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U.S. NUCLEAR REGULATORY COMMISSION } } gp

License number ii

f! 34-19119-01MATERIALS LICENSE" * * " " " " " * '

! SUPPLEMENTARY SHEET pi 030-16096 g, |f )f Amendment No. 104

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! Krause, Lubert & Associates, Inc.Mt. Sinai Medical Building

| 26900 Cedar Road g! Room 129

F:i. Beachwood, OH 44122

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$ In accordance with NRC Form 314 '' Certificate of Disposition" dated September 7,1994 [h and the issuance of Amendment No.-14 to NRC License No. 34+00746-03, License t

); Number 34-19119-01 is hereby terminated. jh

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,' : INFORMATION FROM LTS

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.

L'ICENSE FEE MANAGEMENT BRANCH. ARM : PROGRAM CODE: 02300 -

AND STATUS CODE 0Q REGIONAL LICENSING SECTIONS : FEE CATEGORY: 7A 2B

: EXP. DATE: 19?80930: FEE COMMENTS:: DECOM FIN ASSUR REQDi R-~~~-~~~~-~~

Q ::::::::::::::::::::::::::::::::::::::

LICENSE FEE TRAN5MITTAL

Q A. REGION

I. APPLICATION ATTACHEDAPPLICANT / LICENSEE: KRAUSE, LUBERT & ASSOC., INC.

O RECEIVED DATE: 940909DOCKET NO: 3016096CONTROL NO.: 397520LICENSE NO.: 34-19119-01

Q ACTION TYPE: TERMINATION

2. FEE ATTACHEDAMOUNT: O

Q CHECK NO.: : - d- _:3. COMMENTS

Q SIGNED _ // W 4 # d'DATE

_____ 2, y ~ ~,' 7-~#

,

B. LICENSE FEE MANAGEMENT BRANcF (CHE 101 It($ TONE OPIE ENTERED (//)~

7# ~1. FEE CATECORY AND AMOUNT:

, ,_ ___

2. CORRECT FEE PAID. )? PLICATION MAY BE PROCESSED FOR:O AMENDMENT f

RENEWAL__..____. _____

________-_______ _,

O 3. OTHER

_ _ _ _ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ . . _ _ _ _ _ _ - __

g___________ ____.____________ .__

gSIGNED

_ ___

O DATE _________./h.__....f___._____________._______

_ __ _ . _:

~_~_'?

44

RECEfVEDO

SEP 2 31994

o REGION III

o_________-_ _ - - _ - _ _ - _ _ _ - _ _ _ - - - - _ _ _ _

., - -

NRC FORM 314 U .S . EAR fiEGULAT,ORY COMMISSION APPROVLD BY OMB: LO 31 0 0028

EXPlRES: 05fJ1Al5'

a s2) '

t o crR 30.33tcHIlavl ESTIMATED BURC3 PER RESPON!E TO COMPLY CITH THIS NFORMATION COLLICTION

10 Cr A 40.421en1 Hivl REQUEST: 30 MNUTES. THl3 MANDATORY S IBMITTAL 13 USED BY NRC AS PART OF

to CFR 7o.30tcH1Hrvi THE BASIS FOR ITS DETERMNATION THAT ."HE FAtluTY HAS BEEN CLEARED OF

RADICACTIVE MATERLAL BEFORE THE FACILITY lb RELEASED FOR UNRESTRICTED USE.

CERTIFICATE OF DISPOSITION OF MATERIALS ranu0 C0uutNTS rem 0No BuROEN [$1mii n THE wnuirm mRECOROS MANAGEMENT BRANCH (h04BB 77141, U.S. NUCLIAR REGULATORY

INSTRUCTIONS: ALL ITEMS MUST BE COMPLETED ~ PRINT OR TYPE PROJECT 015'0-0028L OFFICE'OF MAN AGEMENT AND BUDGET, VrASHNGTON,0C 20503.'

SEND THE COMPtETED CERTIFICATE TO THE NRC OFFICE SPECIFIED ON THE REVERSEudNt,U r4AME Abb Abb% UCLh6E NUMblh

Krause Lubert & Associates, Inc. 34-19119-01Mt. Sinai Medical Building oct,s,,xy,s ,,,, ,,1,

26900 Cedar Road, Suite 129BeachwOOd, OH 44122 September 30, 1993

A. MATERIALS DATA (Check one and complete as necessary/

THE LICENSEE OR ANY INDIVIDUAL EXECUTING THIS CERTIFICATE ON BEHALF OF THE LICENSEE CERTIFIES THAT:(Check and/or complete the appropriate item (s) below.)

]1. NO MATERIALS HAVE EVER BEEN PROCURED OR POSSESSED BY THE LICENSEE UNDER THIS LICENSE.OR

[2. ALL ACTIVITIES AUTHORIZED BY THE LICENSE HAVE CEASED AND ALL MATERIALS PROCURED AND/OR POSSESSED BY THELICENSEE UNDER THE LICENSE NUMBER CITED ABOVE HAVE BEEN DISPOSED OF IN THE FOLLOWING MANNER. (// edditionalspace is needed, use the reverse side or provide attachments.)

Describe specific material transfer actions and, if there were radioactive westes generated in terminating this license, the disposalactione including the disposition of low-level radiocctive waste, mixed waste, Greater-than-Class C waste, and sealed sources, ifapplicable.

For transfers, specify the date of the transfer, the name of the licensed recipienL and the recipient's NRC licmse P. umber orAgreement State name and license number.

y g:,9 C 5 % #n ] 'ASee Attachment A

If materials were disposed of directly by the licensee rather tN vansferred to anot r cn ed is i aste~

1contractor, describe the specific disposal procedures (e.g., de< q in storspe). ,/_

B . _< _ -v , , . _ -

Dre CompiobH 7- . - . - _ . _ . . -

' (8. OTHER DATA

d 1. OUR LICENSE HAS NOT YET EXPIRED; PLEASE TERMINATE IT.2. A RADIATION SURVEY WAS CONDUCTED BY THE LICENSEE TO CONFIRM THE ABSENCE OF LICENSED RADIOACTIVE MATERIALS

AND TO DETERMINE WHETHER ANY CONTAMINATION REMAINS Oy THE PREMISES COVERED BY THE LICENSE. ICheck one)

NO (Attach explanation)

[ YES, THE RESULTS (Check one/

( ARE ATTACHED, orgWERE FORWARDED TO NRC ON (Detel

3. THE PERSON TO BE CONTACTED [ $"c",*["**""

'" "E lNFORMATION[G^R Mark S. Rzesz0tarski, Ph. D. 216-421-4689oy DE T ,g

4. M All ALL FUTURE CORRESPONDENCE REGARDING THIS LICENSE TO

RECEIVEDUse present licensee name and address as provided abOve.

SEP 0 91994 |, , , , , ___ |CERTIFYING OFFICIAL

| CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING is TRUE AND COREIAr1.UN 111SIGV DATEgfmNTLD NAME AhD TITLE

PHwP HDEng % /hWeA(_

p[ V7- TY-

*

/WARNING: FALSE STATEMENTS IN THIS CERTIFICATE MAY 4E 6UBJECT TO CIVIL AND/OR CRIMINAL PEN A LTit's. e4RC

REGULATIONS REQUIRE THAT SUBMISSIONS TO THE NRC BE COMPLETE AND ACCURATE IN ALL MATERIAL RESPECTS. 18 U.S.C.SECTION 1001 MAKES IT A CRIMINAL OFFENSE TO MAKE A WILLFULLY FALSE STATEMENT OR REPRESENTATION TO ANYDEPARTMENT OR AGENCY OF THE UNITED STATES AS TO ANYMATTF,RWITHW {TS J,URISQlCTIONS.

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Attachment A: Certificate of Disposition of MaterialsKrause, Lubert & Associates, Inc.

N.R.C. License No. 34-19119-01A. Materials Data

Ownership of the Picker Model 6296D (C9M/80) teletherapy machine, serialnumber 193, containing depleted uranium, has been transferred to Radiation TherapyServices (RTS), Incorporated, X-ray Equipment Company, 2214 Highway 1187,Mansfield, Texas 76063. This device was removed by RTS on August 31,1994. TheirTexas Department of Health Radioactive Material License number is L01485.

Ownership of the Neutron Products, Incorporated Model NPI-15-5200W cobalt-60 source, serial number T-1024, containing 4730 curies of cobalt-60 on February 2, ,

1990, has been transferred to Radiation Therapy Services, Incorporated, X-rayEquipment Company,2214 Highway 1187, Mansfield Texas 76063. This source wasremoved by RTS on August 31,1994. Their Texas Department of Health RadioactiveMaterial License number is L01485.

Ownership of the Theratronics Intemational Limited (AECL) Model T780Cteletherapy machine, containing depleted uranium, will transfer to The Mt. SinaiMedical Center, One Mt. Sinai Drive, Cleveland, Ohio 44106, pending N.R.C. licenseamendment approval. Their N.R.C. license number is 34-00746-03. They intend toinstall and operate the teletherapy machine in the same facility previously occupied bythe Picker teletherapy machine. They have already submitted an amendment requestto the N.R.C., and expect to take possession simultaneously with terminationof this license.

1

13. Other Data IA radiation survey was conducted to confinn the absence oflicensed radioactive |

materials and to detennine whether any contamination remains on the premises. No ilicensed materials are present at 26900 Cedar Road, Suite 129, Beachwood, Ohio at j

this time, and the results of the contamination survey were negative. The contamination i

survey results are attached.

!

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OCT 0 61994

Krause, Lubert & Associates, Inc.Mt. Sinai Medical Bldg.ATTN: Phillip Weiss, M.D.

Managing Partner26900 Cedar RoadRoom 129Beachwood, OH 44122

Dear Dr. Weiss:

Enclosed is Amendment No. 10 which terminates your NRC LicenseNumber 34-19119-01 in accordance with your request.

If you have any questions or require clarification on any of the informationstated above, you may contact us at (708) 829-9887.

Sincerely,

Original Signed ByPatricia J. PelkeMaterials Licensing Section

Enclosure: As stated

RJ)I')

hekelbt hjfb09{g/94 /

/

--

,

Ragactive Contamination Sgvey'

Location: Krause, Lubert & Associates,Inc.26900 Cedar Road, Suite 129Beachwood, OH 44122

Surveyor: Mark S. Rzeszotarski, Ph.D., Senior Physicist and Radiation Safety OfficerAmerican Board of Radiology certified Diagnostic and Medical Nuclear Physicist (June 4,1992)Qualified Expert, Ohio Depanment of Health, State of Ohio, (April 8,1993)Named on NRC Licenses: 34-00746-02 and 34-00746-03.

Survey Meter: Victorcen Model 450P, Serial No. 2111, last calibrated on January 7,1994 by Victoreen, Inc.(attached). A check source was used to verify proper operation, yielding a reading of 0.8 mR/hr,matching the value written on the instmment. Background was measured in the patient waiting room,recording a value of 20 R/hr in the center of the room.

Wipe Tests: Atomic Products Incorporated Model 187-295, Serial No. 8709-1101, multichannelanalyzer (MCA) coupled to a Picker sodium iodide well chamber. This unit is located at TheMt. Sinai Medical Center,1 Mt. Sinai Drive, Cleveland, Ohio, 44106. The unit was placedin manual mode with a wide open energy window, with channel 150 set between the peaksof "Co, as per instructions in Appendix IX of the MCA operators manual. The calibrationpotentiometer was set to 1.45. All readings were taken using a 60 second count interval.

A clean swab in a new plastic vial was used to count background activity. Threemeasurements were taken, yielding the following results: 102,95,98 counts per minute (CPM), meanbackground value = 98.33 CPM. The mean background value was used for computing net counts.

The MCA sensitivity was determined on September 6,1994, using a New EnglandNuclear 0.106 Ci "Co source dated 8/20/81, N.B.S. traceable (calibration certificate attached).Three sample counts were taken: 16738, 16650, 16635 CPM, mean = 16674.33 CPM. Aftercorrecting for radioactive decay (13.047 years, halflife of 5.26 years) and background activity,

5the net count sensitivity was determined: 8.726 x 10 CPM / Ci.The minimum detectable activity (MDA) for this instrument is 3(98.33)% = 29.75 CPM. This

corresponds to an MDA of 0.0000341 Ci.

Procedure: The facility was walked through while monitoring the results of a survey meter. Next, thecobalt-60 treatment room and surrounding area were sampled at fifleen (15) locations for residual,radioactivity. The attached map delineates the locations, designated alphabetically using the lettersA-0. Measurements were taken one (1) centimeter above the floor, and at one (1) meter above thefloor, using the Victoreen survey meter.

Wipe samples were taken using cotton swabs moistened in water. Each swab was2rubbed vigorously on the floor over a 10 cm by 10 cm (100 cm ) area, and then placed in a labelled,

clear plastic vial and sealed. Scaled vials were placed in a plastic bag and transponed to the Mt. SinaiMedical Center using suitable radiation safety practices.

Results: The walk through the facility failed to identify any areas of radioactive contamination. Table1 provides the raw measurements and results for the radiation survey and removable contaminationsurvey. No detectable removable radioactive contamination was found. No detectable nonremovableradioactive contamination was found. The facility is free from radioactive contamination at this time.No sources of radioactivity were found at this site on September 1,1994.

Repon Date: September 6,1994 Physicist Signature: %k } , $g~d~' $(b. Oh

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.

Table 1 '

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Radioactive Contiminstion Survey cf 26900 Cedrr Rud, Suite 129 - '

Location Icm Raw I cm Net I m Raw I m Net Wipe Test Wipe Test Wipe TestR/hr R/hr R/hr R/hr Raw CPM Net CPM Net Ci

,

2A 20 <BKG 21 1 90 <BKG <MDA'

B 18 <BKG 22 2 105 6.67 <MDA,

C 14 <BKG 19 <BKG 90 <BKG <MDA'

D 16 <BKG 15 <BKG 92 <BKG <MDA

E 23 3 22 2 115 16.67 <MDAI

F 17 <BKG 17 <BKG 113 14.67 <MDA -

G 13 <BKG 16 <BKG 109 10.tU <MDA -

H 10 <BKG 18 <BKG 124 25.67 <MDA,

I 23 3 23 3 120 21.67 <MDA

J 15 <BKG 17 <BKG 121 22.67 <MDA

K (Isocenter) 21 1 20 <BKG 107 8.67 <MDA

L 16 <BKG 18 <BKG 95 <BKG <MDA

M 17 <BKG 21 1 102 3.67 <MDA { gN 18 <BKG 13 <BKG 98 <BKG <MDA

>

O 21 1 20 <BKG 97 <BKG <MDA

,

Notes: '

'<MDA = less than the Minimum DetectaW Activity < 0.000034 Ci.2<BKG = readings were at or below backguund values.

03 Location = See attached drawing.

3 1cm Raw R/hr: survey meter raw reading I cm above the floor; I cm Net R/hr: survey meter reading corrected for background. ',

g' I m Raw R/hr: survey meter raw reading 1 m above the floor; I m Net R/hr: survey meter reading corrected for background.m Wipe Test Raw CPM: well counter raw counts in 60 seconds, Wipe Test Net CPM: well counter background corrected counts per minuteO 2Wipe Test Net Ci: Net activity in micro' curies, using 100 cm surface area for each measurement.

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Survey Meter Calibration Report / Certificate of Calibration

Customer

Cust PO # Victoreen #

Model 450 PSerial # 2111

CALIBRATION NOTES

Radiation levels are based on standards whose calibrations are,

traceable to the N.I.S.T.(formerly the N.B.S.).

The suggested re-calibration date is only a suggestion. The actualfrequency of re-calibration may vary depending on Federal, stateor local requirements. It is up to the user to determine this.

During calibration the survey meter was positioned with the detectorperpendicular to the beam axis.

The source used for calibration was Cs-137.

All readings below 10 mR/h were corrected for Background Radiation.

The formula for % Error is:

(( Reading - Rate ) / Rate ) X 100

IMPORTANT

Any corrections made to the instrument reading ( e.g. EnergyDependence ) are up to the user to apply. Care must be used inapplying those factors. *

The test response data is on page two (2) of this report.

Ov6000 Cochran Road

Cleveland. ONo 4413S 3395

(216) 246 9300

FAX (216) 248 9301lWX 814421.d287

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Model 450 P Serial No. 2111

| VICTORE EN

CALIBRATION DATA

RATE_-___________-_____-____-__________-____________________

Range Rate Reading % Error Comments(uR/h) (uR/h) (uR/h)

_----__-----_-__------_-____--______--____--__________--

Background 0- 500 N/A 12 N/A386 411 5.93 Cal Point127 128 0.00

----------___--___-----_---_---__

(mR/h) (mR/h) (mR/h)_____-_-------__---_----____--___

* O-5 3.67 3.67 -0.11 Cal Point1.15 1.16 0.52

0- 50 41.0 40.3 -1.71 Cal Point11.7 12 2.56

0 - 500 430 426 -0.93 Cal Point145 151 4.14

------------_--_-_----_--_____- ..

(R/h) (R/h) (R/h)__---___-___------_---_----------

0- 5 3.91 3.88 -0.77 Cal Point;

INTEGRATE--__--__-_----________--__-------

Range Exposure Reading(mR) (mR) (mR)

__-----__----_______._____--_____

0 - 50 14.3 14.5 1.40 Cal Point

Calibrated by ad@* Er -9- o, 07-Jan-94/ [j'

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{ fOperational checkout by ,/ , _--_ . 30-Dec-93 .

v

Suggested re-cal due 07-Jan-95

Traceable to the N.I.S.T.Test No. DG8953/89

' Dated Feb. 8 ,1989PTW Chamber Model 30-349

Serial No. 610

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: Temperature 21.5 aC M h Rad** * 3"

| Ht, nid i ty 33 %(216) 248 9300

FAX (216) 248-9301TWX 814421-8287

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CERTIFICATE OFI

'

RADIOACTIVITY cal.lBRATION(

.

Cobalt-60 Reference SourceNES- 142S '

Hal f-Life: 5.27110.001 years|

Lot Number:142S082081A i

0 iThe activity of Cobalt-60 was found to be, .106 microcuries on August 20, 1981. |

1lDESCRIPTION OF THE SOURCE !

The activity is deposited and sealed in the colored end of a h" diameter by} 5" long acrylic rod " from the end. - -

|/

DECAY SCHEME Intensity (%)

( Y1 1.173 MeV 99.90.

| Y2 1.332 99.98 i,

Reference: A Handbook of Radioactivity Measurements Procedures, NCRP Report|

No. 58, November 1978. |

(' METHOD OF CALIBRATION~

j~I The source was calibrated by counting on a 2" x 2" NaI(Tl) well crystal. The( crystal had been previously calibrated using standards. certified by the National

Bureau of Standards.'I

If1 PURITIES

Less than 1% by gamma ray spectrometry using a.Ge(Li) detector.

i ERRORS

I

Random Errors (99% confidence level)'

Precision of the NEN measurement 1.2%'

Systematic Errors

|Accuracy of the calibration of the NaI (Tl) crystal 3.0% |

Overall Error| 1.2 + 3.0 4.2%=

-

I -

| | R ADioACTIVE M ATERIAL :' ,

jThe radioactive material described or contained * i} herein is exempt from NRC or agreement stateii

i i licensing requirements. Not for human use. Intro- ;

f'! duction into foods, beverager, cosmetics, drugs or )

, medicinals, or into products manufactured for com-

New England Nuclearg : mercial distribution is prohibited. Exempt quantities. | should not be combined. ' ' ' ' '( !

* * * ' ' " " ' I

543 Albany Street. Boston, Massachusetts o2118|

| CALL TOLL-FREE: 800-2251572 Telex: 944996 |(In Massachuseits and international: 617-482-9595)

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$ bk4],

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04386< "G3tU STDATE TIM E ST ART D ATE ' TI M E COMPLETE D ATE TIM E MODEL & SERI AL NO. S.B. HOU RS H.V. HO U R S

cnc 3/- M t si f'l c9 ) 93CUSTOMERC2RVICE R EQUESTED

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RILLED SERVICE_,_____ _ _ _ __.____._-__ _ -- SERVICE CONTRACT

SOURCE SHOP- ..___ -_ __.__ -_._. _ __ ___ __

REPLACEMENT REPAIR

REM A NU-._ _. -_. ___ _ . __________----------- UNIT

|G N ST A L L' N r FACTURE

-_-._ _____.-__ _____ __. __,..._ ___________

WARRANTY ORDINARY_____________________.__________-_-________

INVOICING IN FORM ATION._ a___._____ _ _ . _ ___.__.____ -___ ___

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SOURCE DISPOSAL CERTIFICATE

THIS IS TO CERTIFY -IIAT A COBALT 60 SOURCE;

HODEL NUMBER: NPI,15-5200W

SERIAL NUMBER: T-1024

CATALOG NUMBER:

CONTAINING 4730 CI COBALT 60

MEASUREMENT DATE: 02 15 j 19907

THE ABOVE SOURCE HAS BEEN DETERMINED BY WIPE TEST TO BE FREE OF REMOVABLECONTAMINATION. THIS SOURCE HAS BEEN REMOVED FROM THE TELETHERAPY UNIT

, DESCRIBED AS FOLLOWS;Picker

MANUFACTURER:

MODEL NUMBER: C-9

SERIAL NUMBER: 193

U 'i ;c. - U BEEN REMOVED FROM SERVICE.THE ABOVE UNIT HAS I .

AND IS HEREBY TRANSFERED TO:

X-RAY EQUIPMENT COMPANY2214 HWY. 1187MANSFIELD, TEXAS 76063

TEXAS RADIOACTIVE MATERIAL LICNESE LO1485

FROM THE POSSESSION OF;

Krause, Lubert & Assoc. Inc.- Mt. Sinai Medi. cal Bldg.|

26900 Cedar Road I- 1

Beachwood, OH 44122|'

RADIOACTIVE MATERIAL LICENSE NUMBER: 34-19119-01!/ /

_fpg%f X-RAY EQUIPMENT COMPANY !REP SENT F

,

[/-- [ ~ 2214 Highway 1187/V i

Mansfield, TX 76063,

YDATE T / f/ / TV ATE Y/ h[ / k

2214 HWY. 1187 MANSFIELD, TEXAS 76063 (817)473-8600

307530e

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