A!&X$ i?J May 30,2006 United States Nuclear Regulatory Commission Division of Materials Licensing 475 Allendale Road Region 1 L t 3li6.z 0 70 ?-7 22-c King of Prussia, PA 19406 p-=d Dear SirMadam, I am a board certified cardiologist who is in the process of opening my new office in Swedesboro, NJ and am applying for my NRC license. My office is scheduled to open on July 10,2006 and therefore I would greatly appreciate it if you could expedite my application. Thank you very much. Respecthll y , Vishal Bahal,DO,FACC
Transcript
A!&X$ i?J
May 30,2006
United States Nuclear Regulatory Commission
Division of Materials Licensing 475 Allendale Road
Region 1 L t 3li6.z 0 70 ?-7 22-c
King of Prussia, PA 19406 p-=d
Dear SirMadam,
I am a board certified cardiologist who is in the process of opening my new office in Swedesboro, NJ and am applying for my NRC license. My office is scheduled to open on July 10,2006 and therefore I would greatly appreciate it if you could expedite my application. Thank you very much.
Respecthll y ,
Vishal Bahal,DO,FACC
i C FORM 313 U.S. NUCLEAR REGULATORY COMMISSION b2005) CFR 30, 32.33, ,35,36,39, and 40
RADIOACTIVE MATERIAL a. Element and mass number; b. chemical andlor physical form: and c. maiximum amount
INDIVIDUAL(S) RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING EXPERIENCE.
which will be possessed at any one time.
APPLICATION FOR MATERIAL LICENSE
6. PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED.
8. TRAINING FOR INDIVIDUALS WORKING IN OR FREQUENTING RESTRICTED AREAS.
APPROVED BY OMB: NO. 3150-0120 EXPIRES: 101311200t Estimated burden per response to comply with this mandatory collection request: 4.L hours. Submittal of the application is necessary to determine that the applicant is ya l i f ied and that ade uate procedures exist to protect the public health and safety
end comments re ar8ing burden estimate to the Records and FOlNPrivacy Services Branch (T-5 F53), 8s. Nuclear Regulatory Commission, Washington, DC 20555-0001 or by internet e-mail to [email protected], and to the Desk Officer, Office o Information and Regulatory Affairs, NEOB-10202. (3150-0120). Office of Managemen and Budget, Washington, DC 20503. If a means used to impose an informatior collection does not display a currently valid OM6 control number, the NRC may no conduct or sponsor, and a person is not required to respond to, the informatior collection.
iRTlFYlNG OFFICER -_ TYPEDPRINTED NAME AND TITLE
ISTRUCTIONS: SEE THE APPROPRIATE LICENSE APPLICATION GUIDE FOR DETAILED INSTRUCTIONS FOR COMPLETING APPLICATION. END TWO COPIES OF THE ENTIRE COMPLETED APPLICATION TO THE NRC OFFICE SPECIFIED BELOW.
DATE
'PLICATION FOR DISTRIBUTION OF EXEMPT PRODUCTS FILE APPLICATIONS WITH:
'PE OF FEE
DIVISION OF INDUSTRIAL AND MEDICAL NUCLEAR SAFETY OFFICE OF NUCLEAR MATERIALS SAFETYAND SAFEGUARDS
FEE LOG FEE CATEGORY AMOUNT RECEIVED CHECK NUMBER COMMENTS
~. - US. NUCLEAR REGULATORY COMMISSION WASHINGTON, DC 20555-0001
'I 16 'PROVED BY
.L OTHER PERSONS FILE APPLICATIONS AS FOLLOWS:
DATE
YOU ARE LOCATED IN:
ABAMA, CONNECTICUT, DELAWARE, DISTRICT OF COLUMBIA, FLORIDA, GEORGIA, :NTUCKY, MAINE, MARYLAND, MASSACHUSETTS, MISSISSIPPI, NEW HAMPSHIRE, NEh IRSEY, NEW YORK. NORTH CAROLINA, PENNSYLVANIA, PUERTO RICO, RHODE LAND, SOUTH CAROLINA, TENNESSEE, VERMONT. VIRGINIA. VIRGIN ISLANDS. OR EST VIRGINIA, SEND APPLICATIONS T O
LICENSING ASSISTANCE TEAM DIVISION OF NUCLEAR MATERIALS SAFETY U.S. NUCLEAR REGULATORY COMMISSION, REGION 1 475 ALLENDALE ROAD KING OF PRUSSIA, PA 19406-1415
IF YOU ARE LOCATED IN:
ILLINOIS, INDIANA, IOWA, MICHIGAN, MINNESOTA, MISSOURI, OHIO, OR WISCONSIN, SEND APPLICATIONS T O
MATERIALS LICENSING BRANCH US. NUCLEAR REGULATORY COMMISSION, REGION 111 2443 WARRENVILLE ROAD, SUITE 210 LISLE. IL 60532-4352
ALASKA, ARIZONA. ARKANSAS, CALIFORNIA, COLORADO, HAWAII, IDAHO, KANSAS, LOUISIANA, MONTANA, NEBRASKA, NEVADA, NEW MEXICO, NORTH DAKOTA, OKLAHOMA OREGON, PACIFIC TRUST TERRITORIES, SOUTH DAKOTA. TEXAS, UTAH, WASHINGTON, OR WYOMING, SEND APPLICATIONS TO:
L t 3 / / & 2
ARLINGTON, TX 76011~005 o*-
~RSONS LOCATED IN AGREEMENT STATES SEND APPLICATIONS TO THE us. NUCLEAR REGU~TORY COMMISSION ONLY IF THEY WISH TO POSSESS AND USE LICENSED 4TERIAL IN STATES SUBJECT TO U.S.NUCLEAR REGULATORY COMMISSION JURISDICTIONS.
THIS IS AN APPLICATION FOR (Check appropriafe item) 5 A. NEWLICENSE
0 6. AMENDMENTTO LICENSE NUMBER
C. RENEWAL OF LICENSE NUMBER
ADDRESS WHERE LICENSED MATERIAL WILL BE USED OR POSSESSED 4. NAME OF PERSON TO BE CONTACTED ABOUT THIS APPLICATION
SfiIJ&CkW
TELEPHONE NUMBER
{Go?) k S - L 3ta4
FACILITIES AND EQUIPMENT. 110. RADIATION SAFETY PROGRAM.
~~~ ~~~ ~
. CERTIFICATION. (Musf be completed by applicant) THE APPLICANT UNDERSTANDS THAT ALL STATEMENTS ANoREPRESEMnTlONS MADE IN THIS APPLICATION, 'ON 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 CONFORMITY WITH TITLE 10, CODE OF FEDERAL REGULATIONS, PARTS 30,32.33,34,35,36,39, AND 40. AND THAT ALL iNFORMATlON CONTANED HEREIN IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE AND BELIEF.
WARNING: 18 U.S.C. SECTION 1001 ACT OF JUNE 25,1948 62 STAT, 749 MAKES IT A C RlMlNAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANY DEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANY MATTER WITHIN ITS JURIS DICTION.
’ Vishal Bahal, D.O. NRC License Application May, 2006
ITEM 5: RADIOACTIVE MATERIAL
B yproduct Material ChemicalPhysical Form
Any byproduct material permitted by 35.200
Maximum Amount
As needed
ITEM 6: PURPOSE(S) FOR WHICH LICENSED MATERIAL WILL BE USED
10 CFR 35.200 Any imaging and localization study permitted for the purpose of cardiac function analysis.
8 Vishal Bahal, D.O. NRC License Application May, 2006
ITEM 7: INDIVIDUALS RESPONSIBLE FOR RADIATION SAFETY PROGRAM AND THEIR TRAINING AND EXPERIENCE
RADIATION SAFETY OFFICER
Vishal Bahal, D.O.
AUTHORIZED USERS
Vishal Bahal, D.O.
See attached
See attached
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VIS€€AL BAHAL, DO, FACC 31 1 Belrnont Court
MuUica Hill, NJ 08062 (H} 856-223-9544 (F) 856-223-9545
vicbahaGh 0tmail.com
OBJECTIVE To work as non-invasive and invasive (non-interventional) Cardiologist.
ACADEMIC PREPARATION
07/99-07/02
07/97-01 / 98
06/94-06/97
06/ 93-06/ 94
09/89-06/93 09/85-06/89
Delwrtah H e a r t and Lung center, Bmwn M a s , NJ - Cardiovascular Diseases Fellowship. Un.ive&tg of lZZinocS, Chicago, 11- Cardiovascular Diseases Fellowship AIkgheng University H a s p i M pahnemann Uniuersitry Ho@mI) Philadelphia, PA- Internal Medicine Residency Uniuetsily of biledtdne and Ventistzy of New w, Straeord, NJ - Rotary Internship. Phi lade lph ia CoLZege of OsteopaUric M d c i n e , Philadelphia, PA-DO Urdnus College, C o U e g d U e , PA-BS., Biology
CERTIFICATIONS Board Certified American Board of Internal Medicine Board Certified American Osteopathic Board of Interndl Medicine Board Certified American Board of Cardiology
LICENSES State of New Jersey Medical License (07/99-Present) State of Pennsylvania Medical License (10/94-Present) State of Delaware Medical License [Pending) State of Illinois Medical License (07197-07/99] Federal Drug Enforcement Agency License (10/94-Present)
RESEARCH EXPERIENCE
A l t e g h g Univasity Hospitul(16lahnemann Uniwmsitg Xospitall), Division of Cardiology. Conducted research on the role of platelets in intq+vascdar thrombogenesis post angioplasty.
SmWtkZfne Beecham, King of Prussia, PA, Division of Molecuk Biology. Worked as a research assistant on the development of protease-inhibitor in the Human Immunodeficiency virus (05/90-8/90]
Advanced CardWogg of South JerSeg,InC, swedesbor% NJ President, CEO, Non-invasive and Invasive cardioIo@st. Internal Medicine associates, PA., Bridgeton, NJ Non-invasive and Invasive cardiologist. West Chester cardiology, West Chester, PA Non-invasive and Invasive cardiologist. Robert W d Jbhnson €€ospituL at WamtEton, Hamilton, NJ House Physician, ICU/CCU/Medid Holy Redeemer libSp.itar2 and Ilbdkal Center, Philadelphia, PA House Physician, ICU/CCU/Medid Kzricbride center, Philadelphia, PA General Internal Medicine Physician, Addiction Medicine, Psychiatric Disorders St. hrutds Hospital , Evanston, IL House Physician Cardiovascular Surgical Heart Unit, Telemetry, Post
Fencot Lakeshare Hospital, Chicago, IL House Physician ICU/Medical Holy Redeemer HospitaZ and Medical Center, Philadelphia, PA House Physician, ICUjCCU/Medical Ncrzareth HospitaL, Philadelphia, PA House Physician, ICU/CCU/Medical lldercy Haoerford Hospital, Haverford, PA House Physician, ICUjCCUIMedical F a m i @ Mediche ofLiOnvfZ&, Lionville, PA Adult/Pediatric Family Medicine Temple UaiverSity Hospital, Philadelphia, PA Dept of Clinical Chemistry, Medical Technician phiwerphia Coglkge of Osteopathic M d M n e , Philadelphia, PA Dept of Internal Medicine, Diabetes Educator SmWaklZne Beecham, Animal Health Division, West Chester, PA ' I k h n i C d Writer. Wrote summary reports on New Animal Drug Applications for the Food and Drug Administration
Angioplasq unit
ACADEMIC APPOINTMENTS
10/04-Present U r ~ k r s i t g of bpedicine and Den#stry of New Jetsey Robert W w d Johnson Medical S c h Z , New Brunswick, NJ C l i n i d Assistant Professor Medicine, Cardiology Division
ultrrtsaund Mugnostic Schoshs, Trevase, PA Medical Director, Cardiovascular Division
03/ 02-Present
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07/02-10/03 Chester County HospitaZ, West Chester, PA Attending Cardiologist, Invasive/Non-Invasive
07/02-10/03 Chester County Hoqpital, West Chester, PA Stroke Committee
07/02- 1 O/ 03 Chester County Hospital, West Chester, PA Intensive Care Unit Committee
HONORS
Who’s Who in Medicine and Healthcare Who’s Who in Science Who’s Who in America Outstanding Achiever of the 2 1st Century- International Biographical Center, Cambridge, England =-Beta Honorary Biology Society Officer of Brownback-Anders Medical Society, Ursinus College (6188- 6/89)
PROFESSIONAL MEMIBERSHIPS
American Medical Association American Osteopathic Association American College of Cardiology American Society of Echocardiography American Society of Nuclear Cardiology American College of Physicians-Society of Internal Medicine Fellow American College of Cardiology Fellow American College of Angiology Founding Member Society of Cardiovascular Computed Tomography New Jersey Association of Osteopathic Physicians and Surgeons Pennsylvania Medicdl Society Diplomate American Board of Internal Medicine Diplomate American Osteopathic Board of Internal Medicine Diplomate American Board of Cardiology
AVOCATIONS Aviation, tennis, golf and travel
CITUENSHIP
United States of America
REFERENCES
Availqble upon request
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.*.om.... ’ .*.**... 0.. I .... .e.. .... Cooper Heart Institute1 University Cardiology 3;;; .... .... .*.e e..* 4.4. Nuclear Cardiology and Exercise Laboratories
Certification of Competency and Completion of Training Requirements
Ceflification Board of Nuclear Cardiology 9929 Main Street - Suite C Damascus, MD 20872 ‘ Phone: 301-253-7122 Fax: 301 -253-7123 E-mail: [email protected]
Date? 2/2 0 7 Re: Vishal Bahal -
This letter certifies that Dr.Bahal completed a fellowship training program in nuclear cardiology that meets or exceeds the requirements outlined in the American College of CardiologylAmerican Sodiety of Nuclear Cardiology COCATS Guidelineg‘(as revised in 2000).
Dr. Bahal has achieved a level of competence suffidient to function.independently as an authorized user for the medical uses authorized under NRC 35,290 [Training for imaging and Localization Studies].
1. ’ ../ :{ ;>s- “.il,,,(2,:I\~:.... i’ y. - : 7 r ; . i p:.:.. :. !!; j i Y ’*
Dr.Bahal outlined in the ACCIASNC COCATS Guidelines (as revised in 2000).
Dr. 5ahal includes: a.) radiation physics and instrumentation b.} radiation protection c.) radiation safety d.) mathematics pertaining to the use and measurement of radioactivity e.) chemistry of byproduct material for medical use f.) radiation biology As well as sufficient interpretation of ciinicai cases and hands-on experience as outlined in the ACCIASNC COCATS Guidelines (as revised in 2000)
Sincerely. - #
has €raining and experience equivalent to Level 2 Training in Nuclear Cardiology as
has satisfactorily completed at least 700 hours of didactic training or work eKperience which
ugusti Director, Nucl&r Cardiology and Exercise Labs Cooper Health System - RWJ Medical School Camden, NJ 08103 NRC License # 29-06285-01
856-223-9545 P.4 may LL Ub UY:lb'a Ur. Vishal Bahal
-: ., .
March 18; 2004
Augusrine Aqocha, M. D, . , FACC 990 Centenzial Dculevzrd Suite €2 Vclclrhees , NJ 0 8 0 4 3
EeaY Pr. Agocba: .
This letter is t3 2 f f i m t h a t 'vishal 3aha1 , . J.O., FACC was' . ' on t h e Medical S t e f f a t The Chester County Ycspi ta l f f ~ ; 1 SepLember 2002 to December 2003. parzFc.i?ated in ar?d .ir,terpret-ed 40E . . m ~ ~ l ~ a r f?y?vio,w sc1,-ns- !gated studies). 14G Cardialire scans (gated> a n d abcuc l r 3 T h a l : l i u m s t u d i e s . at the h o s p i t a l . accumulated 65l hours in w c r k ox2ericnzt with raBiat - ion. He also -has taken a 50 hour didsct ic cbursc , isl Nuclear C~rdiolosy. In my opLr-ian, he has satizfactorily coxpleced the requirements o f TQ CPR 95.230 ar-d a level of.competency sGfficient ta fucction independently iis zn ai l t jor ized us'ei. for the meCical ~ s e s authorized, under 10 CFR 33.209 !linFLed to cardiovascular clinical proceduresl .
.
Durir,g t h a t t i r w - h e . I .
In a d d i t i o n , he 'also
The w t a l hours of coxurren; trainiRg and mxperience v8.s 710 hcur2. hesitate to cor;czct me.
If you have any questims, please da mt
may LL ub U Y : ’ I / ~ Ur. Vlshal Bahal 856-223-9545 P.5
BSSOClflTEf Iff HEDICfiL PHYSICS, A NATlONAL MEDICAL PHYSICS CONSULTTHC GROUP
LLC
NATIONAL OFFICE: 5283 TRANSPORTATION BLVD. www.medo hvsics.com
has completed all reqnirements for the Nuclear Licensing Course for Physicians. Associates in Medical Physics, LLC designates this continuing medical education activity for 30 credit hours in Category 1 of the Physician’s Recognition Award of the American Medical Association.
Dates attended:
AD^ 23-25.2006
I
Director of Training April 25,2006
Date
Associates in Medical Physics, LLC is accredited by the Accreditation Council for COntinUing Medicd Education to sponsor continuing medicdl education for physicians-
NATIONAL OF PICE : 5288 TRANSPORTATION BLVD. CLEVELAND. OH 44125 www.mcdphysics.com
. . . .
This is to certSy that
PHOW: (216) 663-7000 FAX: (216) 581-4361 V M: (800) 709-4855
VisM BahaI. D.O.
has completed all requirements for the Nuclear Physician Licensing Course. As-- in Medical Physics. LLx= designates this continuing medical education activity for 50 credit hours in Category 1 of the Physician's Recognition Award of the American Media Association.
Dates attended.
February 9-13.2004
February 13,2004
Date
Associates in Medical Physics, LLC is accTedited by the Accreditation Council for Continuing Medical Education to sponsor continuing medid education for physicians.
P.2 856-223-9545 ivray LL ub UY:Y% ur. ViShal Bahal
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US. NUCLEAR REGULATORY COMMISSON SUPPLEMENT B
PRECEPTOR STATEMENT
Scrpprement B m w be wrn- by the aj?O&V3r p h y ~ a n ’ s p m c e p m f ~ lfmwe lhan me p-eceptoris newsSary to docvment mpwima. abtein a separnte statemenf fmm ea?&.
1 PROPOSED PHYSICIAN USER% NANn AND AilMlESS FULL NAME
Vcshal Bahal, D.O.
STREET ADDRESS
CrrY STATE ZlP CODE
Z CUNlCAL T W N W G AND EXPERIENCE Of ABOVE NAMED WSICIAN
X
I
I I
UI. VIS l l? l l DSlllSll U30-LLJ-Y343 P.4 I V l U J LL vv v.7.-KJa
I. W E OF INSMUTlW
t. W I N G AOMIESS Associates in Medical Physics, LLC
5288 TransDortation Boulevard
Cleveland, Ohio 44 i 25 d. CM
- 7. PREcmoWs NAME - m o r c r i a
Frank Bloe, DABSNM, DABMP
a OATE
February 13, 2004
1. MATERIALS LICENSE NUME.EA(Si
34-25645-02
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' Vishal Bahal, D.O. NRC License Application May, 2006
ITEM 9: FACILITY DIAGRAM
I - - 1 1 L O O
A
I I-
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3 0 e
Vishal Bahal, D.O. NRC License Application May, 2006
ITEM 9: RADIATION MONITORING INSTRUMENTS
Radiation monitoring instruments will be calibrated by a person qualified to perform survey meter calibrations. We have developed and will implement and maintain written survey meter calibration procedures in accordance with the requirements in 10 CFR 20.1501 and that meet the requirements of 10 CFR 35.61. We have a Ludlum 14C with 44-9 probe Geiger counter survey instrument. We reserve the right to upgrade our survey instruments as necessary as long as they are adequate to measure the type and level of radiation for which they are used. We will have a Capintec CRC-15W dose calibrator and well counter with multi- channel analyzer.
ITEM 9: DOSE CALIBRATOR
The Capintec CRC-15W will be calibrated in accordance with manufacturer’s instructions or nationally recognized standards.
ITEM 9: OTHER EQUIPMENT AND FACILITIES
We have necessary shielding and remote handling implements to maintain exposures ALARA. No, Xe 133 or Mo 99 generators will be used at this facility.
Vishal Bahal, D.O. NRC License Application May, 2006
ITEM 10: RADIATION PROTECTION PROGRAM
OCCUPATIONAL DOSE:
Either we will perform a prospective evaluation demonstrating that unmonitored individuals are not likely to receive, in one year, a radiation dose in excess of 10% of the allowable limits in 10 CFR Part 20 or we will provide dosimetry that meets the requirements listed under “Criteria” in NUREG- 1556, Vol. 9, “Consolidated Guidance About Materials Licenses: Program-Specific Guidance About Medical Use Licensees,” date October 2002.
AREA SURVEYS:
We have developed and will implement and maintain written procedures for are surveys in accordance with 10 CFR 20.1101 that meet the requirements of 10 CFR 20.1501 and 10 CFR 35.70.
SAFE USE OF UNSEALED LICENSED MATERIAL:
We have developed and will implement and maintain written procedures for safe use of unsealed byproduct material that meet the requirements of 10 CFR 20.1 101 and 10 CFR 20.1301.
SPILL PROCEDURES:
We have developed and will implement and maintain written procedures for safe response to spills of licensed material in accordance with 10 CFR 20.1 101.
MINIMIZATION OF CONTAMINATION:
Adherence to the procedures outlined within this application will adequately protect the facility and environment from contamination as well as minimize the generation of radioactive waste.
Vishal Bahal, D.O. NRC License Application May, 2006
ITEM 11: WASTE MANAGEMENT
We have developed and will implement and maintain written waste disposal procedures for license material in accordance with 10 CFR 20.1101 that also meet the requirements of the applicable section of Subpart K to 10 CFR Part 20 and 10 CFR 35.92.
This is to acknowledge the receipt of your letter/application dated
, and to inform you that the initial processing which includes an administrative review has been performed.
D& L ~ c B U J . t r @ P P U W T & & ~0?0772-2/3 1 O / 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.
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 /39F& ,
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)
(6-96) Sincerely, Licensing Assistance Team Leader
BETWEEN :
License Fee Management Branch, ARM
Regional Licensing Sections and
.. . .
(FOR LFMS USE) INFORMATION FROM LTS
Program Code: 02201 Status Code: 3 Fee Category: Exp. Date: 0 Fee Comments: Decom Fin Assur Reqd: - ............................................... ...............................................
LICENSE FEE TRANSMITTAL
A. REGION
1. APPLICATION ATTACHED Applicant/Licensee: BAHAL, VISHAL, D.O. Received Date: 20060601 Docket No: 3037221 Control No.: 138914 License No.: 2?-31/6Z-d Action Type: New Licensee
2. FEE ATTACHED f ill 3-e- fx3 Amount :
Check No. : ??a 3. COMMENTS
B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered /-/I
1. Fee Category and Amount:
2. Correct Fee Paid. Application may be processed for: Amendment Renewal License
