Download - Westwood Cardiology Associates, Amendment Request dtd …Hobbies: playing piano, classical music, playing tennis PROFESSIONAL EXPERIENCE 7/2004-Present 7/2001-6/2004 712002-712003

!,ECEIVED WESTWOOD CARDIOLOGY 'E';lgN -i

333 Old Hook Road Suite 200 Westwood NJ 07675

'05 FE5 -1 !$T :49 L i ce ns i ng Ass istan t Section Nuclear Materials Safety Branch U.S. Nuclear Regulatory Commission, Region I 475 Allendale Road King of Prussia, PA 19406-1415

Re: Notification NRC License # 29- 30454-01 I ) 3c) 3475q January 12,2005

Dear Sir / Madam

1. Addition of Michael Anshelevich, M.D., as an authorized user for Group II cardiovascular clinical procedures. Please find enclosed the following:

a. b. c.

Curriculum vitae for Michael Anshelevich, M. D. Institute for Nuclear Medicine Education Certificates. Preceptorship papers dated April 30,2004 signed by Mark I. Travin, M.D. , Director of Nuclear Cardiology Montefiore Medical Center. NYC facility license number 75-2885-01.

Please make this effective at both our facilities:

333 Old Hook Road Suite 201 Westwood, New Jersey

20 Prospect Avenue Suite 807 Hackensack New Jersey

Please contact Elaine Rovazzi, M.S., DABR, Physicist @ 973-322-51 18 if you need additional information. Thank you in advance for your assistance.

Administrative Director and Authorized User

i 46.lo-C NMSS/RGNI MATERIALS-002

CURRICULUM VITAE MICHAEL ANSHELEVICH, M.D., Ph.D.

'--..c- IC.-

Pager: Home Phone: -

E-mail: - BIOGRAPHICAL

Date of Birth: '-I Place of Birth:*

Children: - Hobbies: playing piano, classical music, playing tennis

PROFESSIONAL EXPERIENCE

7/2004-Present

7/2001-6/2004

712002-712003

6/1998-6/2001

3/1996-211997

911993-211997

Physician in Private Practice Westwood Cardiology Associates Westwood, New Jersey

Cardiology Fellow Montefiore Medical Center Albert Einstein College of Medicine of Yeshiva University Bronx, New York

Chief Cardiology Fellow Montefiore Medical Center Albert Einstein College of Medicine of Yeshiva University Bronx, New York

Resident in Internal Medicine Allegheny General Hospital MCP Hahnemann University School of Medicine Pittsburgh, PA

Medical Director Health Care Center, Medical Academy of Latvia Riga, Latvia

Head, Department of Cardiology Bikur Cholim Hospital Riga, Latvia PERSONAL I!JFORMATION WAS REMOVED

BY FW. NO COPY OF THIS INFORMATION WAS RETAINED BY THE NRC. i

Anshelevich CV, Page 2

211991-2/1997

EDUCATION

811 982-6/1988

National Coordifiator of the following International Multicenter Clinical Trials: FRAXIS (Fraxiparine in Unstable Angina Study) EMIP-FR (European Myocardial Infarction Project-Free Radicals) ESPRIM (European Study of Prevention of Infarct with Molsidomine) EMIP (European Myocardial Infarction Project)

Attending Physician Riga City Hospital #1 Riga, Latvia

Postdoctoral Fellow Department of Internal Medicine, Medical Academy of Latvia Riga, Latvia

Resident in Internal Medicine Medical Academy of Latvia Riga, Latvia

Medical Academy of Latvia Riga, Latvia M.D. Summa cum Laude 1988

MEMBERSHIPS

American College of Cardiology American Society of Echocardiography

LICENSURE EXAMINATIONS

USMLE Step I USMLE Step I1 USMLE Step I11 American Board of Internal Medicine

Date: 10/1997 Date: 3/1998 Date: 1211 998

Date: 8/2001


HONORS AND AWARDS

200 1

2000

1999

1995

1994

1993

1987

1986-1988

1984-1985

1986-1987

1985-1988

1983-1988

Winner of the U.S. National Medical Knowledge Challenge Tournament “Doctor’s Dilemma” (AGH Team) American College of Physicians

Winner of the Pennsylvania Medical Knowledge Challenge Tournament (AGH Team) American College of Physicians

Winner of the Pennsylvania Medical Knowledge Challenge Tournament (AGH Team) American College of Physicians

“The 20th Century Award for Achievement” International Biographical Center, Cambridge, UK

“The Distinguished Leadership Award” American Biographical Institute

Young Investigator Scholarship for Achievements in Medicine The Swedish Institute

Winner of the National Competition in Internal Medicine for Medical Students Ministry of the Higher Education

1 st Place Award in Latvian Students Competition in Internal Medicine Medical Academy of Latvia

1 st Place Award in Latvian Students Competition for the Best Research Work Ministry of the Higher Education of Latvia

2nd Place Award in Latvian Students Competition for the Best Research Work Ministry of the Higher Education of Latvia

State Scholarship for Outstanding Academic Achievements and Leadership

Medical Academy of Latvia

Honors and Awards of the Ministry of the Higher Education of Latvia for Academic Achievements


THESIS

Prehospital Thrombolytic Therapy in Patients with Acute Myocardial Infarction (Problems and Solutions). Defended in 10/95. Degree: Habilitated Doctor of Medical Sciences (equivalent to Ph.D.)

PUBLICATIONS

1. Gibson C.M., Anshelevich M., Murphy S.A., Luu L., Hynes C., Kliris J., Kermgard S., Otten M.H., Antman E.M., Cannon C.P., Braunwald E. for the TIMI Study Group. Impact of injections during diagnostic coronary arteriography on coronary patency in the setting of acute myocardial infarction from the TIMI trials. Am JCardioZ 2000;86: 1378-1 379.

2. Anshelevich M., Anshelevich J. Thrombolysis with bolus streptokinase in acute myocardial infarction. Proceedings of the Latvian Academy of Sciences 1999;53(3): 163- 167.

3. Boissel J.-P., Castaigne A., Mercier C., Lion L., Leizorovicz A. and the EMIP group. Ventricular fibrillation following administration of thrombolytic treatment. The EMIP experience. Eur Heart J 1996; 17:2 13-22 1.

4. Varshavsky S., Kuptsova A., Loginovskaya O., Bolobon S., Anshelevich M., Bzhelyanskaya V., Brenner T. Prehospital thrombolytic therapy in acute myocardial infarction. KardioZogiya

5. Anshelevich M. Prehospital thrombolytic therapy with streptokinase in acute myocardial infarction. Acta Medica BaZtica 1994; 1 (1):82-87.

6. European Study of Prevention of Infarct with Molsidomine (ESPRIM) Group. The ESPRIM trial: short-term treatment of acute myocardial infarction with molsidomine. Lancet

7. Anshelevich J., Kalvelis A., Anshelevich M. Current problems in classification of myocardial infarction based on clinical and electrocardiographic data. Latvian Physician 1993;3:284-286.

8. The European Myocardial Infarction Project Group. Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. N Engl JMed 1993;329:383-389.

9. Shatalin A., Anshelevich M., Khansone S. Unusual observation during resuscitation. Latvian Physician 1992;3 :259.

10. Anshelevich M., Pokrovskaya I., Shatalin A. "Blue Man" syndrome - side-effect of amiodarone therapy. Latvian Physician 1992;3 :26 1.

1 1. Anshelevich M., Sorokina T. Thrombolytic therapy of acute myocardial infarction. Latvian Physician 1 99 1 ; 3 : 3 1 -3 6.

12. Agranonik G., Anshelevich M., Khramkov V., Raibart J., Shusters A. Effects of nitroglycerin on the chronocardiodynamics and cardiokinetics of the anterior right ventricular wall as evidenced by radiokinetocardiography. KurdioEogiya 199 1 ;3 1(7):40-42.

13. Anshelevich M, Fedorovich M., Guzova V., Tarasyuk A. Thrombolytic therapy of acute myocardial infarction at the prehospital stage (the first experience). Latvian Physician

14. Anshelevich J., Agranonik G., Khermanis E., Shusters A., Anshelevich M. Time interval analysis of movement of the right ventricular anterior wall by noninvasive method of intrascopy - radiokinetocardiography. Human Physiology 1990; 16(2):65-70.

15. Dalmane A., Utno L., Anshelevich M., Ratobilsky V. The deep myocardial hypothermia: morphologic estimation. Proceedings of the Latvian Academy of Sciences 1988;4: 10 1 - 106.

1995;35( 1):4-8.

1994;344:91-97.

1990;6:19-21.


ABSTRACTS

1. Gibson C.M., Anshelevich M., Murphy S., Hynes C., Saunders T., Mesley R., Zemble R., Marble S.J., McCabe C.H., Cannon C.P., Braunwald E. for the TIMI Study Group. Is the diagnostic catheterization in acute myocardial infarction therapeutic? Rate of opening of closed arteries with diagnostic injections following thrombolytic administration in TIMI 1 OB and 14. JAm Coli Cardiol 2000;35(Suppl. A):363A. Presented at the 49th Scientific Session of the American College of Cardiology.

2. Anshelevich M., Anshelevich I., Kochkaryov F. Safety of a new accelerated streptokinase regimen in acute myocardial infarction. Eur Heart J 1996; 17(abstr. suppl.):203. Presented at the 18th Congress of the European Society of Cardiology.

3. Anshelevich M., Pokrovskaya I., Kozlov I. Long-term efficacy of prehospital thrombolytic therapy in acute myocardial infarction. Eur Heart J 1994; 1 S(abstr. suppl.):595. Presented at the Joint 12th World Congress of Cardiology and 16th Congress of the European Society of Cardiology.

4. Anshelevich M., Pokrovskaya I., Shatalin A., Kozlov I., Sorokina T. Efficacy of prehospital thrombolysis with streptokinase in acute myocardial infarction. Eur Heart J 1993; 14(abstr. suppl.):72. Presented at the 15th Congress of the European Society of Cardiology.

5. Anshelevich M., Pokrovskaya I., Shatalin A., Kozlov I., Liepa L., Anshelevich J. Prehospital thrombolysis in acute transmural myocardial infarction preserves left ventricular function. Journal of Heart Failure 1993; 1 (abstr. suppl.): 154. Presented at the 2nd International Symposium on Heart Failure - Mechanisms and Management.

6 . Anshelevich M. Prehospital thrombolytic therapy in acute myocardial infarction diminishes myocardial infarct size. Proceedings of the 2nd Congress of Latvian Physicians. Riga, 1993; 1 :22.

7. Anshelevich J., Anshelevich M., Kozlov I. Temporary pacing after prehospital thrombolysis in acute myocardial infarction. Proceedings of the 1st Baltic Sea Conference on Cardiac Interventions. Riga, 1993:58.

8. Anshelevich M. Intravenous bolus administration of streptokinase in acute myocardial infarction. Eur Heart J 1992;13(abstr. suppl.):423. Presented at the 14th Congress of the European Society of Cardiology.

9. Anshelevich M. Modified regimen of celiase administration in acute myocardial infarction. Current Problems in Cardiology. Riga, 1991 :23. Presented at the 4th Latvian Conference of Cardiology.

10. Anshelevich M., Shatalin A., Kozlov I., Paidere L. Effectiveness of therapy with celiase in early hours of acute myocardial infarction. Current Problems in Cardiology. Riga, 1991 :24. Presented at the 4th Latvian Conference of Cardiology.

11. Tarasyuk A., Anshelevich M., Shatalin A., Alka I. Side-effects and complications of thrombolytic therapy. Current Problems in Cardiology. Riga, 199 1:44. Presented at the 4th Latvian Conference of Cardiology.

12. Anshelevich M. Thrombolytic therapy by celiase in patients with acute myocardial infarction at the prehospital stage. Proceedings of the 1st Congress of Latvian Scientists. Riga, 1991;7:11.

13. Anshelevich M. Some aspects of differential diagnosis of B-cell lymphoproliferative diseases. Proceedings of the Joint Scientific Conference of Young Medical Researchers and Students of Latvia. Riga, 1988;II: 1 1.


14. Khramkov V., Agranonik G., Anshelevich M., Shusters A. Radiokinetocardiographic intrascopic noninvasive study of myocardial contractility. Proceedings of the 3rd Conference of Young Medical Researchers of Latvia. Riga, 1987: 191.

15. Anshelevich J., Agranonik G., Raibart J., Anshelevich M. Radiokinetocardiography - a new noninvasive method of evaluation of heart function. Current Problems in Internal Medicine. Tallinn, 1987:51-52. Presented at the 8th Estonian Congress of Internal Medicine.

16. Anshelevich M. Immunological characteristics of lymphoid cells in patients with absolute lymphocytosis. Modern Clinical and Experimental Aspects of Human Diseases. Riga, 1987:14.

17. Anshelevich M. New method of studying the function of the right ventricle of the heart. Modern Problems of Theoretical and Clinical Medicine. Grodno, 1986173-74.

18. Anshelevich J., Agranonik G., Raibart J., Anshelevich M. Radiokinetocardiography - new noninvasive intrascopic method of evaluation of the right ventricular function. New Methods of Diagnosis and Treatment, Comprehensive Investigations in Cardiology, Mass Screening, Prophylaxis of Arterial Hypertension and Coronary Heart Disease. Moscow, 1986:44. Presented at the 4th National Congress of Cardiology.

19. Anshelevich M. Effects of nitroglycerin on contractility of the right ventricle of the heart. New Aspects of Human Diseases. Riga, 1986: 1 1.

20. Dalmane A., Utno L., Anshelevich M., Ratobilsky V. Morphological changes in myocardium under deep hypothermia. Prophylaxis, Screening, Diagnosis, and Treatment of Cardiovascular Diseases. Riga, 1985:98-100. Presented at the 3rd National Conference of Cardiology.

2 1. Agranonik G., Anshelevich M. First results of clinical use of radiokinetocardiography. Prophylaxis, Screening, Diagnosis, and Treatment of Cardiovascular Diseases. Riga, 1985 : 7-8. Presented at the 3rd National Conference of Cardiology.

22. Anshelevich M. First experience in the clinical use of radiokinetocardiography. Clinical and Physiological Aspects of Adaptational Processes in Human Organism. Riga, 1985: 16.

23. Anshelevich M., Ratobilsky V. Morpho-functional characteristics of myocardium under hypothermia. Modern Aspects of Human Diseases. Riga, 1984: 10.

,'

L

L

D a n I -

D h

c In W W

m

- 0 N

Q. 0

I c a 0 I V w n

NUCLEAR MEDICAL EDUCATIQN PROGRAM Affidavit of Academic Completion & Competency

This docirment is lo oftest that

Micfiael Rnshelevich! MI> /ms successjdhy cov-rpleted the didactic pi*ogram

MEDICAL RADIATION INSTRUMENTATION and tm yrovtdpd euidetice ufattenrlalzce iri [his p o q m nnd errida1ce

&hievir,o the ob~ectives of this pi-ugrtznz IJzrozrgb emmination. 27zis program provides [he follou~irzg lads of ilccomplishnmit: a

4

4 5.0 Continumg Education Units (CEU) 50 Didactic htruchonal Hours OlHJ

In compliance wth 1OCFR35/ AEA 73-689 50 Board Accepted Hours NUSPEX, hrM’I%B lII b,

AE3hIIRs0, CBNC, tvl3V.B 3 .O Semesler Hoius American Council on

Education (ACE), American Association for

1

c Collegiate Registrars

- c/ Certifying Official b.-\

Date Completed Certification # Institute for Nuclear Medical Education

CertiFid, Approved nnd Regulated by the Division of Private Occupatid schools, Department of Higher Education in Colorado. Validated Lp the Accreditir\g F ( 6 &- Commissionof the Accredit3@hmcil forContinuingEdu~tion9’raining,a 1 l a t i O M l acuediting agencylisted by the USSrcrehryofEducatinn Validated by the Antedran Cuundl on Education, recol,;nired by the American Association for CoUegiate Regisban, Cuuncil on Pffil-Secondary Education. Licewed by NT\C g: ADeerno l l Staks. [I

h - 5

NUCLEAR MEDICAL EDUCATION PROGRAM - Affidavit of Academic Completion & Competency

Miefiael andielevich! MD

MEDICAL RAD1ATlON PROTECTION

This duccttriient is to ntlest thnt

hrrs srrccessfirll!y cniripleted the dickrctic pi*ogmnr

arid as pr ouirltrll evirience cfatfnidnrzce irz /his p opnm nird euiderrce 4ic\iimiiig tlie oLijectiw @t/Lis yrogt*nvi L/iroi.rgh emninnt icriz.

This progmii provides tliefollwznuing lm~els of nccoriipiislzrnent:

5.0 Cmtirtuing Education Umts (CEU) 50 Didachc Instructional Hours (DEI)

In compliance with 10CFR35/AEA 73-689 50 Board Accepted Hours NUSPEK, NMvfTCB UI b,

ABMRSO, CBNC, MRLB 3.0 Semester Hours American Council on

Educdhon (Am) , American Association for Collegiate Registrars . .

21 March 2004 2 0 2 1 8 0 Date Completed Certification

Institute for Nuclear Medical Education Certified, Aptttoved and Re,oulaled by t h e Division of Private Occupational Scliools, Department uf Higher Education in Colorado. Validated by the Accrediting C o d s i c n o f Ute Accwdilili&cuncd ~rCon~inrliREdocation’Traininasnationalaccredilingagency~fedLyLheUSSecrrelarynfEducation. Val jdatd by h e American

)E Counril an Dducation, recognized by the Arriericiui Association for Collegiate Registrars, Councll CUI Post Secondary Education Licensed by NKC - - k Ageemenl ~~ States. @J$

CERTIFICATE OF COMPLETION HAZMAT TRAINING - RADIOACTIVE MATERIALS

nfi A Has received trailziizp and has been tested

as i‘ required by 49CFR l72.704(4. This ,“e,- training was limited to diagnostic

radioactive nznterials received or offered for shipment in approved Type A

Packages, Class 7, UN2915, Yellow 11.

i A

22 April 2004

20201 1 Ce rtifi cation

Training Materials and Records are located at

IMME - Institute for Nuclear Medical Education 5660 Airport Boulevard, Suite 101 Boulder, Colorado 80301 (303) 541-0044 (303) ,s41-0066 FAX p (800) 548-4024 inme~nuclearc~diolng)..com ht~prl/\nvw.nuclearcIrdiology.comlncs

Ccrrification Board of Nuclcar Cardiology 9929 Main St.. Suiti: C

y Damascus, MD 20872

*'

TO whom It rnay concern

Tlus leiicr I S to document i11;it l iorl l l u l p 2001 to Jirilc 20(3-1. Dr. Michacl Aiishclc\'ich S ~ C I I ~ a loktl of 3 inonrlis panicipaling on the niiclciu cardiology scmicr: a1 blonlcfiorc Medical Chtcf . ih r ing LhIS tiJ1W

Dr. Anshclwich initrprcicd, tinder snpctvision. gcrlusion images and gated blood pool studies (using qualitaiivc and quantimive mc~liods or image display ii1K.l analys~s) or OVQ 900 paIicnLs. a1 least 30 of \vl~om had angiographic confmna[ioll. Tn Ihis dcpanincnt Dr. AnShdCViCh had over 700 hour5 of supeniscd clinical ;ind work cspcrieiice Iiandlirrg radiophiirma~~uticals, during whch IIC ordcrcd. rcceiilcd and unpacked radioactive malcrials and pcrtonncd rclatrd radiation surveys; prcforined qualilj. control proccdurcs I'or dose calibrators and performed chccks Tor proper opcralion of S U I V C ~ niciws. lcarncd LO use adinirtisualivc controls to prcvcnt a iiiediciil cvcnt involving usc ol byproduct iualcrials: lcarncd procedurcs io safely contaiil spilled radioactive rnalcrials using proper dcconwriinniion proccdurcs; lixnicd LO use elriling generator sysrei~s for preparation of radioactive dnigs: cxain~ncd pailenis and rmiewed hislorics to dc[crrninc the suitability for 11.1csc proccdurcs: sclcclcd thc d k t b l c radiopharmaceu~ical, calculated, 2nd iiieasurcd Lhc dose: idmiiiistered r,?diDpharinaccuticllls using a syringe shicld: collabocitod with. nn authorized USCT i n 11rc inlcrprctation of Lhe proccdurcs. and uscd thc illtcrprcration iii the managcmcn~ of paiicnrs. Dr. Anshclcvich lus providcd to MC doairncritation of Completion and Compctcncy i r i ;]TI outside Radiation Physics. Radiation [nsinimcntation. Radialiori Protectiorj. ;md K;ldioplialmaceuticals ;md Chemistry course (providcd by LIIC Insiitiitc for Nuclear Mcdical Educakiori), 3lld togcllicr with his tinic: here has ovcr 700 hours 01' diclacctic. clinic31 skid!. inrerprctation, and hands-on clinical c:m and radiation sdtty training in nuclcar cardiolosy.

Director. Nuclrar Cardiology Monicliore Medtcal Ccnter - Moscs Division Associare Profcssor of Nriclcir Mcdici tic and Mcdicinc Albcn EIIISIYO Collcgc of Medtcinc

F X J ~ I ~ I,isciisc Nurubcr KL?V Ysrk C I I ~ 75-2885-0 I

This is to acknowledge the receipt of your letter/application dated

includes an administrative review has been performed. I i I ni ao d , and to inform you that the initial processing which

application was assigned to a technical reviewer. Please note that the technical review may identify additional omissions or require additional information

c] 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 When calling to inquire about this action, please refer to this control number. You may call us on (610) 337-5398, or 337-5260.

3 @ill .( 3 .

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: 0 : Fee Category: 7C : Exp. Date: 20080731 : Fee Cormnents: : Decom Fin Assur Reqd: N ................................................. .................................................

LICENSE FEE TRANSMITTAL

A. REGION

1. APPLICATION ATTACHED Applicant/Licensee: WESTWOOD CARDIOLOGY ASSOCIATES Received Date: 20050201 Docket No: 3034754 Control No. : 136405

Action Type: Amendment License No.: 29-30454-01

2. FEE ATTACHED Amount : Check No. :

3. COMMENTS

Signed Date

B. LICENSE FEE MANAGEMENT BRANCH (Check when milestone 03 is entered /-/)

1. Fee Category and Amount:

2. Correct Fee Paid. Application may be processed f o r : Amendment Renewal License

3. OTHER

Signed Date

..

/