PET Facility
CZ-186
cs-137
Rod
Hot Lab
.500 uCi 0611 12003
IPL
780-1 6-44
GF-0008
Cs-137
Rod
Hot Lab
5.0 rnCi 02/01/2001
IPL
CZ-172
HEG-0096
c s - I 37
Rod
Hot Lab
10 mCi 08/01 /04
IPL
89-033
DATE
1211 9/05 X X X X X X X
05/03/06 X X X X X X X
9/01 106 X X X X X X X
12/5/06 X X X X X X X
03/06/07 X B X E X B B
05/25/07 B B Y B B B B
X - INDICATES SOURCE INVENTORIED A - Returned for disposal B - Sent to Phillips Cleveland on 3/5/2007
RSO Signature
* See Report
12
992
SEALED SOURCE INVENTORY
FACILITY: Philips Medical Systems
LOCATION: Philadelphia, PA
Nuclide:
Type:
Location:
Assay: (Date)
Mgr:
Serial No.:
Model:
DATE
1211 9/05
05/03/06
09/01 106
12/5/06
03/06/07
05/25/07
Na-22
Disc
Hot Lab
0.10 mCi 02/01 I2001
IPL
747-7-8
GF-0227
X
X
X
X
X
B
Na-22
Disc
Hot Lab
0.10 mCi 05/01 12002
IPL
730-92-30
GF-0227
Na-22
Disc
Hot Lab
0.10 mCi 05/01 12002
IPL
730-92-29
GF-0227
DEPARTMENT: PET Facility
Na-22
Disc
Hot Lab
0.10 mCi 01 11 812001
IPL
7 4 7 - 7 - 5
GF-0227
Na-22
Disc
Hot Lab
0.10 rnCi 12/01 12000
IPL
730-20-9
GF-0227
X - INDICATES SOURCE INVENTORIED A - Returned to Manufacturer B - Sent to Cleveland Office
RSO Signature
Na-22
Disc
Hot Lab
100 uCi 1 1 I01 12000
IPL
730-20-5
GF-0227
Na-22
Disc
Hot Lab
100 uCi 08/01 12000
IPL
730-3
GF-0227
* See Report 992
13
SEALED SOURCE INVENTORY
FACILITY: Philips Medical Systems DEPARTMENT: PET Facility
LOCATION: Philadelphia, PA
Nuclide:
Type:
Location:
Assay: (Date1
Mgr:
Serial No.:
Model:
DATE
1211 9/05
05/03/06
09/01 106
12/5/06
03106l0 7
Ge-68
Cylinder
Hot Lab
0.75 rnCi 07/10/2001
IPL
730-50-01
EG-0310
X
X
X
X
X
05/25/07 B
Ge-68
Rod
Hot Lab
10.0 mCi 0 1 12712000
I PL
RR-450
HEG-0108
Ge-68
Rod
Hot Lab
7.0 rnCi 12/01 I2003
I PL
84-763
___.
Ge-68
Rod
Hot Lab
5.0 rnCi 03/01 I1 996
IPL
FF-942
...-
X B X
X B X
X - INDICATES SOURCE INVENTORIED A - Returned to Manufacturer B. Sent to Cleveland offices
Ge-68 Ge-68 Ge-68
Rod Rod Rod
Hot Lab Hot Lab Hot Lab
5.0 mCi 5.0 mCi 5.0 mCi 0211 611 990 0210311 994 1 111 511 991
I PL I PL IPL
30R 2379 R-553
_ _ _ _ ___. ....
X X X
X X X
X X X
X X X
X X X
E B B
Ge-68
Rod
Hot Lab
10.0 mCi 0711 1120 0 1
IPL
22-992
.___
X
X
RSO Signature
* See Report 992
14
SEALED SOURCE INVENTORY
FACILITY: Philips Medical Systems
LOCATION: Philadelphia, PA
DEPARTMENT: PET Facility
Nuclide:
Type:
Location:
Assay: (Date)
CO-57
Point Marker
Hot Lab
90.3 uCi 09/30/1993
Na-22
Button
Hot Lab
100 uCi 03/01 I2000
Na-22
Button
Hot Lab
100 uCi 0711 511 999
Na-22
Button
Hot Lab
20 uCi 1011 4/04
Na-22
Button
Hot Lab
100 uCi 05/01 I06
Cs-137
Rod
Hot Lab
1 0 mCi 08/01 I04
Mgr: Med-Phvs IPL IPL I PL IPL IPL
Serial No.:
Model:
OK346 567-93 61 4-87 1053-24 1142-74
D2886
89-033
DATE
05/03/06 X
09/01/06 X
12/5/06 C
03/06/07 C
05/25/07 C
X - INDICATES SOURCE INVENTORIED A - Sent to Penn 211 412007 - 2/26/07 B - Sent to Cleveland office C - Disposed As Normal Trash
RSO Signature
* See Report 992
15
MEDICAL PHYSICS SURVEY SEALED SOURCE LEAK TEST ANALYSIS REPORT
FACILITY: Philips Medical Systems DEPARTMENT: PET Facility
LOCATION: Philadelphia, PA Gregory M. Breznai, RSO
Analysis of the WIPE used to conduct a leak test on the sealed sources identified below was performed by gas or scintillation detection and reveals removable contamination was less than 0.001 uCi, unless otherwise noted, when compared against NIST traceable standards.
Source: 6 1 3 7 , Vial; 204.1 uCi on 11/01/2002; IPL S/N: 935-62-6; RV-137-200U
Date: 12/19/05 05/03/06 09/0 1/06 12/5/06 03/27/07
Wipe No.: PM127 PM 166 PM191 PM278 PM369
MDA (uCil: 5.6E-5 5.6E-5 5.6E-5 5.6E-5 5.6E-5
Net CPM: 7 29 6 25 16
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.001 uCi: 236 236 236 236 236
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
Source: Cs- 137 Rod, 5.0 mCi on 10/02/2002, IPL, S/N: CZ-290; Model #HEG-O096
Date: 12/19/05 05/03/06 09/0 1/06 12/5/06 03/2 7/07
Wipe No.: PM128 PM168 PM192 PM279 PM368
MDA luCil: 5.6E-5 5.6E-5 5.6E-5 5.6E-5 5.6E-5
Net CPM: 9 29 22 7 18
Net uCi: < MDA < MDA < MDA <MDA < MDA
CPM for 0.001 uCi: 236 236 236 236 236
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
Source: Cs-137, 20.0 mCi on 03/15/2001; IPL; S/N: XX-714; Model #: HEG-137-M
Date: 12/19/05 05/03/06 09/0 1/06 12/5/06 03/2 7/0 7
Wipe No.: PM129 PM 169 PM193 PM280 PM367
MDA (uCil: 5.6E-5 5.6E-5 5.6E-5 5.6E-5 5.6E-5
Net CPM: 27 16 1 7 16 10
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.00 1 uCi: 236 236 236 236 236
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
RSO Signature
* See Report
16
992
MEDICAL PHYSICS SURVEY SEALED SOURCE LEAK TEST ANALYSIS REPORT
FACILITY: Philips Medical Systems DEPARTMENT: PET Facility
LOCATION: Philadelphia, PA Gregory M. Breznai, RSO
Analysis of the WIPE used to conduct a leak test on the sealed sources identified below was performed by gas or scintillation detection and reveds removable contamination was less than 0.001 uCi, unless otherwise noted, when compared against NIS T traceable standards.
Source: Cs-137, Rod; 5.0 mCi on 6/1/2000; IPL SIN: CZ-186 Date: 12/19/05 05/03/06 09/0 1/06 12/5/06 03/2 7/0 7
Wipe No. : PM130 PM170 PM195 PM283 PM336
MDA luCil: 5.6E-5 5.6E-5 5.6E-5 5.6E-5 5.6E-5
Net CPM: 38 22 8 17 7
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.001 uCi: 236 236 236 236 236
Analyst M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
Source: C s
Date:
Wipe No. :
MDA (uCil:
Net CPM:
Net uCi:
CPM for 0.00 1 uCi:
Analyst:
.I37 Rod, 5.0 mCi on 02/0 1/200 I ; 12/19/05 05/03/06 09/0 1/06
PM132 PM 1 72 PM197
5.6E-5 5.6E-5 5.6E-5
27 16 7
< MDA < MDA < MDA
236 236 236
M. Lairmore M. Lairmore M. Lairmore
IPL; S/N: CZ- 172; Model #I HEG-0096
12/5/06 03/2 7/07
PM285 PM334
5.6E-5 I . 7OE-5
29 9
< MDA < MDA
236 297
M. Lairmore M. Lairmore
RSO Signature
* See Report 992
17
MEDICAL PHYSICS SURVEY SEALED SOURCE LEAK TEST ANALYSIS REPORT
FACILITY: Philips Medical Systems DEPARTMENT: PET Facility
LOCATION: Philadelphia, PA Gregory M. Bremai, RSO
Analysis of the WIPE used to conduct a leak test on the sealed sources identified below was performed by gas or scintillation detection and reveals removable contaminah'on was less than 0.001 uCi, unless otherwise noted, when compared against NIST traceable standards.
Source: Ge-68 Rod; 10.0 mCi on 07/11/2001; IPL S/N: ZZ-992: Model Number: HEG-0108
Date: 12/19/05 05/03/06 09/01/06 12/5/06 03/27/07
Wipe No.: PM133 PM 172 PM 198 PM286 PM33 1
MDA fuCil: 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5
Net CPM: 28 11 31 8 9
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.00 1 uCi: 297 297 297 297 297
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
Source: Ge-68 Cylinder, 0.75 mCi on 07/70/200 I , Date: 12/19/05 05/03/06 09/01/06
Wipe No.: PM 134 PM 1 73 PM199
MDA luCil: 1.7OE-5 1.7OE-5 1.7OE-5
Net CPM: 6 26 9
Net uCi: < MDA < MDA < MDA
CPM for 0.001 uCi: 297 297 297
Analyst: M. Lairmore M. Lairmore M. Lairmore
IPL, S/N: 730-50-01: Model Number: EG-0370
12/5/06 03/27/07
PM287 PM330
1.7OE-5 1.7OE-5
23 15
< MDA < MDA
297 297
M. Lairmore M. Lairmore
Source: Ge-68 Rod, 10.0 mCi on 0 1/27/2000; IPL; S/N: RR-450; Model #: HEG-0 108
Date: 12/19/05 05/03/06 09/0 1/06 12/5/06 03/27/07
Wipe No.: PM135 PM 1 74 PM200 PM288 PM329
MDA IuCi): 1.7OE-5 1.7OE-5 1.7OE-5 1.70.5-5 1.7OE-5
Net CPM: 2 27 4 19 1
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.001 uCi: 297 297 297 297 297
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
RSO Signature
* See Report 992
18
MEDICAL PHYSICS SURVEY SEALED SOURCE LEAK TEST ANALYSIS REPORT
FACILITY: Philips Medical Systems DEPARTMENT: PET Facility
LOCATION: Philadelphia, PA Gregory M. Bremai, RSO ATTENTION:
Analysis of the WIPE used to conduct a leak test on the sealed sources identified below was performed by gas or scintillation detection and reveals removable contamination was less than 0.001 uCi, unless otherwise noted, when compared against NIST traceable standards.
Source: Ge-68 Rod; 10 mCi on 08/01/2004; IPL; S/N: 08/01/2004; IPL; SIN: BO-033
Date: 12/19/05 05/03/06 09/0 1/06 12/5/06 03/27/07
Wipe No.: PM137 PM 175 PM20 1 PM290 PM328
MDA luCil: 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5
Net CPM: 22 18 27 7 19
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.001 uCi: 297 297 297 297 297
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
Source: Ge-68 Rod, 5.0 mCi on 03/01/1996, IPL, S/N: FF-942
Date: 12/19/05 05/03/06 09/01/06 12/5/06 03/27/07
Wipe No.: PM138 PM176 PM202 PM29 1 PM327
MDA (uCil: 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5
Net CPM: 11 8 25 6 8
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.001 uCi: 297 297 297 297 297
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
Source: Ge-68 Rod, 5.0 mCi on 02/16/1990; IPL; S/N: 30R
Date: 12/19/05 05/03/06 09/01/06 12/5/06 03/27/07
Wipe No.: PM139 PM177 PM203 PM292 PM326
MDA luCi): 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5
Net CPICI: 21 9 29 16 8
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.001 uCi: 297 297 297 297 297
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
RSO Signature
* See Report 992
19
MEDICAL PHYSICS SURVEY SEALED SOURCE LEAK TEST ANALYSIS REPORT
FACILITY: Philips Medical Systems DEPARTMENT: PET Facility
LOCATION: Philadelphia, PA Gregory M. Breznai, RSO ATTENTION:
Analysis of the WIPE used to conduct a leak test on the sealed sources identifled below was performed by gas or scintillation detection and reveals removable contamination was less than 0,001 uCi, unless otherwise noted, when compared against NIST traceable standards.
Source: Ge-68 Rod; 5.0 mCi on 02/03/1994; IPL S/N: 2379 Date: 12/19/os 05/03/06 09/01/06 12/5/06 03/27/07
Wipe No.: PM140 PMI 80 PM204 PM294 PM324
MDA (uCi): I . 70E-5 1.7OE-5 1.7OE-5 1.7OE-5 1.7OE-5
Net CPM: 1s 3 17 1 16
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.001 uCi: 297 297 297 297 297
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
Source: Ge-68 Rod, 5.0 mCi on 11/15/1991, IPL, SIN: R-553 Date: 12/19/05 05/03/06 09/01/06 12/5/06 03/27/07
Wipe No.: PM141 PMI 81 PM205 PM295 PM323
MDA (uCi): 1.7OE-5 I . 7OE-5 1.7OE-5 1.7OE-5 1.7OE-5
Net CPM: 14 26 11 9 I 7
Net uCi: < MDA < MDA < MDA < MDA < MDA
CPM for 0.001 uCi: 297 297 297 297 297
Analyst: M. Lairmore M. Lairmore M. Lairmore M. Lairmore M. Lairmore
RSO Signature
* See Report 992
20
MEDICAL PHYSICS SURVEY SEALED SOURCE LEAK TEST ANALYSIS REPORT
FACILITY: Philips Medical Systems DEPARTMENT: PET Facility
LOCATION: Philadelphia, PA Gregory M. Bremai., RSO ATTENTION:
Analysis of the WIPE used to conduct a leak test on the sealed sources identified below was performed by gas or scintillation detection and reveals removable contamination was less than 0.001 uCi, unless otherwise noted, when compared against NIST traceable standards.
Source: Ge-68 Rod; 10.0 mCi on 07/11/2001; Date: 12/19/05 05/03/06 09/01/06
Wipe No.: PM142 PMI 82 PM206
MDA (uCi): I . 7OE-5 I . 7OE-5 I . 7OE-5
Net CPM: 25 5 3
Net uCi: < MDA < MDA < MDA
CPM for 0.001 uCi: 297 297 297
Analyst: M. Lairmore M. Lnirmore M. Lairmore
IPL: S/N: 22-992 12/5/06 03/2 7/07
PM297 PM322
1.7OE-5 1.7OE-5
25 6
< MDA < MDA
297 297
M. Lairmore M. Lairmore
Source: Cs- 137 Rod, 10.0 mCi on 08/0 1/2004; IPL; S/N: 69-033
Date: 031.2 7/07
Wipe No.: PM334
MDA (uCi): 1.7OE-5
Net CPM: 9
Net uCi: < MDA
CPM for 0.001 uCi: 236
M. Lairmore
RSO Signature
* See Report 992
21
Philips Medical Systems Philadelphia, PA
Area Ambient Exposure Survey Removable Contamination (mR/hr) (DPM/300 cm2)
Close-Out Survey Results
Initials
May 25,2007
9
10
11
12
13
14
15
16
Hot Lab (Refer to Diagram)
0.03 741 dpm - 742 dpm = 0 dpm MWL
0.03 746 dpm - 742 dpm = 4 dpm MWL
0.03 777 dpm - 742 dpm = 35 dpm MWL
0.03 743 dpm - 742 dpm = 1 dpm MWL
0.03 788 dpm - 742 dpm = 46 dpm MWL
0.03 771 dpm - 742 dpm = 29 dpm MWL
0.03 MWL
0.03 748 dpm - 742 dpm = 6 dpm MWL
71 1 dpm - 742 dpm = 0 dpm
1
Philips Medical System Philadelphia, PA
(Refer to
Area Ambient Exposure Survey
Bkg 0.03
17 0.03
18 0.03
19 0.03
20 0.03
21 0.03
22 0.03
23 0.03
24 0.03
25 0.03
26 0.03
27 0.03
28 0.03
29 0.03
30 I 0.03
(mR/hr)
Close-Out Survey (Continued)
Diagram)
Removable Contamination (DPM/300 cm2)
645 cpm x 1 . 1 5 = 742 dpm
740 dpm - 742 dpm = 0 dpm
735 dpm - 742 dpm = 0 dpm
744 dpm - 742 dpm = 2 dpm
755 dpm - 742 dpm = 13 dpm
760 dpm - 742 dpm = 18 dpm
740 dpm - 742 dpm = 0 dpm
727 dpm - 742 dpm = 0 dpm
749 dpm - 742 dpm = 7 dpm
739 dpm - 742 dpm = 0 dpm
757 dpm - 742 dpm = 15 dpm
744 dpm - 742 dpm = 2 dpm
730 dpm - 742 dpm = 0 dpm
766 dpm - 742 dpm = 24 dpm
I 754 dpm - 742 dpm = 12 dpm
May 25, 2007
Initials
MWL
MWL
MWL
MWL ~
MWL
MWL
MWL
MWL
MWL
MWL
MWL
MWL
MWL
MWL
MWL
1. Counting Efficiency = 86.4% (Correction Factor = 1 .I 5) 2. Survey Meter Used For Testing = Ludlum 14C, S/N 21 3275 (Calibration Date = 03/20/2007) 3. Ludlum 261 SCA & Well Counter Used For Testing 4. Survey conducted by Michael W. Lairmore Associates. 5. Survey Results analyzed b y Michael W. Lairmore, Medical Physics Consultant
2
Philips Medical Systems Philadelphia, PA
Close-Out Survey (Continued)
May 25,2007
2. Survey Meter Used For Testing = Ludlum 14C, S/N 213275 (Calibration Date = 03/20/2007) 3. Ludlum 261 SCA 81 Well Counter Used For Testing 4. Survey conducted by Michael W. Lairmore Associates. 5. Survey Results analyzed b y Michael W. Lairmore, Medical Physics Consultant
3
Philadelphia Medical Systems Philadelphia, PA
Close-Out Survev (Continued)
Area
Bkg
44
45
46
47
48
49
50
51
Mav 25,2007
Ambient Exposure Survey Removable Contamination (mR/hr) (DPM/SOO cm2)
0.03 645cpmx1.15 = 742dpm
0.03 702 dpm - 742 dpm = 0 dpm
0.03 745 dpm - 742 dpm = 3 dpm
0.03 736 dpm - 742 dpm = 0 dpm
0.03 732 dpm - 742 dpm = 0 dpm
0.03 750 dpm - 742 dpm = 8 dpm
0.03 732 dpm - 742 dpm = 0 dpm
0.03 761 dpm - 742 dpm = 19 dpm
0.03 740 dpm - 742 dpm = 0 dpm
54
55
56
Initials
0.03 746 dpm - 742 dpm = 4 dpm MWL
0.03 749 dpm - 742 dpm = 7 dpm MWL
0.03 739 dpm - 742 dpm = 0 dpm MWL
MWL
~~
59
60
61
62
63
~
MWL
MWL
MWL
MWL
MWL
MWL
MWL
MWL
~ -~ ~ ~
0.03 736 dpm - 742 dpm = 0 dpm MWL
0.03 755 dpm - 742 dpm = 13 dpm MWL
0.03 715dpm-742dpm = Odpm MWL
0.03 740 dpm - 742 dpm = 0 dpm MWL
0.03 743 dpm - 742 dpm = 1 dpm MWL
52 I 0.03 I 742 dpm - 742 dpm = 0 dpni
53 I 0.03 I 744 dpm - 742 dpm = 2 dpm
MWL
MWL
57 I 0.03 1 735dpm-742dpm = Odpm 1 MWL
58 -1 0.03 I 745dpm-742dpm = 3dpm I MWL
1. Counting Efficiency = 86.4% (Correction Factor = 1 . I 5) 2. Survey Meter Used For Testing = Ludlum 14C, S/N: 213275 (Calibration Date = 03/20/2007) 3. Ludlum 261 SCA & Well Counter Used For Testing 4. Survey conducted b y Michael W. Lairmore Associates.
Philips Medical System Philadelphia, PA
Close-Out Survey May 25,2007
Hot Lab Work Area
1 2 3 4 5 A 6 7 8 9 10 1 1 12 13 14
22 23 24 25 26 B 27 28 29 30 31 32 33 34 35
15 16 17 c la 19 20 21
36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 -******
Legend:
A. L-Shield & Preparation Area B. Phantom Storage & Waste C. Sealed Source Storage Cabinet ** Locked Door
Location: PET Service Training (circle one) PMRS Philly
mCi
Sealed Source Return From Philadelphia to Cleveland
Source mEuhr Date
3-5-07 Nuclide Amount Serial # 1 meter CS-137 9.42 B9-033 1.4
3-5-07
3-5-07
3-5-07 ICs-137 [ 4.28 [ CZ-186 0.85
(3-137 4.52 CZ-290 1.4
(3-137 4.35 CZ-172 0.85
mR/hr Surface
45
45
18.5
18.5
dPm BKG
63 8
63 8
638
63 8
Net dpm Pckg wipe 34
34
0
Meter Serial #
2511
2511
251 1
2511
Print Name
Greg Breznai &$
Greg Breznai 0
Greg Breznai 6- 8
Greg Breznai C b
_ __- _ _ _ _--_C- ---- L._ . Location: PET Service Training S e w %ur€e-Return
(circle one) PMRS From Philadelphia to Cleveland
-
- n / 7/21/m -37 ST -- A n * -
3 81 251 1 Greg Brezr -- - .
3' 5/21/07 Ge-68 I nCi 30R 0.01 2.6 384 249 2511 crreg Breznai
P
5/21/07 Ge-68 0.2 uCi FF-942 0.01 2.6 384 249 251 1 Greg Breznai
5/21/07 Ge-68 6 nCi R553 0.01 2.6 384 249 251 1 Greg Breznai
5/21/07 Ge-68 16 uCi RR-450 0.01 2.6 384 249 251 1 Greg Breznai
5/21/07 Ge-68 43 nCi 2379 0.01 2.6 384 249 251 1 Greg Breznai
5/21/07 Ge-68 59 uCi ZZ-992 0.01 2.6 384 249 251 1 Greg Breznai - - - -
5/21/07 Na-22 26 uCi 730-92-30 0.01 2.6 3 84 249 251 1 Greg Breznai
--
5/21/07 Na-22 26 uCi 730-92-29 0.01 2.6 384 249 251 1 Greg Breznai
---- " - m 0.01 P
-- -- -
--.- - .- - . - ----
Date 5/21/07
Nuclide Ge-68
Print - - A
Name. - - - - Greg Breznai
mCi Amount 4 uCi
Souree Serial #
730-50-1
~ R R K 1 meter
0.02
nWhr Surface 0.06
dPm BKG
384
Net dpm Pckg wipe 140
Meter Serial #
2511
- Location: Service Training- .
(circle one) PMRS Philly
Date 1 iii - 1 Nuclide 1 o ! F r 5/23/07 1: 15 p Ge-68
Sealed Source Receipt ---- -.. - -.- - - A- - . - .-
NMC-110-05 Rev. A Ju12006
.
mRkr Meter dpm Net dpm mCi Source Print Surface Serial # BKG Pckg wipe Amount Serial # Name
0.1 3630 399 25 4 uCi 730-50-1 Greg Breznai @
--
2.6 3630 399 46 * 1 * 1 Greg Breznai fl I I I I I I
2.6 1 3630 1 3630 1 46 1 *2 1 *2 1 Greg Bremai @
‘ mUNIVERSITYOF PENNSYLVANIA VY HEALTH SYSTEM
Richard Freifelder, Ph.D.
Department of Radiology Physics and Instrumentation Group
University of Pennsylvania School of Medicine Hospital of the University of Pennsylvania
23-Apr-2007
Richard Freifelder 1 10 Donner/HUP 3400 Spruce St. Phila., PA 19104 215.662.721 3
Gregory Breznai Radiation Safety Officer Philips Medical Systems -- Cleveland Nuc Med 595 Miner Road Highland Heights, OH 44143 Phone: 440-483-2222
To Whom It May Concern:
This is to acknowledge the receipt of three radioactive sources from Philips Medical Systems.
We are in possession of a 100 pCi rod source, a 20 pCi point source in a plastic cube and a 20 mCi point source. Relevent information is in the table below. Shown in the table is the original date of purchase and the new ID#
Nuclide Date of ID # Location Original Last Visual Description Purchase Activity Leak Inspect.
22Na 5/06 30C Physics 100 pc i 3/27/07 3/27/07 Rod source
22Na 11/04 30D Physics 20 pc i 3/27/07 3/27/07 Plastic Cube Point source
I3’Cs 3/0 1 30YY Physics 20 mCi 3/27/07 3/27/07 Point source
Sincerely,
1 10 Dormer Bulding 3400 Spruce Street Philadelphia, PA 19104-4283 Phone: (215) 6627213 *Fax: 2 15-573-3880 Email freifeld0,rnail.med.uuennedu
UNIVERSITY OF PENNSYLVANIA HEALTH SYSTEM
Richard Freifelder, Ph.D.
Department of Radiology Physics and Instrumentation Group
University of Pennsylvania School of Medicine Hospital of the University of Pennsylvania
Richard Freifelder, Ph.D. Cyclotron Facility Director Department of Radiology
110 Donner Bulding 3400 Spruce Street Philadelphia, PA 191044283 Phone: (2 15) 66372 13 Fax: 2 15-573-3880 5mail fi-eifeld@,mail.med.uuennedu
FedEx I Ship Manager I Label 7917 0082 5763
From: Origin ID: LNNA (440)483-2222 Grea Bremai
595 Miner Road
Highland Heights, OH 44143
CLS822S7Rv23
SHIPTO: (610)337-5000 BILL SENDER Licensing Assistance Sect ion U.S. NRC Region I 475 Allendale Road
King of Prussia, PA 19406
Page 1 of 1
;hip Date: 06JUN07 idwgt: 1 LB ;ystem#: 726287611NET2600 ,p$ccwnt#: s t**tt.ttt Delivery Address Bar Code
Ill llllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllll Ref # Invoice # PO # Dept #
STANDARD OVERNIGHT THU Deliver By:
'RK# 7917 0082 5763 'o"2"o": 07JUN07
PHL A2
XB KI L9406 -PA-US
IDA
This is to acknowledge the receipt of your letter/application dated ' /' 1 *"7 , and to inform you that the initial processing which includes an administrative review has been performed.
g* -3?/70--/ d T h e r e were no administrative omissions. Your application was assigned to a
technical reviewer. Please note that the technical .review may identify additional omissions or require additional information.
c] 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 Receivable Branch, who will contact you separately if there is a fee issue involved.
Your action has been assigned Mail Control Number / W U 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-eel Sincerely, Licensing Assistance Team Leader
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