ACCEPTANCE REVIEW MEMO (ARM) Licensee: Gritman Medical Center License No.: 11-27337-01

Docket No.: 030-32281

Type of Action: Amend

Reviewer Assigned :

Mail Control No.: 471 157a

Date of Requested Action: 09-26-06

ARM reviewer(s): Torres

Response Deficiencies Noted During Acceptance Review

[ ] Open ended possession limits. Limit possession. Submit inventory. [ ] Submit copies of most recent leak test results. [ ] Add - delete IC license condition. Add IC paragraph in cover letter. [ ] Split license from cover letter. Add SUNS1 marking to license. [ ] Ask the licensee if they have any type-amount of EPAct Material.

Submit NRC Form 313a with T & E documentation. - Reviewer's Initials:- Date: 1

OYes UNO

a y e s UNO UYes UNO Termination request 90 days from date of expiration

UYes UNO

OYes UNO

Unrestricted release Group 2 or >: Transfer memo to FCDB within 10 days

Decommissioning notification should be completed within 30 days.

Expedite (medical emergency, no RSO, location of use/storage not on license, RAM in possession not on license, other)

TAR needed to complete action.

I Branch Chief's andlor Sr. HP's Initials: Date:

SUNS1 Screening according to RIS 2005-31

a y e s d Non-Publicly Available, Sensitive if item below is checked General guidance:

RAM = or > than Category 3 (Table 1, RIS 2005-31), use Unity Rule Exact location of RAM (whether = or > than Category 3 or not) Design of structure and/or equipment (site specific) Information on nearby facilities Detailed design drawings and/or performance information Emergency planning and/or fire protection systems

Specific guidance for medical, industrial and academic (above Category 3): RAM quantities and inventory Manufacturer's name and model number of sealed sources & devices Site drawings with exact location of RAM, description of facility RAM security program information (locks, alarms, etc.) Emergency Plan specifics (routes to/from RAM, response to security events) Vulnerability/security assessment/accident-safety analysis/risk assess Mailing lists related to security response

Branch Chief's andlor Sr. HP's Initials: Date: 'o-'&~-f2~

Name: Gritman Medical Center

Location: ID

Instructions for Step 1: Complete Step 1 for all applications If ail your responses in Step 1 are "No" then do not complete Step 2 (Screening Cnteria) Sign and date the completed step-sheet and add it as the sensitive and non-publicly available OAR in ADAMS If a "yes" response is indicated for any item in Step I, also complete Step 2 If the type of use is subject to a Security Order or the requirements for increased controls, complete Step 3 (Item A or Item B) without delay

Type of Request: Amend Program Code+):

License No.: 11-27337-01 Docket No.: 030-32281

Yes or No

(Category 2 Quantities. IAEA Safety Guide No. RS-G-1.9, Categorization of

Radionuclide Risk Significant Risk Significant Radionuclide Quantity (TBq') Quantity (Ci')

Am-241 0.6 16 Pm-147

Am-241lBe 0.6 16 Pu-238

Cf-252 0.2 5.4 Pu-239lBe

Cm-244 0.5 14 Ra-226'

CO-60 0.3 8.1 Se-75

cs-137 1 27 Sr-90 (Y-90)

Gd-153 10 270 Tm-170

lr-192 0.8 22 Yb-169

I A. The request is from a new applicant.

Radioactive Sources, August 2005)

Risk Significant Risk Significant Quantity (TBq') Quantity (Ci')

400 11,000

0.6 16

0.6 16

0.4 11

2 54

10 270

200 5,400

3 81

6. NUREG-1556, Volume 20, Section 4.9 indicates a licensing site visit is needed for the requested type of use, e.g., (1) Type A broad scope license, (2) panoramic irradiator containing > 10000 curies, (3) manufacturers or distributors using unsealed radioactive material or significant quantities of sealed material, (4) radioactive waste brokers, (5) radioactive waste incinerators, (6) commercial nuclear laundries, and (7) any other application that in the judgement of the reviewer and cognizant supervisor involves complex technical issues, complex safety questions, or unprecedented issues that warrant a site visit.

Calculations of the Total Activity or the Unity Rule are attached to document whether or not the screening criteria in Step 2 were also completed to evaluate the application.

will include the oreviouslv authorized quantities for the radionuclide(s). NOTE-If an amendment of an existing license is being requested, the calculations

d\j* C. The applicant requested certain radionuclides and quantities that equal or exceed the Risk Significant Quantity (TBq) values in the table, below, that have been "highlighted" by the reviewer

Yes , No, or Not Applicable

(NA)

Total Activity-multiple activities are requested for a single radionuclide and the sum of I the activities equals or exceeds the quantity of concern for the radionuclide

Unity Rule--multiple radionuclides are requested and the sum of the ratios equals or exceeds unity, e.g.,[(total activity for radionuclide A) + (risk significant quantity for radionuclide A)] + [(total activity for radionuclide B) + (risk significant quantity for radionuclide B)] 2 1 .O.

Signature and Date for Step 1 : c

License Reviewer and Date

700 S. Main MOSCOW, ID 83843-3046

(208) 882-451 I

fdy 3dd~gS3 -65 3. I

Sept. 26, 2006

Nuclear regulatory Commission Region IV 61 1 Ryan Plaza Dr., Suite 400 Arlington, TX '7801 1-8064

To Whom It May Concern:

Please add Dr. Mark Bechtel to our license. He is a board certified radiologist working here at Gritman Medical Center. Any questions, please call us.

Sincerely,

President and CEO Gritman Medical Center

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11/15/2006 10: 47 2088836464 GRITMAN RADIOLOGY PAGE 01/05

IMAGING SERVICES

208-883-2228 208-883-6464 FAX

CzXrMAN M E D I C A L C E N T E R

This message i s intended only for the use o f the individual to whom i t is addressed and contains information that is privileged, confidei3tial and exempt from disclosure under applicable law. Tfthe reader ofthis message is not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information i s strictly prohibited. Tf you have received this communication in error, please notify us immediately,

GRITMAN RADIOLOGY UbNW HlV

PAGE 02/05 P m E ezti35

SUhJECl": REQUEW FOR ADDITIONAL lNFOF$dATIaN, LICENSE NO, 7 1-2?337-01, DOCKET NO. 030-32281, CONTR30L NO. 471 157

UW the ~inelased Nk2 Pam 313A to resubmit ybur amendment sihce Or. &echtel cannot be name as an arltharlmd user WM the documerwtiah 'that ycrw r>rlg!nally ssnl, Please also clarify whether Dr. BecHtid la a boctor of Medicine (M.D.) Or a Doktor of OEkOpRfhic Medieirre (D.0 , ) .

You rhey cci.htad me et 8??460-6189 or by fafacsEmlle at 817-880-8263 if you have any questions about thiS requet3t.

11/15/2006 10: 47 2088836464 GRITMAN RADIOLOGY PAGE 03/05

B. Medical use permitted by 10 CFR 35.200

C, Medical use permitted by 10 CFR 35.300 30, 1998, limited to less than or equal to 33

0. Medical us@ p@mitted by It) CFR 35,400.

I O . Licensed material may be used or s;tar@d only at Brainerd, Minnesota.

NIJV-1 b-ZU116' WE0 12 : 18 PM SJMC RAD IOLOCY FAX NO. 2188287829 I

(ex;luding xancln-l33),

(thyroid carcinoma therapy as described in letter dated July rnillicuri#!!5 of iodine-131 per administration).

CONDITIBNQ

tie licensee'!$ WliSim lamtti!d igt 523 North Third Street,

P, 02 I I -

PACE , 1 OF 3 ,,PAGE3 kmsndrnent No, 31

lrsuant to the Atomic Energy Act of 1@4,as amended, the ' Federal Regulations, Chapter I, Parts 30,31, 32.38,

Reor@mi&aticn Actof 1974 (Public Law EL3.4381, and Tltle IO, Code 3CI, 40. and 70, and h reliance on ~talcarnwL and repmsnitisns

the licenseo ta mcaive, acqulm, pome%, and transfer byproduct, for tha purpnse(s) and at the phce(s) deslgnatea MOW; to

with the reegulatlons dtXr.9 applicable Part(5). This license Znergy Act Of 1 O N , ati amended, and is ~utllect to all

or hereafter in effwt and to any conditions SD&Clfled

4' fet&k made by the Ilcensea, a liwnse is hemsby wm, and special nuclear materlal deslgnateu dllverarlnderauch materlal ta perfianb shall be deemsd to conbin tne appliaable rules, regulafians,

Ill below. 111 Licensee rtiance with letter dstsd

1. St. Joseph's Medlcal Center

2. 523 North Third Street Nuclear Medlcine Department

Septemtler 22, 2003, 3. Liceinsla number 22-1 6966-01 is amended in its entirety to road as fallawss;

date October 81,201 2 Bralnerd, MN 58401

6. Byp~tlrrct, sour&, and/trr special num amount that Ilccsnaaa may 6s at any one tlme under this nuclear rnaterlnl

A. Any byproduct materia@ permitted by I O CFR &. I00

9. AuthotiEd Use:

A. Medical use. permitted by 10 Ill

P 4. The Radiation Safely Officer far this license is Jo n M. Holmen, M.D.

GRITMAN RADIOLOGY PAGE 04/05 11 /15 /2006 10: 47 2088836464

NOV-15 2000 WED 12i20 PM SJMC RADIOLOGY FAX NO, 2188213 16'2U P, 03 ._

PAGE 2 Of 3 PAGES NRC FORM 3fM U.B. N U G L M REGUW\TO

Duncan R. Dickson, M.D.

Mark A. Bisignani, M.P. Palladlurr4O3

Jam@$ J. O'Hearn, M.D.

Ted W. alds, M,D.

Wayne! T. Spears, M-D. Palladium-1

John A. Kasiak, M.D. Palladiunr-lO3

Jeffrey 3. Herman, M.D. Palladium-I

Kimberly K. McCollow, D.O. Palladiuni-I03

Kurt Nlsi, M.D. Palladiuri-I

10 CFR

10 CFR

MATERIALS LICENSE SUPPLEMENTARY SHEET

1'

in I O CFR 35.400,

a9 deecribasl in 10 CFR 35,400.

25,'IOO and 35,200 (excluding renon-133).

?5:lOO and 25.200 (excluding zrsnon-933)

03 as daaicribed in I O CFR :35.400.

as deficrlbed in I O CFR 35,400.

03 as dewxibed in I D CFR 03fi.400,

as dWcribed in 10 CFR 35.400.

03 8s de:;cribed in I tl CFR 35,490,

12. Licensed materlal is only authoriz~d for use by,

Individuals permitted to work as an

the supervision of:

and/or authorized medical physicist in A. accordance with 10 CFR 35.13 and 35.14,

B. The following indlviduals are

31 for thyroid carcinoma).

Charles A, Benson, M.D.

James D. Raalafs, M.D.

xsnali-l33), and 35.300

Mark VV. Ooyscher, M.4& non-l33), and 35.300 miilicuries of iadiine-I31

John H, Holmen,

Robert 0. Posch, F R m

luding x@m-.133), and 35.300.

n-133) and 35.300 llicuries of iodine-?31

Douglas Olsan, M.D.

Richard F. Diat, M.D.

GRITMAN RADIOLOGY PAGE 05/05 11/15/2006 10:47 2088836464

FAX NO, 2188287629 P, 04 i w v - l 3 - / ~ J ~ l H WklI I2:2U PM SJIC RADIOLOGY I

NPC FORM 374A U$. NUCLEAR R643

MATERIALS LICENSE SUPPLEMENTARY SHEfiT

Paul Sperduto, M.D.

Mark Ha BecnteI, M.D. I

A. Appllcertian dated Ap

B. Letter dated July 30, 19

F R THE W.S. NUCLEAR REGlJLATQRY COMM1SSION p’ n,

Rsegion Ill

I t L IC- . ,

GRITMAN RADIOLOGY PAGE 0 1 / 0 4

IMIAGI[MG SERVICES

208-883-2228 208-883-6464 FA=)(

(2EaN" M E D I C A L C E N T E R

~~

This message is jntended oaly for the use o f the ind.ividual to whom it is addressed and contains information that is privjleged, confidential and exempt from disclosure under applicable law. If the reader o f this messago i s not tlie intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is strictly prohibited, If you have received this communication in error, please notie us iminediately.

GRITMAN RADIOLOGV USNRC Rf;V

October 31,20#6

Gritmen MLdical Center ATTN: Jt%ffrey W, MWtin

700 Sodth Maln MOBCOW, Idaho 83843

President and CEO

SUEjJECT: REQUEST FOR ADDITIONAL INFCYRMATIUW. LICENSE NO, I 1-27337-01, DOCKET NO. 030-32231, CONTROL NO, 474 157

Vaur IeFer dsteci September 26,2006 &questing to add Qr. Mark Beehtel to NRC License No. 11-2?33&01 issued to Oritbat7 Medical Center Was reCeiv&d !h this ofice on Ocbber l a , 2006. The revised rntsdldal trtlinlng and experiehce tegulatsons mqwlre a physicIan who wan& to beeme an authorized u$er to have:

a b ' rd certification @cognized by NRC end a pMmptot attestation, or

dacclment8kicrn of training and exparietlce and a pncaptbr at@station, or

bE? listed as an authorized user in an FldC ar AgteeMant State license far the same type of uses for which tHb individual is seekirrg recogrrltlan.

Training and experience riaquiremen& for a physldlah who wants tls admlnistw radionuclides for irna.gltlQ and localizatlan Etludies are described In $0 CFR 35.290 which can be found 3t

htttx ~rl\nnruw. rirc.nu~mW i n d m W ~b-gal Iu&:iong/t$&aB03 6ha rtO3S2@3~. Utml

Gurrmt Wards recaprlizad by NRC can be found at:

0 2)

3)

USe the @!hclased NRQ Farm 313A to reswbmlt your arnendmant since Dr. Bechtkl cannot be naine as an alrtharirad user wlth the dacumerltdtiotl that y6u originally sent. Please also clarify whe'lhbr Dr. BescWtid Is a Doctor rrf Medicine (M.D.) or a Doctor af Osteopathic Medicine (DO.).

You rhay contact ml! dt 817-1360-8189 or by facsirnlie at 817-860-8263 if you have m y qu@stibri$ about this request.

Sincerely, ?-..

GRITMAN RADIOLOGY USNRC RIV

PAGE 03/04 PAGE BJ/BG

, .,. , " , , , .,% , , I , , , , I , _ W ' ' ' ' " ' " ' ' " & " " '

Far PhYRlciYns, Pmlldtrlats, akritists, Pharmacists - ShtB ur Teflitcsry Where Llctsnead

rlsta items 4 through I O d Wining or dlnlcsll rage Wrk required by 35.5D e ; IlJ seeking 36,200 authod2etlon: 35,3bt)(b)(11ii)(G); 36.396(d)(I) and 35.3 4d (6)/2);

b. CcirnpIPte items 6c (and I d whim tkirrlng is provided by an RSO, AMP, ANP, ar AW) and preckpfat ibms 11 b through I I d to meet requirements far: R80 In 3!3.50(~)(2) or 35.501e); or All in 35.290(c)(I)(ii)(Q) or 35,39O(b)(1)(!1)(Gj or 36,59D(e) or 35,89O(c); or AMP under 35"51 IC).

c, Cathplete Itwm 5, 6a. ob, I O , and Preceptor items 11w through 114 lib mwt AU rqulkmef& in 35.396(e).

Radiation PhysiCS dnd InstrUml;htation I

Chemlatry df Bypratlud Mat@rfal for Medical Use

OTHER

A PAGE i FRINT4D ON REGYELED PAPFA

11/14/2006 11 :51 2088836464

BozlrdCeirtifidDocs GRITMAN RADIOLOGY PAGE 04/04

Page 1 of1

'. 4

Dlegnastlc Radiolo& 06/O4/2003 - 12/31/20 13 Dlplarnate Self Rapafikd uatra

EbMCATltON: (1!398, MD)

LDCATZClNt Brained, MN

Abbreviation Explar.

thls prafile contains primary Source board certlflcatbn data. t3aardCettifietlDbcs has been designatdd by the ABMs as an Offlclal Display Agent and Is able to provide thls prlrnary sourc data on behalf of the AElhS. The ABMs has been designated a primary source of board certlflcation infomatlon by tho .lolnt CommiSstOn for Accreditation of Healthtare Organization (JCAWO), the National CoMmlttee far Quality Assurancs (NCQA) and URAC,

Copyrlght 02006 ElSevler Inc. and the Arnerlcan Board of Medical Speclalties, All rlghts reser

I . . C ,,

U . S . NUCLEAR REGULATORY COMMISSION Region IV

611 Ryan Plaza D r i v e , S u i t e 400 Ar l ington, Texas 76011

DIVISION OF NUCLEAR MATERIALS SAFETY

DATE/TIHE:

PRIORIlY :

Imnedi ate1 y

1 Hour

2-4 Hours

HESSA6E TO:

TELECOPY

CONTACT:

"BER: 208- 88 3-6 5 7/ VERIFICATION NUMBER:

SPECIAL INSlRUCTIONS/A7'rA~IirrMTS :

Transmitted and Verified by: DISPOSITION:

Return t o Originator:

M E DATE Place i n Hail :

Other:

TRANSMISSION VERIFICATION REPORT

TIME : NAME : FAX : TEL : SER. # :

10/31/2006 E39: 55 USNRC R I V 8178608263

BROL2J847623

DATE, TIME FAX NO. /NAME DURATION PAGE ( S ) RESULT MODE

10/31 E39:53 712088836571 00: 01: 59 06 OK STANDARD ECM

U. S. NUCLEAR REGULATORY COMMISSION Region IV

611 Ryan Plaza Drive, S u i t e 400

DMSION OF iWCLEAR MAmMALS SMETY Arl i r'tgton , Texas 7601 1

DATE/TIHE:

PRIOR In: Imedi ate1 y

1 Hour

2-4 Hours

RESA6E TO:

UNITED STATES

NUCLEAR REGULATORY COMMISSION R E G I O N I V

611 RYAN PLAZA DRIVE, SUITE 400 ARLINGTON. TEXAS 76011-4005

October 31 I 2006

Gritman Medical Center ATTN: Jeffrey W. Martin

700 South Main Moscow, Idaho 83843

President and CEO

SUBJECT: REQUEST FOR ADDITIONAL INFORMATION, LICENSE NO. 11-27337-01, DOCKET NO. 030-32281, CONTROL NO. 471 157

Your letter dated September 26, 2006 requesting to add Dr. Mark Bechtel to NRC License No. 11-27337-01 issued to Gritman Medical Center was received in this office on October 16, 2006. The revised medical training and experience regulations require a physician who wants to become an authorized user to have:

1) a board certification recognized by NRC and a preceptor attestation, or

2) documentation of training and experience and a preceptor attestation, or

3) be fisted a s an authorized user in an NRC or Agreement State license for the same type of uses for which the individual is seeking recognition.

Training and experience requirements for a physician who wants to administer radionuclides for imaging and localization studies are described in 10 CFR 35.290 which can be found at:

htt~://www.nrc.nov/readins-rm/doc-coliections/cfr/~artO35/~a~O35-0290. html

Current boards recognized by NRC can be found at:

http://www. nrc.aov/materials/m iau/med-use-toolkit/sPec-board-cert. html

Use t h e enclosed NRC Form 313A to resubmit your amendment since Dr. Bechtel cannot be name a s an authorized user with the documentation that you originally sent. Please also clarify whether Dr. Bechtel is a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.).

You may contact me at 817-860-8189 or by facsimile at 817-860-8263 if you have any questions about this request.

Sincerely, r'\

Roberto J. Torres, Senior Health Physicist Nuclear Materials Licensing Branch