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Application for Amend to License 20-00551-07,Authorizing Use of Xe

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Application for Amend to License 20-00551-07,Authorizing Use of Xe - , l f !', ; e * ' ] # "' ' Ferm AEC-313 '.'m ops".'ed- N') ' " ' " ' " * " " ' ' ' " ' ' ' ) APPLICATION FOR BYPRODUCT MATERIAL LICENSE l 1 INSTRUCTIONS.-Complete items I throui,h 16 if this is en initial application. If application is for renewel of a license, com- ) plete only items 1 through 7 and indicato new information et changes in the program os requested in items 8 through 15. Use supplementel sheets where necessary. item 16 must be completed on all applicetions. Mell three copies 'on U. 5. Atomic Energy D. C. Attention: Isotopes Branch, Division of Licensing end Reguletion. Upon opproval of this Commission,applicetion; the Washington opplicent wi 25, ll receive en AEC Byproduct Meterial License. An AEC Syproduct Meterial License is issued in accordance with the general requirements contained in Title 10, Code of Federal Reguletions, Port 30 end the Licensee is sub- iect to Title 10, Code of Federal Reguleelons, Port 20. l. (e) NAME AND ATRiti ADDatSS Of APPLICANT. (inefetufen, Arm, hospefoi, (b) STRit? ADDatS5(t5) AT WHICH SYPRODUCT MAfft|AL WILL Bt UltD. (if | , ej d.ae e.e som (.j s Richard Gorlin, M.D. Peter Bent Brigham Hospital g 721 Huntington Avenue . , Boston 15, Massachusetts . ; 1 2. OtPARTMENT TO USE BYPRODUCT MAftetAL 3. PetVIOU5 LICENSE NUMAER(5). (W Ihes es en opphcareen for renew.f..f a Cardiovascular Division ' Department of Medicine '"b'"" *E- ,7''"" Amendment I*"* ""d 6 '""(E64) """'" 8 , 4. D4DivlDUAL U5tt(5). (Nem. and es#8. of inde. dve#s) wh. N vs. er directly S. RADIATION PROftCTION OFflCER (Neme of person d.s.y es d es redesteen pre. i .,<.en om r .f e*, m.n .w...d.ms .- . .f he .,e , .,em.,,, ow .-. m , e e d An.h ,n, e . t.; I .Rd~ chm of 6ard''G'o''rEe., M.D. c -m=. - m s m. s -d 9.s ! . Asst. Professor of Medicine F 2 - ; - @ e'- " -4 f e l Harvard Medical School l - _- St'.- Associate in Medicine .- , ; Luther W. Brady, M.D. ' Peter Bent Brigham Hospityt1 ' t s. (.) SYPRODUCT MAfttlAL. (Elemenes (b) CHEMICAL AND/OG PHYSICAL FORM AND MAXIMUM NUM$tt Of AutLICutits OP EACH CHEM' CAL AND/OR PHYS. ! and mess number of each ) ICAL PORM THAT YOU WILL POSSESS AT ANY 094 TIME. (if se.Jos s.wrc.is), sis. sees none of - __' -:.., mesi.f ( number, numh.r .I a.wres and momemum actswty per source ) | hXenon-133 , Xenon 133 gas,1 curie (13 ml.) in 150 ml. metal - | cylinder (sealed source), supplied by: - | .- Union Carbide Nuclear-Company ' Oak Ridge National Laboratory - - - ' t - . PO Box X,.0ak; Ridge, Tennessee ' | l - ;. - . : : : _ ..- _ * ' ' - _ . 7. Descaise PUaPOSt FOR wHsCH SYPeODUCT MATERIAL WILL st U5tp. (W byproduct mes.r=# es for "homen ," suppi.e ne A (7,= AEC-313e; snuse b. som. ,s..a a se. .f me ,mr o m *. s . of 6,,,,ms.rt .f . so.aw s , a,* m. m.b. a m e n.m , .f s ,.,. s.n.m w .nd/s, . c. m wherh the sourc. w N b. sfered and/.c we f.) .. ..- , ; _ , I . - t .- . ., , r.; - i 7 '., ' ' , - } . , " y, , = . .- \\ } 0 r u - .r. w. = - e , s. -- 9505080113 941129 fy,s,M,,. y , d.;6d --a ] PDR FOIA ~~~~~ CASTRON94-111 PDR Icontin.,ed en .o rs. s.) - _ . ! F.,,n AE C-313 (5 58) Pop two TRAINING AND EXPERIENCE OF EACH INDIVIDUAL NAMED IN ITEM 4 (U .upps.mensat .h + .t n.c.nory) | 3. TYPE OF TRAirtNG DURATION OF ON THE JOS I WHERE TRAINED ggaiwing gc,,, g, ,,,,,,y FCIMs.Lg c,,c i, ,,,,,, COUR,SE p,.c,.ce. .e ..d. non Peter Bent Brigham Hospital 60 yrs | Princen and Y.. No Yn No j ,,,,.c,,nn ' 6. R.d.e.c . , m. men, .ondo,d.cobass. Gen. Hosp. Isotope 5/3 to n .d mon. o,.n i.chn. iv.. .no on.| Committee Lectures" Radio- 6/9/60 v. No v. No : aumea'. lisotopes & Radiological Halth No ve. No . .e m.o. , of ,.d.coc,...., c. Moth.motec. ond colcul.- hon bonec to the| |Ya 1 i ! No Ye. No .f ,ed. .on | e s,.io. cot .n.c | | | Yn 9. EXPERINCE WTTH RADIATION (Actual v.. of ,od.os.otop.. or .que.or.nr .sp.r nce.) mOTOPE I maximum AMOUNT | WHERE EXPERIENCE WAS GAINED } DURATION OF EXPERIENCE TYPE OF USE 1-131j30 max. IUS Naval Hosp., Portsmouth diagnostic studies of up to 100 ; Virginia ; caniiac function in- per patient! Peter Bent Brigham Hospital 6b years cluding blood volumes ; ' |' l 10. RADIATION DETECTION INSTRUMENTS (Use .upplemen,ol .heet. af aece..orr ) TYPE OF INSTRUMENTS NUMSE R RADIATION SENSITIVITY RANGE WINDOW THICKNESS USE (R,civa m.k. .nd mod.1 numbe, e earn) AYAllABLE DETE CTED (eng /cen') (Mon,#.reng, .vre.y ng. me v,eng) | (.nr / Ar) i portable survey meter #B81-1 gamma .02-25 gamma 860 ponitor, survey, ' measure scintillation probe beta 30 detector JS10-1 gamma decade-scaler B2105-1 gamma - measure i fi.1m badges ! 15 gamma measure | II. METHOD, FREQUENCY, AND STANDARD 5 USED IN CAU$4ATING IN5TRUMENT5 LISTED ABOVE. E-131. standards obtained from Nuclear Chicago . ' l | | TERS DURES USED. ofc h ,.c. .i .up h , | )11m2. FILM -bDC.E5 DOTeve,.gND SiO; ASSAY PSdO t . oges opea wee y tnroughF., $1,mnarvar e.og... T'.hmedYeale m,$.c h.adoo "L (..ng.use ord ~by a"L'l) personnel in area) INFORMATION TO BE SUBMITTED ON ADDITIONAL 5HEET5 | i2. FACitme5 AND EQUieMENT. D..... i. , e.c.i.. .no ..m . *.noone ..v .,m.ni . ,... c.n...n. .. .* ,.i.. eum. E., ion. , .. cn .e i.a..r i. .n.c a <C.,o. .n..e,) vo N. 5eo Form AEC 313a, G4C 44. RADIATION PROTECTION PROGA AM. De.c, m. ..d.oh.a p,.'.<'..n pro s 'n encivdeg cons,.i me...,... ee pol.c.. n c . .i.s .. se.. .ubmis le.k on .. n i. ....n .n.n e., .v .,. .. , i m. c.c .. .c..i.. nom. ...n.n.. ...nc. .e m i. 6 ... .nd .n. m.o.i .....o.n .c.ne. .n,-nc. .. ...e -,c.: As cutlined in Bureau of Standards Handbooh :"42 ' is. wA5ft DiSPO5At n . comm.....i ... d.. i .. .c. .. ... ,... .- .., nom. .. com n, . O., ..v.m ..a.. .c.,,,...n ., ,,, . ,cs .ii I n. v d e., d . .e ,.d. ci. ... .nd w M. .e . er a end . une .e .c y ' ,.d. I CERTIFICATE (This item must be completeel by applicent) j 16. THE s.PPLICANT AND ANY OFFICIAL EXECUTING THIS CERTIFICATE ON SEHALF OF THE APPLICANT NAMED IN ITEM 1, CERTIFV THAT THl1 APPLICATION 15 PilETARED IN CONFORMITY WITH TITLE 10. CODE OF FEDER AL REGULATON5T PART 30. AND THAT ALL INFORMATION CONTAINED HEREIN, INCLUDING ANY . I SUPPLEMENTSLubscribed ATT ano ACHED sworn MERETOto affirrnea) t1 TRUE (ANS CORRECT TO THE SE57 OF_OUll KNOWLEDGE, ANQ DELIEF before me thisMI day Of M&q; 1943 M,, t m L ij. u.. ; in the Ity Rp5 ton, County of Suffolk, e'8n= m 'M= 8 May 2 - os 'e Doe, umsmem a m chus - Syi - . A $< " m~/ .nNOTAstY i'n| 'PUBLIC - k MY COMMISSION EMtftES l AUGUST 2.1963 , i ? I , WARNIN'd.-18 U. 5. C., 5echen 1001; Act ce June 25,194 8; 62 Stat.14 9, me... .: o c,.m.nol oei.n.e v. moh. .ilievisy fois. ..... ment or =p,..enso%.n e. .ny 6.portment o, op.ncy of % unseed 59..e. o. to ony mener . then sv. p,i.dichon. | ..-..,v,.....,o.,,c. _ . 1 __ _ _ _ _ _ __ _ i %. - - """"5''"'''**'*'*C*"""'" 7.,m AEC-si 2 . n o-e n APPLICATION FOR BYPRODUCT MATERIAL LICENSE |''' *, s**.~. *. N. as.noso i ' ' ' ' ' ; SUPPLEMENT A-HUMAN USE Of byproduct mokr.ol is for " human use" (internal administration of byproduct motoriol, or the radiation therefrom to hu won beings), i complete this supplement and ottoch to the opplication for byproduct malereal license. 1. (.) USING PHY51CIAN'S NAmt (b) NAME AND ADDAESS Of APPLICANT (If d,A .n. 8,.m l|.)) Richard Gorlin, ':.D. 721 Huntington Avenue Boston 15. M ssachusetts 2. THE USING PHYSICIAN INDICATED A40vt 15 UCENSED TO DISPfM54 DAUG5 (N THE PRACTICE OF MEDICINE BY A STATI 04 TERRITORY Of THE UNITtD STATES THE OfstalCT OF COLumalA. OR THE COMMONWEALTH OF PUf RTO RICO. VES NO CfpCLf ANIWEA 3. A STATimf MT OF U54NG PHY51CIAN'S CUNICAL RADIOtSOTOPE EXPEtifNCE (PAGE 3 Of THIS SUPPLEntNT)15 5UtmifftD IN SUPPORT OF THis APPUCAtlON. IF AN5 wit IS fiQ, USE PAGE 2 OF THl5 5UPPLEMENT TO fEPLAIN OR refit TO OTHER APPUCAT40N OA YES NO | neLAftD DOCUMENTS ON WHICH THIS INPORMAftON APPtAAS. C.CLE AN5M4 PROPOSED DIAGNOSl5 OR TREATMENT 4. i.) DE5CRSE PURPO58 Poa WHICH SVPRODUCT MAff alAL WILL DE USED INCLUDING SPECIFIC CONDITIONS O! DISEASES TO St DLAGNO5ED Ot faEATED ! .,vr , (u : a Diagnostic: determination and other regional blood flows, ' residual volumes, cardiac outputs, in conditions of heart failure, valvular heart disease, coronary artery disease. (b) CHEwCAL FOtm ADwNISTERfD 1. application of Xe-133 will be identical with the already approved uses of Kr-35; no new or different use planned. Storageici De5 Cast mOCeDunes in lead-shielded wHiCH wilt u O.5eeviD enclosure 70 =Nimize HAzanD within P Om HANDuMG, exhaust STOaAGe, hoodg;AND 5POSAt OF all THe transfer svP=0 DUCT m4TeniAt. of gas to be performed within hood; gloves will be worn and discarded; syringes capped and transported in lead lined metal pan. After use syringes will be * 80 N HE PE 5i i AL 1NG5 arf 15 W (1) ATTACHED (UTERATURE REfftfNCf 5 WILL SUFFICEl Cl#CLE ANSWit (2) ON FILE wtTH THE ISOTOPts (KTENSION YES NO 9tFIR TO APPUCATION NO CMCLI AN5MR 5.
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