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January 5. 1988' '

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W ..U.S.: Nuclear' Regulatory Commission- if" . . P " ---~~-

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Materials? Branch- ; ---

.~Divisi6niof!' Materials and_ Fuel Cycle ;

3: g ~;~ ^Facil'ity Licensing =f ----

;.Regi on . l l!L M j

'd99~ Roosevelt' Road- f

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CQ'RE: 1.scense #34-10921-03- - +--- c _:., .

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1-: Dear; Sir ~ '

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'-This letter!isdo amend our current list of authorized' userson Materials. License #34-10921-03. I'wish to add

. Mary Margaret Knoedler,'M.D. as a user.of Groups 1-V: Materials.;..Please.... find'two copies of' Supplement A - Training and Experience-Land Supplement B Preceptor Statement. I have also enclosedcopies of'Dr. Knoedler's Ce*tification by' the American Board ofRadiology.

1.would also like to add Sun 0. Sim, M.D..to the above, ,

.. license as a Group VI-user. Dr. Gim is currently'a_ Group'VI user' ~

=on License #21-04515-01, Amendment #61, of'the'Dakwood. Hospital,-18101,Oakwood Boulevard, Dearborn. Michigan 48123-2500. .Please-Mind two copies of Dr. Sim's Board Certification as well.

If any-other information is required'concerning thesephysicians, please contact me..

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T- cra' ccm

Siyterely yours,._7 % $ ''

8902140087 880201 |,

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-0 3 PNU El;l'Rubenstein/M.D.,R.S.D.DirectorEcf Nuclear Medicine

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I: / Attachments T C'El V E C 3 gg"

hJAN 131988

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~""i on* esdaOakikspital 619 Oak Street Cincinnati, Ohio 45206-16(X)<a ;

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+oae NRC 313M SUPPLEMENT A U.S. NUCLE AR REGULATORY COMMISSION*

TRAINING AND EXPERIENCEAUTHORIZED USSR OR RADIATION SAFETY OFFICER

1. IvAME OF AUTHORIZED USER OR RADIATION SAFETY OFFICER 2. STATE OR TERRITORY IN'

WHICH UCENSF D TOPRACTICE MEDeCtNEg $&bSLT N'/II t/ES OTAI Iri AtDtYlbA > 0|N|0ASY /i

'3. CERTIFICATIONSPECIALTY EOARD CATEGORY MGNTH AND YEAR CERTIFIED

A B C

. D I b h & C .b ? | (. .$ Mh|$, |$ r 750

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4. TRAINING RECElVED IN BASIC RADIOISOTOPE H ANDLING TECHNIOUESs

*TYPE AND LENGTH OF TRAINING

LECTURE / SUPE RVtSEDFIE LD OF TRAINING LOCATION AND DATE(S) CF TRAINING LABORATORY LABORATORY

A B COURSES . EXPERIENCEIHours) (Hourst

C D

Univ of Mx, klpt se. R ADI ATION PHYSICS AND h )-

INST RUME NT ATION

!b. R ADI ATION PROTECTIO *.*

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c. MATHEMATICS PERTAINING TO-

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al. RADI ATION BIOLOGY D l

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e. R ADIOPH ARMACE UTIC AL // jgCHEMISTRY

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E. EKFERIENCE W|TH R ADI ATION. (Actustust of Radioisotopes or Equivalent Experience) j

ISOTOPE MAxlMUM AMOUNT WHERE EXPERIENCE WAL CAINED DURATION OF EXPERIENCE TYPE OF USE

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E, PRECEPTOR STATEMENT (Continued)

} 2. CLINICAL TR AINING AND EXPERIENCE OF ABOVE NAMED PHYSICIAN (Coritinued/

NUMBER OFCA&ZS INVOLVINO COMMENTS

ISOTOPE CONDITIONS DI AGNOSE O OR TRE ATED PE RSON AL (Aswericmat en formesion or eswv mens erwr erPARTICIPATION auerrwred sn abphese an apparew 8herILi

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P 32 TRE ATMENT OF POLYCYTHEMIA A VE R A,isoebel LEUKEMIA, ANO BONE METASTASES

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TRE ATMENT OF HYPERTHYROiotSM fAu- 198 INTR AC AVIT ARY TRE ATME NT -

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St 90 TRE ATMENT OF EYE DISE ASE

RADIOPHARMACEUTICAL PREPARATION

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4. THE TRAINING AND EXPERIENCE INDICATED ABOVE E PRECEP GNATURE

WAS OBTAINED UNDER THE SUPERVISION OF:& NAME OF SWPE RVi&OR

/MM ,Robert J. Boudreau, M.D. , Ph.D.;a6 =AME or issT TuTso" I. PRECEPTOR'S NAME Peaw type erannt)

University of Minnesota Hospital Robert J. Boudreau, M.D., Ph.D.Associate Professor and Director." ~ s. M Asumo apoREss

Box 382, 420 Delaware St. S.E. Division of Nuclear Medicinea Csty B. DATE

Minneapolis, Minnesota 5545512/22/87s. uATERi ALs ucENsE NUMBE R($3

22-00218-299 04M NRC-313M&vPP LE ME NT Ses-?os Page 7

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U. S. NUCLEAR REGULATORY COMMISSIONUPPLEMENT B,,y

s,e,I PRECEPTOR STATEMENT

L, pre,ement E msst te compteir3 at the sooticent physician's preceptor. If snore than one preceptoris tuecessary to docurnentopr >ce, cou n o secerete stsrernent from esen.rKEY TO COLUMN C

g, APPLIC ANT PHYSICI AN'S N AME AND ADORESSPE RSON AL PARTICIPATION SHOULD CONSIST OFi

Egguavg 14upervised eumination of patients to determine the suitability for

f/ redelsotope diegnosis and/or t'setment and recommendation for

MY M M N IVt/D t-WM prescribed donego,

noneboration in .os. .env tion end.etuer e mininreion t ecee~ M " ^ a "' "s to the petient inciueno rsiewistion of sne racission sose,related5

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2924 Oycloram>9 L)ni ur 3 Adsouste period of training to enable physician to menege radioactimCITY / | $T ATE { ZIP CODE petients and follow petsents througn d.sge.osis and/or course of

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0-1de o NWATI OM/O .!/ Ql/2. CLINICAL TR AINING AND EXPERIENCE OF ABOVE N AMED PHYSICIAN

NUMBER OF l COMMENTSCASES INVOLVINGPE RSON AL (Aaastiame/ in formation or commen n mey

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