danbury hospital, amendment request dtd 3/10/2010. · danbury hospital material license. this...

NRC FORM 313 US NUCLEAR REGULATORY COMMISSION (3-2009) 10 CFR 30 32 33 34 35 36 39 and 40

APPLICATION FOR MATERIALS LICENSE

APPROVED BY OMB NO 3150middot0120 EXPIRES 33112012

Estimated burden per response to comply with this mandatory collection request 43 hours Submittal of the application is necessary to determine that the applicant is qualified and that adequate procedures exist to protect the public health and safety Semiddotnd comments regarding burden estimate to the Records and FOIAIPrivacy Services Branch (T-5 F53) US Nuclear Regulatory Commission Washington DC 20555middot0001 or by internet e-mail to infocoliectsresourcenrcgov and to the Desk Officer Office of Information and Regulatory Affairs NEOB-10202 (3150middot0120) Office of Management and Budget Washington DC 20503 If a means used to impose an information collection does not display a currently valid OMB control number the NRC may not conduct or sponsor and a person is not required to respond to the information collection

INSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRlCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIEC BELOW

APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH

OFFICE OF FEDERAL amp STATE MATERIALS AND ENVIRONMENTAL MANAGEMENT PROGRAMS DIVISION OF MATERIALS SAFElY AND STATE AGREEMENTS us NUCLEAR REGULA TORY COMMISSION WASHINGTON DC 20555-0001

ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS

IF YOU ARE LOCATED IN

ALABAMA CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA KENTUCKY MAINE MARYLAND MASSACHUSETTS NEW HAMPSHIRE NEW JERSEY NEW YORK NORTH CAROLINA PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA TENNESSEE VERMONT VIRGINIA VIRGIN ISLANDS OR WEST VIRGINIA SEND APPLICATIONS TO

LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR MATERIALS SAFElY US NUCLEAR REGULATORY COMMISSION REGION I 475 ALLENDALE ROAD KING OF PRUSSIA PA 19406-1415


ILLINOIS INDIANAIOWA MICHIGAN MINNESOTA MISSOURI OHIO OR WISCONSIN SElf) APPLICATIONS TO

Sri MATERIALS LICENSING BRANCH US NUCLEAR REGULATORY COMMISSION REGION III 2443 WARRENVILLE ROAD SUITE 210 LISLE IL 60532-4352

ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO HAWAII IDAHO KANSAS LOUISIANA MISSISSIPPI MONTANA NEBRASKA NEVADA NEW MEXICO NORTH DAKOTA OKLAHOMA OREGON PACIFIC TRUST TERRITORIES SOUTH DAKOTA TEXAS UTAH WASHINGTON OR WYOMING SEND APPLICATIONS TO

NUCLEAR MATERIALS LICENSING BRANCH vt US NUCLEAR REGULATORY COMMISSION REGION IV I 612 E LAMAR BOULEVARD SUITE 400 ) )0 ARLINGTON TX 76011-4125

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE US NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO USNUCLEAR REGULATORY COMMISSION JURISDICTIONS

1 TH IS IS AN APPLICATION FOR (Check appropriate item)

NEW LICENSE

AMENDMENT TO LICENSE NUMBER ~ ~ 0 8St~ f C RENEWAL OF LICENSE NUMBER

3 ADDRESS WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED

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2 ltlAME AND MAILING ADDRESS OF APPLICANT (Include ZIP code)

D q I) b VI ~Sf- -hf Z--i hle11 ( (ITSf f7I (

D Plf) 10 7 I D6PID

4 NAME 01= PERSON TO BE CONTACTED ABOUT THIS APPLICATION

Wi II ~h J fYJDtI)

TEl Pf NUMBER

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SUBMIT ITEMS 5 THROUGH 11 ON 8-112 X 11 PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED INTHE LICENSE APPLICATION GUIDE

5 RADIOACTIVE MATERIAL a Elemenl and mass number b chemical andlor phySical form and c malximum amount

which will be possessed at anyone time

7 INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFElY PROGRAM AND THEIR TRAINING EXPERIENCE

---

9 FACILITIES AND EQUIPMENT

11 WASTE MANAGEMENT

6 PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED

8 TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS

10 RADIATION SAFETY PROGRAM

12 LICENSE FEES (See 10 CFR 170 and Section 17031)

FEE CATEGORY 1~~gu~JFr $

13 CERTIFICATION (Must be completed by applicant) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THIS APPLICATION ARE BINDING UPON THE APPLICANT

THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT NAMED IN ITEM 2 CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMllY WITH TITLE 10 CODE OF FEDERAL REGULATIONS PARTS 30 32 33 34 35 36 39 AND 40 AND THAT ALL INFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF

WARNING 18 USC SECTION 1001 THE OF JUNE 25 194862 STAT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION I

-=--=-=- CERTIFYING OFFICER -- TYPEDiPRINTED NAME AND TITLE V e IS~~~ L IDAW ItJl n M tL r (hv 1i1lgt ex epound IAt I( JreJ ljvrt- _L~_~ xl0 I

FOR NRC liSE ONLY J f I lYPE OF FEE FE LOG CHECK UMB R iCOMMENTS - VIFEE CATEGORY IMOUNT

I APPROVED BY DATE Iff-OO

~I ~~if~ l i ii il~L Smiddot(102 NRC FORM 313 (3-2009)

NRC FORM 313 US NUCLEAR REGULATORY COMMISSION APPROVED BY OMB NO 3150middot0120 EXPIRES 33112012 (3-2009)

Estimated burden per response to comply with this mandatory collection request 43 10 CFR 30 32 33 34 35 36 39 and 40

hours Submittal of the application is necessary to determine that the applicant is qualified and that adequate procedures exist to protect the public health and safety Semiddotnd comments regarding burden estimate to the Records and FOIAIPrivacy Services Branch (T-5 F53) US Nuclear Regulatory Commission Washington DC 20555middot0001

APPLICATION FOR MATERIALS LICENSE or by internet e-mail to infocoliectsresourcenrcgov and to the Desk Officer Office of Information and Regulatory Affairs NEOB-10202 (3150middot0120) Office of Management and Budget Washington DC 20503 If a means used to impose an information collection does not display a currently valid OMB control number the NRC may not conduct or sponsor and a person is not required to respond to the information collection

INSTRUCTIONS SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRlCTIONS FOR COMPLETING APPLICATION SEND TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIEC BELOW

APPLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH IF YOU ARE LOCATED IN

OFFICE OF FEDERAL amp STATE MATERIALS AND ILLINOIS INDIANAIOWA MICHIGAN MINNESOTA MISSOURI OHIO OR WISCONSIN SElf)

ENVIRONMENTAL MANAGEMENT PROGRAMS APPLICATIONS TO

DIVISION OF MATERIALS SAFElY AND STATE AGREEMENTS Sri us NUCLEAR REGULA TORY COMMISSION WASHINGTON DC 20555-0001

MATERIALS LICENSING BRANCH US NUCLEAR REGULATORY COMMISSION REGION III

ALL OTHER PERSONS FILE APPLICATIONS AS FOLLOWS 2443 WARRENVILLE ROAD SUITE 210 LISLE IL 60532-4352


ALABAMA CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO HAWAII IDAHO KANSAS KENTUCKY MAINE MARYLAND MASSACHUSETTS NEW HAMPSHIRE NEW JERSEY LOUISIANA MISSISSIPPI MONTANA NEBRASKA NEVADA NEW MEXICO NORTH NEW YORK NORTH CAROLINA PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH DAKOTA OKLAHOMA OREGON PACIFIC TRUST TERRITORIES SOUTH DAKOTA TEXAS

CAROLINA TENNESSEE VERMONT VIRGINIA VIRGIN ISLANDS OR WEST VIRGINIA UTAH WASHINGTON OR WYOMING SEND APPLICATIONS TO

SEND APPLICATIONS TO

LICENSING ASSISTANCE TEAM NUCLEAR MATERIALS LICENSING BRANCH vt DIVISION OF NUCLEAR MATERIALS SAFElY US NUCLEAR REGULATORY COMMISSION REGION IV I US NUCLEAR REGULATORY COMMISSION REGION I 612 E LAMAR BOULEVARD SUITE 400 ) )0 475 ALLENDALE ROAD ARLINGTON TX 76011-4125 KING OF PRUSSIA PA 19406-1415

PERSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE US NUCLEAR REGULATORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED MATERIAL IN STATES SUBJECT TO USNUCLEAR REGULATORY COMMISSION JURISDICTIONS

1 TH IS IS AN APPLICATION FOR (Check appropriate item) 2 ltlAME AND MAILING ADDRESS OF APPLICANT (Include ZIP code)

~ NEW LICENSE D q I) b VI ~Sf- -hf AMENDMENT TO LICENSE NUMBER ~ 0 8St~ f Z--i IT Sf f7I ( hl e 11 ( (

C RENEWAL OF LICENSE NUMBER D Plf) 10 7 I D6PID

3 ADDRESS WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED 4 NAME 01= PERSON TO BE CONTACTED ABOUT THIS APPLICATION

-gtC V b (Af7 ~ ~f I fz l Wi II tI) ~h J fYJD 21 ~~61ft1 A-vClpound~

I

TEl Pf NUMBER

tgttA bL1 I CT () 6O zo~- 73Cf- 7 Y 2

-~------ _

SUBMIT ITEMS 5 THROUGH 11 ON 8-112 X 11 PAPER THE TYPE AND SCOPE OF INFORMATION TO BE PROVIDED IS DESCRIBED INTHE LICENSE APPLICATION GUIDE

5 RADIOACTIVE MATERIAL a Elemenl and mass number b chemical andlor phySical form and c malximum amount 6 PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED

which will be possessed at anyone time

7 INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFElY PROGRAM AND THEIR 8 TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS

TRAINING EXPERIENCE ---

9 FACILITIES AND EQUIPMENT 10 RADIATION SAFETY PROGRAM

12 LICENSE FEES (See 10 CFR 170 and Section 17031) 11 WASTE MANAGEMENT

1~~gu~JFr $ FEE CATEGORY

13 CERTIFICATION (Must be completed by applicant) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS AND REPRESENTATIONS MADE IN THIS APPLICATION ARE BINDING UPON THE APPLICANT

THE APPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATION ON BEHALF OF THE APPLICANT NAMED IN ITEM 2 CERTIFY THAT THIS APPLICATION IS PREPARED IN CONFORMllY WITH TITLE 10 CODE OF FEDERAL REGULATIONS PARTS 30 32 33 34 35 36 39 AND 40 AND THAT ALL INFORMATION CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF

WARNING 18 USC SECTION 1001 THE OF JUNE 25 194862 STAT 749 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF UNITED STATES AS TO ANY MATTER WITHIN ITS JURISDICTION I

-=--=-=- CERTIFYING OFFICER -- TYPEDiPRINTED NAME AND TITLE V e I S~ ~ ~ L I DAW It Jl n M tL r ( hv 1i1lgt ex e pound IA t I( JreJ lj vrt- _L~_ ~ xl 0 I

FOR NRC liSE ONLY J f I lYPE OF FEE FE LOG I FEE CATEGORY I MOUNT CHECK UMB R i COMMENTS - V

I Iff-OO APPROVED BY DATE

~I ~~if~ l i ii il~L Smiddot(102 NRC FORM 313 (3-2009)

ItDAN BURY HOSPITAL A Higher Level of Care

March 22010

Licensing Assistant Section Nuclear Materials Safety Branch US Nuclear Regulatory Commission Region I 475 Allendale Road King of Prussia PA 19406-1415

Re NRC License No 06-08544-01 (Danbury Hospital)

To Whom It May Concern

Enclosed you will find an application and supporting information for an amendment to the Danbury Hospital material license This amendment is to add Iftikhar Ali MD as an authorized user in Nuclear Medicine (35100 35200 35300 In vitro studies)

Dr Ali completed his residency in Nuclear Medicine here at Danbury Hospital in June 2007 and has been a clinicalresearch fellow in Nuclear Cardiology in Ottawa Canada since completing his residency He is certified by the American Board of Nuclear Medicine (ABNM) and the Certification Board in Nuclear Cardiology CBNC During his training here he performed all stUdies and has much experience with radionuclide therapy

Please inform us if you require any further information Inquiries may be directed to the Chairman of the Radiation Safety Committee (William Johns MD - 203-739-7428) or to the Radiation Safety Officer (Vladimir Monastyrenko PhD - 203-739-7988)

Sincerely

WDJwdj 3210

It DAN BURY HOSPITAL A Higher Level of Care

March 22010







Sincerely

WDJwdj 3210

r------------------------- ~---------------------------~~~~~----------------------~NRC FORM 313A (AUO) US NUCLEAFt REGULATORY COMMISSION (3-2009)

AUTHORIZED USER TRAINING AND EXPERIENCE APPROVED BY OMB NO 3150-0120 AND PRECEPTOR ATTESTATION EXPIRES 3312012

(for uses defined under 3510035200 and 35500) [10 CFR 35190 35290 and 35590]

Name of Proposed Authorized User State or Territory Where licensed

Jf-~ khtV Ai J fvJh I

wV)()ecTcuT Requested Authorization(s) (check all that apply)

~35100 Uptake dilution and excretion studies

i35200 Imaging and localization studies =35500 Sealed sources for diagnosis (specify device ) --~-----------------------

PART I -- TRAINING AND EXPERIENCE (Select one of the thme methods beow)

Training and Experience including board certification must have been obtained within the 7 years preceding the date of application or the individual must have obtained related continuing education and experience since the required training and experience was completed Provide dates duration and description of continuing education and experience related to the uses checked above

g 1 Board Certification D- If (vt r k -f-tlt tJtA c (uvshyme (t l L L Yur- ru I de~a Provide a copy of the board certification A SillM (J)

b If using only 35500 materials stop here If using 35100 and 35200 materials skip to and complete Part II Preceptor Attestation

IC~ 2 Current 35390 Authorized User Seeking Additional 35290 Authorization

a Authorized user on Materials License meeting 10 CFR 35390 or equivalent Agreement

State requirements seeking authorization for 35290

b Supervised Work Experience (If more than one supervising individual is necessary to document supervised work experience provide multiple copies of this section)

Location of ExperienceLicense or Clock Dates ofDescription of Experience

Permit Number of Facility Hours Experience

Eluting generator systems appropriate for the preparation of radioactive drugs for imaging and localization studies measuring and testing the eluate for radionuclidic purity and processing the eluate with reagent kits to prepare labeled

lioactive drugs I I

bull

Total Hours of Experience

Supervising Individual LicensePermit Number listing supervising individual as an i3uthorized user

--- ------ ------__-_

Su VIltgtUI meets the requirements below or equivalent Agreement State requirements (check al that apply)

35290 35390 + generator experience in 32290(c)(1 )(ii)(G)

I

NRC FORM 313A (AUD_ (3-2009) PRINTED ON RECYCLED PAPER PAGE 1

r------------------------- ~---------------------------~~~~~----------------------~ NRC FORM 313A (AUO) (3-2009)

US NUCLEAFt REGULATORY COMMISSION

AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION

APPROVED BY OMB NO 3150-0120 EXPIRES 3312012


Name of Proposed Authorized User

Jf-~ khtV Ai J fvJh Requested Authorization(s) (check all that apply)

~ 35100 Uptake dilution and excretion studies

i35200 Imaging and localization studies

I State or Territory Where licensed

wV)()ecTcuT

= 35500 Sealed sources for diagnosis (specify device ) --~-----------------------



g 1 Board Certification D- If (v t r k -f-tlt tJ tA c (uvshyme (t l L L Y ur- ru I de~ a Provide a copy of the board certification A Sill M (J)






Description of Experience

Eluting generator systems appropriate for the preparation of radioactive drugs for imaging and localization studies measuring and testing the eluate for radionuclidic purity and processing the eluate

Location of ExperienceLicense or Permit Number of Facility

Clock Hours

Dates of Experience

I

with reagent kits to prepare labeled lioactive drugs

bull

I

Supervising Individual


LicensePermit Number listing supervising individual as an i3uthorized user

--- ------ ------__-_



I


--

--

--

--

--

--

--

--

--

NRC FORM 313A (AUO) US NUCLEAR REGULATORY COMMISSION (3-2009)

AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

D 3 Training and Exerience for Proosed Authorized User

a Classroom and Laboratory Training -shy

Description of Training Location of Training Clock Hours

Dates of Training

Radiation physics and instrumentation

Radiation protection

Mathematics pertaining to the use and measurement of radioactivity

Chemistry of byproduct material for medical use (not required for 35590)

Radiation biology

Total Hours of Training ---shy

b Supervised Work Experience (completion of this table is not required for 35590) (If more than one supervising individual is necessary to document supervised work experience provide multiple copies of this section)

Supervised Work Experience I Total Hours of Experience

Description of Experience Location of ExperienceLicense or Dates of ConfirmMust Include Permit Nlumber of Facility Experience

Ordering receiving and unpacking DYesradioactive materials safely and

performing the related radiation DNo surveys

Performing quality control procedures on instruments used to DYes determine the activity of dosages and performing checks for proper DNo operation of survey meters

PAGE 2




a Classroom and Laboratory Training --

Description of Training Location of Training Clock Dates of Hours Training


--


--


--


--

Radiation biology

Total Hours of Training ----


--


--

Description of Experience Location of ExperienceLicense or Confirm

Dates of Must Include Permit Nlumber of Facility Experience

--

Ordering receiving and unpacking DYes radioactive materials safely and

performing the related radiation DNo surveys --

Performing quality control DYes procedures on instruments used to

determine the activity of dosages DNo and performing checks for proper

operation of survey meters --

PAGE 2

NRC FORM 313A (AUD) US NUCLEAR REGULATORY COMMISSION

(3-2009) AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATIESTATION (continued)

3 Training and Experience for Proposed Authorized User (continued)

b Supervised Work Experience (continued)

Description of Experience Location of ExperienceLicense or Dates ofConfirm

Must Include Permit Number of Facility Experience

measuring and safely patient or human research

subject dosages

Using administrative controls to prevent a medical event involving the

of unsealed byproduct material

Using procedures to contain spilled byproduct material safely and using proper decontamination procedures

Administering dosages of radioactive to patients or human research

Eluting generator systems appropriate for the preparation of radioactive drugs for imaging and localization studies measuring and testing the eluate for radionuclidic purity and processing the eluate with reagent kits to prepare labeled radioactive

idrugs

Supervising Individual LicensePermit Number listing supervising individual as an authorized user

Supervisor meets the requirements below or equivalent Agreement State requirements (check one)

35190 35290 35390 D 35390 + generator experience in 35290(c)(1

c For 35590 only provide documentation of training on use of the device

Device Type of Training

d For 35500 uses only stop here For 35100 and 35200 uses skip to and complete Part II Preceptor Attestation

PAGE 3





Description of Experience Must Include


Confirm Dates of

Experience


subject dosages






idrugs







PAGE 3

NRC FORM 313A (AUO) US NUCLEAR REGULATORY COMMISSION

(3-2009) AUTHORIZED USER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

PART 11- PRECEPTOR ATTESTATION Note This part must be completed by the individuals preceptor The preceptor does not have to be the supervising

individual as long as the preceptor provides directs or verifies training and experience required If more than one preceptor is necessary to document experience obtain a separate preceptor statement from each (Not required to meet training requirements in 35590)

By checking the boxes below the preceptor is attestin~ that the individual has knowledge to fulfill the duties of the position sought and not attesting to the individuals general clinical competency

First Section Check one of the following for each use requested

For 35190

Board Certification A-13 V tJ g I attest that d=B-lt ~ir- A 4 (1J) mm__ has satisfactorily completed the requirements in

Name of Proposed Auitorlzed User

10 CFR 35190(a)(1) and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35100

OR

Training and Experience

I attest that has satisfactorily completed the 60 hours of training and


experience including a minimum of 8 hours of classroom and laboratory training required by 10 CFR 351 90( c)( 1) and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35100

For 35290

Board Certification -A(3A1~

~ I attest that ~-h ~ tff I Y1j) has satisfactorily completed the requirements in


10 CFR 35290(a)(1) and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35100 and 35200

OR Training and Experience

I attest that has satisfactorily completed the 700 hours of training


and experience including a minimum of 80 hours of classroom and laboratory training required by 10 CFR 35290(c)(1) and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35100 and 35200 ~bullbull_----

Second Section Complete t)ie following for preceptor attestation and Signature

li I mjget the requirements below or equivalent Agreement State requirements as an authorized user for

~35190 ~~5290 35390 V~390 + generator experience f---------~~---~- -mmmiddotmiddotmiddot~__middot----middotmiddotmiddotmiddotmiddot~middotmiddotT----------------------middotmiddotmiddotmiddotmiddotmiddotmiddot-----------------~

Name of Preceptor Sigl Telephone Number Date

WIICtM rhflSI (1lL_ J~d Z- v l-)J1 742AP z-Ierllo

LicensePermit NumberFaciljo Name II o 6- Os- 7- --() DAI)~ gt I ngtJ-p d~ (

PAGE 4







For 35190





I attest that Name of Proposed Authorized User

OR

has satisfactorily completed the 60 hours of training and


For 35290

Board Certification

~ I attest that

-A(3A1~

~-h ~ tff I Y1j) has satisfactorily completed the requirements in





OR

has satisfactorily completed the 700 hours of training

and experience including a minimum of 80 hours of classroom and laboratory training required by 10 CFR 35290(c)(1) and has achieved a level of competency sufficient to function independently as an authorized user for the medical uses authorized under 10 CFR 35100 and 35200 ~ bullbull _----



~ 35190 ~~5290 35390 V~390 + generator experience f---------~~---~- - mmmiddotmiddotmiddot~ __ middot----middotmiddotmiddotmiddotmiddot~middotmiddotT----------------------middotmiddotmiddotmiddotmiddotmiddotmiddot -----------------~




PAGE 4

Tgt037396889 P281203 739 6473 F=l3-22-20l0 1501 F-omNUCLER MED

Iffkh AI M bull

Personal Medical School Punjab Medical College Pakistan Year ofOradu~(ion 1992 Citizellship Board Certification ~fNUtiear Medicine (AFlNM)

Certiticalion Board ofNuelear Cat-diology (CBNe)

fQst-gnlduat~ MedJ~al Trai1dug

July 2007 Present Clinicalllte8seach fellow in Nuclear Cardiology and Cllrdiae PET

University of Ottawa Heart Institute Ottawa ON Canada Responsibilities include daily interpretation of Myocardial Perfusion rmagittg (SPECICTPIITCT) studies and StteSl3 le$t8 about 3035 cardiac SPECr and 4-5 cardiac PET teaching cardiology residents supervising cardiac strel~ lest (exercise and pharmacological)

llellearcit projett$ Solid state (CZT) Camem - comparison of Tc-99m and Tl~201 based images with standard ~amma

camera imaging bull The OSCARS (QptimiZlltioll of SPECT ~djao Imaging through Compen$adon for Attenuation

B~olution loss and Scaner) Testretest Repeatability ofMyocardiai SPECT Perfusion Imaging bull Does Androgen Suppression Treatment In Prostate Cancer reduce Myocardial Blood Flow Reserve Phase analysis for CardillJ Resynchronizntion Therapy using cardiac SPEeT and PET bull CQutrast EnhlUlJed Ml1ltisUce Computed Tomography and F-lS FOG PET for the assessment of

Myocltnlial Viability bull Comparison of haJfmiddottime lItquisition reconsuUOted with Evolu1ioJt for Cardiac 1M (OE Healthcare)

depth depen4ant resolution ncovery and full-time acquisition reconstnteted with olinically used FBP and OSEM with and wilbollt CT - based attenuation (omlttion

July 2005 - June 2007 Nuclear Medicioe Re$ldeucy

University of Connecticut at Danbury Hospital Danbury CT USA Rotation Geneml Nuclear Medicine Pediatric Nuclear Medicme SPEcr in Oncology (Octreotide PfO$tasltint Iodine 13 t (iallium) PIHleT in Oncology (100150 casesyear) Bone Oeositics al1d Nuclear Cardiology including stress testing laquogt)(lMcise and pharmacology) Lymphoscintography flaquo Serttin~1 Lymph node localization of Breast C3lICet and Melanoma ( lOa WISE3) Rarliafion Therapy Ablatioo therapy for thyroid rEmnant recurrence and melastass of thyroid cancer is

well at Hyperthyroidism (90-100 cuesyear) Samarium 153 therapy for metllstatic bone disease July 2004 ~ JUlle 2005 Intern ia Gene- Surgery

Saint Barnabas Medical Center Livingston IIJ USA Rotation included pre- and postmiddotoperative patient care assistlIDce in OR Sutgical lev and Sum ICU patient (are Trauma rotation at Jersey City Medical Center NJ included asseslling and managing ofaCtlte trauma patient

July 1993 middotlu) 1994 House PbysilillQ

Medical Unit Allied Ho~pital Faisalabad PakistOlfl luly 1992 June 1993 House Physician

Surgical Unit Allied Hospital Fai$~labad PakiStim

Page002 R=95IDCV STRESS TESTFrom 1203 739 6473FEB-22-2010 040BPM

F=l3-22-20l0 1501 F-omNUCLER MED 1203 739 6473

Personal Medical School Year ofOradu~(ion

Iffkh AI M

Punjab Medical College Pakistan 1992

bull

Citizellship Board Certification ~fNUtiear Medicine (AFlNM)




University of Ottawa Heart Institute Ottawa ON Canada

Tgt037396889 P28

Responsibilities include daily interpretation of Myocardial Perfusion rmagittg (SPECICTPIITCT) studies and StteSl3 le$t8 about 3035 cardiac SPECr and 4-5 cardiac PET teaching cardiology residents supervising cardiac strel~ lest (exercise and pharmacological)







University of Connecticut at Danbury Hospital Danbury CT USA Rotation Geneml Nuclear Medicine Pediatric Nuclear Medicme SPEcr in Oncology (Octreotide PfO$tasltint Iodine 13 t (iallium) PIH leT in Oncology (100150 casesyear) Bone Oeositics al1d Nuclear Cardiology including stress testing laquogt)(lMcise and pharmacology) Lymphoscintography flaquo Serttin~1 Lymph node localization of Breast C3lICet and Melanoma ( lOa WISE3) Rarliafion Therapy Ablatioo therapy for thyroid rEmnant recurrence and melastass of thyroid cancer is


Saint Barnabas Medical Center Livingston IIJ USA Rotation included pre- and postmiddotoperative patient care assistlIDce in OR Sutgical lev and Sum ICU patient (are Trauma rotation at Jersey City Medical Center NJ included asseslling and managing of aCtlte trauma patient




FEB-22-2010 040BPM From 1203 739 6473 IDCV STRESS TEST Page002 R=95

FEB-22-2010 1502 FromNLlCLER MID 1203 739 54-3 Tgt gt03 739 6889

W(Jrk EXJeriente

July 1998 June 2004 Network Administrator and Projec~ Manager (IT IndustrY) Danbury CT USA In 1998 due to my daughfllts illness (Bilateral Retinoblastoma) I had to temporarily switch my priorities in order to stabilize my family situation To support family 1 worked in th~ IT industry Through a lairgely self-ltudy effort I became an IT applkatiOI1$ expert within a few weeks This demonstrates that l am focu3ed resocu-(eful and capable of quickly learning and developing new technologjes

Sep 1997-Apr 1998 Observcf$hip in PaUlology DlIllbury Hospital Danbury ConnecticlJt USA Aug 1996-Jul 1997 Observenhip in Oncology Danbwy Hospital Danbury CT USA Oct 1994 - Feb 1995 poundmetgenq Medical Palllmedics Or Everttt Chalmers Hospital Fredericton NB

Other Euenepoundts Hand on experiences on PAC8 sysleTll inchJdwg transferring 1ETCT data from Gpound PETCT scanner to PACS system merging outside PET studies with CT data Excellent (omputer experience both in Ilardware and software side induding netwoddng TCPIP routing Microsoft windows (servers and client) lIlld Microsoft office

Lao20Rle Fluency (Otberbn EnglWl)

Urdu Hindi Punjabi

Educatiop Degree in Medicine (Ma BS) Punjab Medical CoJJege Pakistan Year ofGraduation ~ 1992 Pre-medical school (fl Sc) GovernmMt College faisailibad Pakistan Year ofGraduation 1985

PublicatioDI

PtqUrs~

1 Iftikbar Ali Tellm)te D Ruddy Abduluiz Algamdi R Glent WIl)1s Test-retest Repeatability of Myocardial SPECT Perfusion tmllgog (Submitted for review to INM)

2 IftikbBr Ali Terrence D Ruddy Abd11Jaliz Almgrabi It Glenn Wtlls Half~tjme SPECT Myocardial Perfu5ion Imaging witb Attenuation Correction in bltlftbe time INM Apn12009J()4)~554-j62 Front COVeT on 1NM - April 2009

3 Utikbllr AU William Johns Shiv vuPta SenmdqJitous d~teeticm of Testicular Seminoma on FmiddotIS fOG positron tomography Clinical Nuclear Medicine 2007 32201middot202

4 Iftikbar AU WjlIiaro J(lMS Shiv Gupta Visullliution of Hepatic Mewtampseamp of Medullary Thyroid Carcinoma on Tc-m MOP Bone Scintigraphy Clinical Nuclear Medicine 2006 31 611middot613

Abslrllct I lftlkbaf Afi R Glenn Wells Terrence D Ruddy et aL Myocaroial Perfusion Imaging with a New Cadmium

Zinc Telluride based SPECT Camera (accepted for oral presellWion at AHA annual meding Nov 2009 Orlando FI USA)

2 Tftilda8r Ali Terrence j) Ruddy Abdulaziz Aigarnd R Glenn Wells Attenuation Corr~tion imprQIS Slres-only Myocardial PertU$ioo SPECT compared to PET SNM Mnual meeting 2009

3 Ifiikbu Ali Terrmte D Ruddy Abduluiz Algamdl Brian Marvin R Glenn Wells Repeatability of Perfusion pbase Analysis SNM annual meeting 2009

4 Ambuj Dewall Utikbar Ali Terrence 0 Ruddy R Glenn Wells Sin~h CT for attenuation correction of restistre$$ cardiae SPECT perfusion imaging SNM annual meeting 2009

5 Irtikhar AU TelTence D Ruddy Abdulazit Algarndi R CI~nn Wells Te$t-tetest Repeltltability of Myocardial SPECT Perfusion Imaging fCNC9 Barcelona Spain May 2009 (Young Investigators Award)

6 Inikbar Ali Terrence Ruddy Abduluiz Almw-tIli Glenn Wells Sitlg~ photon emlJ$ion computed tomography p(ffu~ion imaging in haJfthe fime JNM 2001J 49 72P

2

IDCV STRESS TEST page007 R=96FEB-22-2010 0409PM From 1203 739 6473


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July 1998 June 2004

Sep 1997-Apr 1998 Aug 1996-Jul 1997 Oct 1994 - Feb 1995

Other Euene poundts

Network Administrator and Projec~ Manager (IT IndustrY) Danbury CT USA In 1998 due to my daughfllts illness (Bilateral Retinoblastoma) I had to temporarily switch my priorities in order to stabilize my family situation To support family 1 worked in th~ IT industry Through a lairgely self-ltudy effort I became an IT applkatiOI1$ expert within a few weeks This demonstrates that l am focu3ed resocu-(eful and capable of quickly learning and developing new technologjes Observcf$hip in PaUlology DlIllbury Hospital Danbury ConnecticlJt USA Observenhip in Oncology Danbwy Hospital Danbury CT USA poundmetgenq Medical Palllmedics Or Everttt Chalmers Hospital Fredericton NB

Hand on experiences on PAC8 sysleTll inchJdwg transferring 1ETCT data from Gpound PETCT scanner to PACS system merging outside PET studies with CT data Excellent (omputer experience both in Ilardware and software side induding netwoddng TCPIP routing Microsoft windows (servers and client) lIlld Microsoft office


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PublicatioDI

PtqUrs~

Urdu Hindi Punjabi

Degree in Medicine (Ma BS) Punjab Medical CoJJege Pakistan Year of Graduation ~ 1992 Pre-medical school (fl Sc) GovernmMt College faisailibad Pakistan Year of Graduation 1985












2

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7 Abdulaziz Almgrahi Terrepce Ruddy Jftikhar AU frank Anstett snd ROJenn Wells Attenuation correction in half-time SPBCT cardiac perfusion imaging JNM 2008 49 73P

g Masoud Mohammad Benjamifl Cbow Mary Dalipaj Robert deKemp Iftikhar Ali R Glenn Wells Ross Davies Rob Beanlanos and Terrence Ruddy R(tent of dipyridamole induced bypoperfusiQn with T c tetrofosmin and sestamibi SPECT imagj$ eompftled to i2Rb PET lmagjng JNM 2008~ 49 I27P

9 Jftikbar Ali William Johns Shiv Cupta Empiric Radioiodirlf therapy fur NOIl~locaJbed Differentiated Thyroid Carcinoma with devuted serum Tbyroglobulin (Abstract) Conn~ieut Medkine 2()06 7() 560

to Itti~har Ali William Johns Shh Gupta Somatostatin Receptor Scintigraphy for the Evaluation of Neuroendocrine Tumors C()Iluecticut Medicine 2007 7

II Utikhar Ali William Johns Shiv Gupta Role of Hepatobiliary Scintigraphy ill Diagnosis and Evaluation of Bile Leak Connecticut Medicine 2007 71 (9) October

pesmtlllltns t Myocardial Perfusion Imaging with a New Cadmium Zinc Telluride bll$ed SPECT Camera (accepted for

oral presentation at AHA annual meeting Nov 2009 Orlando FI USA) 2 Attenuation Correction impr~ves Stress-ooly My()(laldial Perfusion SPECT compared 10 PET SOCiety of

Nuclear Medicine Annual Meeting Toronto ON Canada June 2009 3 RepeatabiJity of Perfusion Phase Analysis Society of Nuclear Medicine Al1Ilual Meeting Tor()1lW ON

Canada JWlC 2009 4 Test-retest Repeatability of Myocmdial SPECT Jgternlsion Imaging International Conference of Non-Invasive

cardiovascular Itmlging 2009 (lCNC9) Barcelona Spain May 2009 (YoLlng Investigator Award Session) 5 Single Photon Emission Computed Tomography Perfttsion Imaging in Half the Time Society of Nuclear

Medicine Annual Meeting New Orleans LA USA lune 2008 6 Attenuation Correction in Half-time SPEeT Caiiillpound Perfusion hnaging Society of Nuclear Medicine

Annual Meetine New Orleans LA USA June 2008 7 Single Photon Emssion C()mputed Tomognphy Perfusion in Half the Sual time Presentation at 21t

Annual Research Day at Unillersity OfOttaw8 Heart Institute Ottawa anI_ Canw April 2008 8 Role of Hepatobiliary Scintigraphy in Dillgno$js and Evaluation of Bile Ieak Annual Dr Belsky Resear~1t

Day at Danbury H(lSpital Danbury CT USA May 2007 9 Somatostatin Receptor SciJltigmphy fur the EVllluati(Jn of Neuroendocrine Twlors (Poster) AO-nial Dr

Belsky (tesear(b Day at Oanbury Hospital OanbilIJI CT USA May 2007 10 Empiric Radioiodine therapy for Noomiddotlocalized Oifferentiated Tilyt()id Carcinoma with elevated serum

Thyroglobulin two years twperience at Danbury Hospital Annual Dr Belsky Research Day at Danbury Hospital Danbury CT USA April 2006

ll f-18 fOG PET evaluation for Breast Cancer at CME meeting at Danbuty Health Systems Oallbury CT USA December 2006

AWlIflU I Roentgen Resldentlfellow Research Awlltd - 2007 Radiological SQciety ofNorth America (RSNA) - 2007 2 The Canadian Nucl~r CardiololY Society I GE Healthcare Radiant Travel Awu-d - 2003 3 Young Investigator Award ICNC9 the Intenmtionat Conference (If Non-Invasive Cafdiovasculat

Imaging 2009 Barcelona Spain 4 University ofOttawa Cardiovascular Research endowment Award 2009

References

Available 011 request

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g Masoud Mohammad Benjamifl Cbow Mary Dalipaj Robert deKemp Iftikhar Ali R Glenn Wells Ross Davies Rob Beanlanos and Terrence Ruddy R(tent of dipyridamole induced bypoperfusiQn with T c tetrofosmin and sestamibi SPECT imagj$ eompftled to i2Rb PET lmagjng JNM 2008~ 49 I 27P
















AWlIflU I Roentgen Resldentlfellow Research Awlltd - 2007 Radiological SQciety of North America (RSNA) - 2007 2 The Canadian Nucl~r CardiololY Society I GE Healthcare Radiant Travel Awu-d - 2003 3 Young Investigator Award ICNC9 the Intenmtionat Conference (If Non-Invasive Cafdiovasculat

Imaging 2009 Barcelona Spain 4 University of Ottawa Cardiovascular Research endowment Award 2009

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bull






Tgt037396889 P28
















W(Jrk EXJeriente





Urdu Hindi Punjabi


PublicatioDI

PtqUrs~












2



W (Jrk EXJeriente

July 1998 June 2004


Other Euene poundts




Educatiop

PublicatioDI

PtqUrs~

Urdu Hindi Punjabi













2






















References


J






















References


J

















v-r-~ ---~- ~---

IIC~SO



03middot815942



QltiH~ ~














1 Hl un u ~AlJUO






IIC~SO



03middot815942


~~( -

v-r-~ ---~- ~---


poundL

b9

6

poundL

pound~21 WOJ~

Wd60b0

0102-22-83~lS

31

SS3~lS ~JOI

03W ~3IJONwOJ~

10

S1

0102-22-83~

68

89

5pound1


U 2021

o W E

ffi g E o i

LL

lSI ~

lSI (lj I

(lj (lj

I

ffl LL




~ (J) (J) w ~ fshy(J)

13 o H

E o i

LL

E 0 IJ) IS)

ltt IS)

IS) -i IS) (lJ I

(lJ (lJ

I iII W LL


~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)









subject dosages






idrugs







PAGE 3







Confirm Dates of

Experience


subject dosages






idrugs







PAGE 3







For 35190




OR





For 35290















PAGE 4







For 35190






OR



For 35290

Board Certification

~ I attest that

-A(3A1~






OR









PAGE 4


Iffkh AI M bull





















Iffkh AI M


bull






Tgt037396889 P28
















W(Jrk EXJeriente





Urdu Hindi Punjabi


PublicatioDI

PtqUrs~












2



W (Jrk EXJeriente

July 1998 June 2004


Other Euene poundts




Educatiop

PublicatioDI

PtqUrs~

Urdu Hindi Punjabi













2






















References


J






















References


J

















v-r-~ ---~- ~---

IIC~SO



03middot815942



QltiH~ ~














1 Hl un u ~AlJUO






IIC~SO



03middot815942


~~( -

v-r-~ ---~- ~---


poundL

b9

6

poundL

pound~21 WOJ~

Wd60b0

0102-22-83~lS

31

SS3~lS ~JOI

03W ~3IJONwOJ~

10

S1

0102-22-83~

68

89

5pound1


U 2021

o W E

ffi g E o i

LL

lSI ~

lSI (lj I

(lj (lj

I

ffl LL




~ (J) (J) w ~ fshy(J)

13 o H

E o i

LL

E 0 IJ) IS)

ltt IS)

IS) -i IS) (lJ I

(lJ (lJ

I iII W LL


~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)








For 35190




OR





For 35290















PAGE 4







For 35190






OR



For 35290

Board Certification

~ I attest that

-A(3A1~






OR









PAGE 4


Iffkh AI M bull





















Iffkh AI M


bull






Tgt037396889 P28
















W(Jrk EXJeriente





Urdu Hindi Punjabi


PublicatioDI

PtqUrs~












2



W (Jrk EXJeriente

July 1998 June 2004


Other Euene poundts




Educatiop

PublicatioDI

PtqUrs~

Urdu Hindi Punjabi













2






















References


J






















References


J

















v-r-~ ---~- ~---

IIC~SO



03middot815942



QltiH~ ~














1 Hl un u ~AlJUO






IIC~SO



03middot815942


~~( -

v-r-~ ---~- ~---


poundL

b9

6

poundL

pound~21 WOJ~

Wd60b0

0102-22-83~lS

31

SS3~lS ~JOI

03W ~3IJONwOJ~

10

S1

0102-22-83~

68

89

5pound1


U 2021

o W E

ffi g E o i

LL

lSI ~

lSI (lj I

(lj (lj

I

ffl LL




~ (J) (J) w ~ fshy(J)

13 o H

E o i

LL

E 0 IJ) IS)

ltt IS)

IS) -i IS) (lJ I

(lJ (lJ

I iII W LL


~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)



Iffkh AI M bull





















Iffkh AI M


bull






Tgt037396889 P28
















W(Jrk EXJeriente





Urdu Hindi Punjabi


PublicatioDI

PtqUrs~












2



W (Jrk EXJeriente

July 1998 June 2004


Other Euene poundts




Educatiop

PublicatioDI

PtqUrs~

Urdu Hindi Punjabi













2






















References


J






















References


J

















v-r-~ ---~- ~---

IIC~SO



03middot815942



QltiH~ ~














1 Hl un u ~AlJUO






IIC~SO



03middot815942


~~( -

v-r-~ ---~- ~---


poundL

b9

6

poundL

pound~21 WOJ~

Wd60b0

0102-22-83~lS

31

SS3~lS ~JOI

03W ~3IJONwOJ~

10

S1

0102-22-83~

68

89

5pound1


U 2021

o W E

ffi g E o i

LL

lSI ~

lSI (lj I

(lj (lj

I

ffl LL




~ (J) (J) w ~ fshy(J)

13 o H

E o i

LL

E 0 IJ) IS)

ltt IS)

IS) -i IS) (lJ I

(lJ (lJ

I iII W LL


~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)



W(Jrk EXJeriente





Urdu Hindi Punjabi


PublicatioDI

PtqUrs~












2



W (Jrk EXJeriente

July 1998 June 2004


Other Euene poundts




Educatiop

PublicatioDI

PtqUrs~

Urdu Hindi Punjabi













2






















References


J






















References


J

















v-r-~ ---~- ~---

IIC~SO



03middot815942



QltiH~ ~














1 Hl un u ~AlJUO






IIC~SO



03middot815942


~~( -

v-r-~ ---~- ~---


poundL

b9

6

poundL

pound~21 WOJ~

Wd60b0

0102-22-83~lS

31

SS3~lS ~JOI

03W ~3IJONwOJ~

10

S1

0102-22-83~

68

89

5pound1


U 2021

o W E

ffi g E o i

LL

lSI ~

lSI (lj I

(lj (lj

I

ffl LL




~ (J) (J) w ~ fshy(J)

13 o H

E o i

LL

E 0 IJ) IS)

ltt IS)

IS) -i IS) (lJ I

(lJ (lJ

I iII W LL


~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)






















References


J






















References


J

















v-r-~ ---~- ~---

IIC~SO



03middot815942



QltiH~ ~














1 Hl un u ~AlJUO






IIC~SO



03middot815942


~~( -

v-r-~ ---~- ~---


poundL

b9

6

poundL

pound~21 WOJ~

Wd60b0

0102-22-83~lS

31

SS3~lS ~JOI

03W ~3IJONwOJ~

10

S1

0102-22-83~

68

89

5pound1


U 2021

o W E

ffi g E o i

LL

lSI ~

lSI (lj I

(lj (lj

I

ffl LL




~ (J) (J) w ~ fshy(J)

13 o H

E o i

LL

E 0 IJ) IS)

ltt IS)

IS) -i IS) (lJ I

(lJ (lJ

I iII W LL


~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)

















v-r-~ ---~- ~---

IIC~SO



03middot815942



QltiH~ ~














1 Hl un u ~AlJUO






IIC~SO



03middot815942


~~( -

v-r-~ ---~- ~---


poundL

b9

6

poundL

pound~21 WOJ~

Wd60b0

0102-22-83~lS

31

SS3~lS ~JOI

03W ~3IJONwOJ~

10

S1

0102-22-83~

68

89

5pound1


U 2021

o W E

ffi g E o i

LL

lSI ~

lSI (lj I

(lj (lj

I

ffl LL




~ (J) (J) w ~ fshy(J)

13 o H

E o i

LL

E 0 IJ) IS)

ltt IS)

IS) -i IS) (lJ I

(lJ (lJ

I iII W LL


~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)


poundL

b9

6

poundL

pound~21 WOJ~

Wd60b0

0102-22-83~lS

31

SS3~lS ~JOI

03W ~3IJONwOJ~

10

S1

0102-22-83~

68

89

5pound1


U 2021

o W E

ffi g E o i

LL

lSI ~

lSI (lj I

(lj (lj

I

ffl LL




~ (J) (J) w ~ fshy(J)

13 o H

E o i

LL

E 0 IJ) IS)

ltt IS)

IS) -i IS) (lJ I

(lJ (lJ

I iII W LL


~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)



~

co I() IS)


CL (JJ



1lftrrJ IS) ru


i -

x (J) 1IJ Ishy


o


[gtshyltt U)

rrJ


I

J


I]l rrJ


[gtshy


E


CY l-W ll g

E 0E OJo IS)

lshyI ltI

IS) IS)

IS) lfl IS)


I COru 1IJru I ll

CO W I

CD shyIf)

a

o UJ E

ffi g E o ishy

LL

IS) IS) ru

I ru ru

I m UJ LL


Certfies tJiat





If) is) is)

lshyto W I-


E 0

ishylL

E 0 (l) is)

ltT is)

is) -l is) ru

I ru

ru bull I [0

W lL

bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)


bull V0

(Tl II IX

OJ

0 ~ (S)

0 (lJ



fl


I-shy








63 E

ED ~

~ E o ~


f) -

IS) d IS) ru

I

8J I

CD 1I1 LL

-fgti

ltt shy

0

S 11 Sl lJ -

ampanny E o ~

lJ

~ ltt (S)

IS) - (S) (lJ

I (lJ OJ

I CD

~

IX

D

0

o I-

Il I-ltt D

~ I-jrJ IS) ru

IS) d IS) ru

I ru ru I

ffi LL





NUCLEAR CARDIOLOGY



E o Soshy

IL

~ ltt IS)

IS) IS) ru I

ru ru

I m w

-IL
















NRC FORM 532 (RI)

(6-96)

















NRC FORM 532 (RI)

(6-96)


danbury hospital, amendment request dtd 3/10/2010. · danbury hospital material license. this...

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