0 b O ' 61V9 b- -'

'*

0 MacN:ol Memenol Hospital -,

!~F

!

!

----) 3219 9>mliOak Pd Aunue. . , . . . . - . . -

k Bei w)n. Illinois G0102NJ -

November 25, 1981 c. I- 1 | ~Ieleptone (312n95-91ooa; : o- r>- -

,;..u. .

-

r.' :s.. .a < .) N ~-~~~..i

-

z.a.a 3 cf . .; g- E]g- p'D BY f Pt.:t

Bruce Mallett, Ph.D. j

Licensing Section ''8- ..f.-

United States Nuclear Regulatory Commission Ln,C <.

D4 ['' ~ ~ ' "799 Roosevelt RoadGlen Ellyn, Illinois 60137 ,s..

W: ::. '

, .

. . . ' ~

* / []a'u) ComN. /$ .'//[' ' 1Subject: MacNeal Memorial Hospital - 12-09155-01 -

. ;

" ' 'Dear Dr. Mallett:

We request that you amend our byproduct materials license to showthe following changes:

1. Please add Drs. James Barron, David Gibson andRobert Marshall as users of byproduct materialsfor diagnostic and therapeutic pruposes.

Dr. Barron - Groups I - VDr. Gibson - Groups I - VDr. Marshall - Groups I - V

2. Please add Dr. Robert Marshall's name as a memberof the Radiation Safety Committee.

The addition of these users was discussed in a Radiation Safety Com-mittee Meeting and approval was granted.

Also enclosed is a Preceptor Statement for Dr. Robert Marshall;statements for Drs. Barron and Gibson have been filed previouslywith your office.

We have adopted the ALARA programs as outlined in the NRC bulletinof June 18, 1980. We have our copy on file for review.

A check for $40.00 to cover the amendment fee is enclosed.

(Continued)

CONTROL. NO. 0 5 6 7 2r

't" " ',c''

8507120636 850614REC 3 LIC30 Nirrnkt of ihr \ fen"Pnaan thu ago C mue12-09155-01 PDR ni ennerm or liiirun Attiluic<iilospaals

N0Y 271991

-

', O O'-

. .

*

Bruce Mallett, Ph.D. -2- November 25, 1981

Should you have any questions, please contact:

Mr. Ronald D. EdwardsRadiation Protection Consultants, Ltd.604 North Washington StreetNaperville, Illinois 60540

(312) 369-6488

Thank you for your cooperation. -

Very truly yours,

f. Lu'ce cGuinness

President

JLM:mkAttachment: Preceptor Statement - Dr. Robert Marshall

Check #098767($40.00)cc: Dr. Harold S. Firfer

Mr. Murray D. LeipzigMr. Warren LyonsDr. Enrique PalaciosDr. Gabriel PulidoNRC License File

CONTROL NO. 05672

.

[1

'

'

' * ... .

!- Ny..

. .

l1

ponu NRC 313M SUPPLEMENT A U.S. NUCLEAR REGULATORY COMMISS

EE,'n no TRt.INING AND EXPERIENCEAUTHORIZED USEll OR RADIATION PROTFCTION OFFICER

'~ . . - - _

1. NAME OF TUTHORIZED UEER OR RADIATION PROTECTION OFFICER 2. STATE OR TC#1RITORT w, , WW H UMNSED 'O

"J CT8CF '#138C8Nt11obert Alan !!a; anall, It.D. g,,

~~

| 3. CERTlF1 CATION-

SPECIALITY 80ARD CATEGORY MONTH AND YEAR CERTlP8ED. ,

A B C[ ,

! '

. . .

'j ItADI WIGY December 1974.*

I

i!

.

.

.

*.

I

, ,

i

4. TRAINING RECEIVED IN BASIC RADIOL 30 TOPE HANDLING TECHNIQUESj ;, .

TYPE AND LENGTH OP TR AININ

LECTUREl SUPE RVISE

| f FIE LD OP TRAINING LOCATION Ah D DATttSI OP TRAINING LABORATORY LA80 RAT 05

!. ; A B COU,RSE5 EXPERIENC*

lNews! INesnes!i C O;

N O4/T Wr& $g [Nb S h,g f| e. RADIATION PHYSICS AND gg g'/ f hINSTRUMENTATION$

| 1914- 4pj;ii !)

**

b. RADIATION PROTgCTION|| /CrD,

. ..

!

! c. MATHEMATICS PERTAINING TO #/l .THE USE AND MEASUREMENT

[C@OF RADIOACTIVITYj

U~

d. RADIATION elOLOGY yp4

,

CONTROL NO| O 5 6 7 2; ,

- ,

.. RAoiOPHARuACtsT: CAL ,,CHE MtSTRY g

,' .6,,. c ....- ... m . ]

~

O e: -;.

romu N RC-313M-SUPPLEMENT B U.S. NUCLEAR REGULATCRY COMMIS$lON. . .

.

I M 7)to cr n so OPRECEPTOR STATEMENT J O.JSupplement 9 must be completed by the soplicantphysicis s's procoptor. If mtwo shan orse preceptoris necessory to documentexponence. Obtain a sepersto steternent from each.

1. APPUCANTPHYSICIAN'S NAME AND ADOREOs KEY TO COLUMN CPERSON AL PARTICIPATION SHOULD CONGl&T OFsPU LL N AME% ' 14upoMood enomlnotion of patients to determiae the owltability for

' * * * * ********4**8'*"'*"'""*''"d''**""****"i'*'*'ROBERT ALEN MARSHALL, M.D. pre cne"ed demse.

sTettT ADDRESS 2Cottetoeotion in slooo enlibrotion ond ectual eeministration ef doneto the patient inctwdag emicunstion of the radiation dose.reested

25 W 110 Cape Road meesuremente end poott.no or deu.*

c TY | sTAf t eZeeCoot 3 A8183usto Period ot training to enable physicien to rnenege radioectie'

petients and foBow petlente throwgh depose enclor soures ofITaperville Illinois 605 60- t =iment.1

2. CLINICAL TRAINING AND EXPERIENCE OF ABOVE NiMEO PHYSICIAN' NUMBE 4 iP

CASES INVOLVING COMMENTSISOTOPE CONDITIONS DI ACNOSED OR TRE ATID PERSONAL a.'c4/e'esat a .1onnet/ess er emn er mer*

PARTICIPATION 3e ,pae,,/rerst k sheticear en ar- -er ;,seesi.tA D C | O

D.AGNOst$ OF THYRCID FutiCT'ON p' OETE RM4N ATVsN OF DLOOD ANO

OLOOO PLASM.4 VOLUME $l.131 UVE R FUNCTION STUDIESer

1125 FAT ABSCRPTION STUD ES [~~

ICli)N.tY P JNCTION SRADIES 3 *'

EN V11ROSTUDIES 3 t)*

---, .

OTHER*

8 12S DETECTION OF THROMOOSIS

l'.13i THYROID IM AGING g]P.*D EYE TUMOn LOCAUZATION

S*-75 PANCRE AS IMArilNG

Yt>169" QSTE RNOGR APHY [SLOOO FLCW STVolES ANO gj A

i Xo.2 PUUdONARY FUNCTION STUDIES I Orl OTHER *

Qo :pcnxin tuActnG r.

CARDI AC IMAG NG ,,,

i

i THYROID IMAQNG

i SAUVARY GLAND IMAGING. [TC* 5LOOD POOI. IMAGING SC

'PLACENTA LOCAUZATION "

UVER AND SPLEEP' IMAGING Qgp*

LUNG IMAGING ]g;

DONE IM AGING g ), g,

OTHER,

Popu Nnc 313n,4 suPPLeut NT ePage 5(M7) -

CONTD.O' NO. '' 5 ? 7 2-, t

. m .

_ _ _ _ _ _ _

_.

\- - O O -; ..

..

.

PHECEPTOR STATEMENT (Continued / -.

( 2. CLIN! cal. TRAINING AND EXPERIENCE OF A8OVE NAMED PHYSICIAN / Continued)L NU845ER OF,

[ CASES INVOLVING COMMENTSL ! ISOTOPE CENDITIONS DIAGNOSED OR TREATED PERSONAL TAW /shutaf Mfemneees er temmen s mer ee ,

PARTICIPA**lON auem/redM staplices se sepereer wies a.),

g, A* S * C D

h P 32 TRE ATMENT OF POLYCYTHEMBA VERA,' *

}saw=J LEUKEMBA. AND BONE METASTASES, ,

# ^#^ ^ "ICo ode!I

*

I TREATMENT OF THYROID CARCINOMA, ''TREATMENT OF HYPERTHYROIDISM -

AND CARDI AC CONDITION hOAv.198 INTRACAVITARY TRE ATMENT

Co.60 INTERSTITI AL TREATMENT .

er .

C6137 INTR ACAVITARY TREATMENT .

*INTERSTITIALTREATMENT

In197 ,

e TELETHE RAPY TRE ATMENT

|S*90 TRE ATMENT OF EYE DISE ASE

RADIOPHARMACEUTICAL PREPARATIO 4

$ GENERATORy .

8i GENERATOR

.. Tc 99tn REAGENT KITS

Q |. Oser

f

.:|.t:

.-

.s

s, . e

,

f,' 3. DATES AND '.*OTAl.NtIMSER OF HOURS fliCEIVED IN CLlHICAl. RADIO 430TDPE TRAINING

'; h'/Y] VGJyIf ) ( h$1Ly/97O ~]b.t .

,

-{' 4. THE TRAINING AND EXPERIENCE INDICATED ABOVE e PRECEPTO 5 54GNATUME

1 ,

WAS OBTAINED UNDER THE SUPERVislON OF'

a. NAMt 08 SUPERV850 A

n .F e n w M.D. '

s

b NAa45 OP 4Npf tTWT.O 7. P PTOR*$ NAME Pfpase s'rpe orpaar)

D10 n.Tt-- e v rt h a p. 4. Mtl.. C144'

,Lund m. M unam m.o.. l ....m

III EnsY 3db ST-,

'WRDWA N.Y,/0'/l,7 'M'S e er. /0 / P /,.MmR.mf.AM.ER,5. IN .Y C .i I/ fr-7

g,.,p .e . . ,u m N 1. cg s,7,,,, g,,

t . -..

-' hps-

- . .

, ..

4pb (m)"

V. .., ..

* *Fonu NRC.313M. SUPPLEMENT A 'J.S. NUCLEAR REGU'..%TChY CCt5f'.5SiOi' ' " ' '

4 TRAINING AND EXPERIENCE5- AUTHORIZED 'JSER OR RADIATION SAFETY.OFFlCCR,

.

--

1 NAME OF AUTHORIZED U:,,ER,OR P ADIATION SAFETY OFFICER 2. E TATE O.t i: . e s s,f t e*milch LaCLf.d.(' TO

James Barron M.D. PRACTICE MEDICINE-

3. CERTIFICATION, ,_

. - - . _.SPI'Cis.LT'* BC ARD CATEGORY MONTH AND YEAR CE9T8ff 8!D

,-'

A B C-_

i-

*,,.

.

. .

%

4. TR/*lNING RECEIVED IN BASIC RADIOISOTOPE HANDLING TECHNIOUES* *

TYPE AND LENGTH OF TRE"Il58[.

LECTURE / SUPEl'* 5' O.

FIELD OF TRAINING LOCATION AND DATE(S1OF TRAINING LABORATORY L A Bol". A :C't *, A B COURSES . /XPEtt8F.Pl * 8*

(Hours). (Hos **l*

1 C O_ ..

#

.. RADI ATION PHYSICS AND * *

INSTRUMENTATION 7-5-78 to ,-5-81 100;^.' T

. . ' . . _,

'.I b. RADIATION PROTECTION; "

225

__... ...._'c. MATHEMATICS PERTAINING TO ,

THE USE AND MEASUREMENT 34-

OF RADIOACTIVITY ,

*i

I

_ - . . . _,,

' "' d., RADIATION BIOLOGY 31,'

i .,,

.

e. R ADIOPHARMACEUTICAl' ".

CHEMISTRY 28

'lL[

S. EXPERIENCE WITH RADIAT ON. (Actualuse of Radioisoto,.cs or Equ' valent hperience],

!| ISOTOPE MAXIMUM AMOUNT WHERE EXPERIENCE WAS GAINED DURAT i)N OF EX)ERIENCE TM Le ME

*,

l I- Tc-99m 25 mci Loyol.a Univer sity "4 months n|;u.19 , Br ?.151, 'I

.i orm ,Medich.1 Center

} Xe-133 20 mci Blood '?co.1 & Thyroid" "3

'! I-131 15 0 uCi " " Lungh,,} Thyroi 3 CA Rx, Rer.

'. i

_

FunctionI-125 100 uC1 " "* Deep Vein Thrombo

: I-lll 50*.1 2C: " "' Cyster lography

T1-201 r.tCi* " "Infarc ; Heart-

! FORM NRC-313M Supplement A ~'~,

leasl: Page5 CONTROL NO. 0 5 61 'o m~> -

,.

*'_ _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ __

. ._ - -- .. ~. . . _. . .- -. . . . _ _ _ _ _ _ _

: .-

.e :| ;, ' O-

.

.- .. .

'*I roar.* N RC.313V sun'PLET.1ENT B U. S. NUCLE AR REGULATORY COMMISSIONi

' truva: -

, . , .

7 PRECEPTOR STATEMENT*

2. .

-i,3

)i Sac temen: 6 must ir comotered by the applicantphysiciars*sprereptor. Iimore than onepreceptorisnecessary to document

} ':[| _esperience, o,btain a secorate sta_tement from each.

'1. APPLICANT PHYS'CI AN'S NAME AND ADDRESS | KEY TO COLUMN C

ib PE RSON AL PARTICIPATION SHOULD CONSIST 08:ult. NArAE$ 1-Supervised enemination of patients to determine the suitrYisty for4 , Dr. James T. BSTI'00 |'

'*d'*''*'***d'''"**''*"dh'''**'**"'*"d'******'*"'*"'*'4

y presc4 bed dosege.,

SNEET ADDRESS; 2(,ollooratian in dose celitration and actual administret * - of dose

to the patient including calculation of the radiation doss, related. ,f messurements and plotting of date.*,

'!'

' ,j~

r ry | siATE | 2 P cocg 3.Adeo Jete pe'iod of training to enable physic;ee .o men N t radioective 1.

| patie its en J 'ollow patients through dianosas end/or coarsfot 4i

i- , ,? , treatenent.+ . .

.

'g 1, ". CLINICAL TRAINING AND EXPERIENCE CF ABOVE NAMED PHYSICIAN, q|;

, ==

NUMSER OF,

- CASES INVOLVING COMMENTS;

*!. - CONDIT;Or.S DIAGNOSED OR TREATED PERSONAL (Aalslitlose/intermeries orcomments mayISOTOPEPARTICIPATION As svamitarerin abatices on asperse a4eeer.lt

1 :d ..

. B C.

A 'D, 2*

~

| j.. Q:ITE RM: J ATION OF SLOOD AND

__

;. Of AGNO3'S OF THYRO 80 8UNCTIW, , gg .

*

! f'' 8'.000 F'. A S*A A VOLUME 2J ;*

; j.- 1 131 . '. /ER F LNC*lON STUDIES I 24t ,

' .- --,

3 Q 125 *. AT ABSOsteilON STL 0,fES-

KIONEy rh.CTION S1'JCIES I *Or, pg

} 99mTC ps vlTR: s.oiss aa,.

!,1 - - OTHER !... _

f,_ 10 5 | DETECTl**' *.F TaRCM80 SIS l !

3*

i;j /N HvROsc ivAGING 99mTC 04 80

*

j ..,

3.32 EYE TUMOF LOCALIZA'8M; 0f. { *** 3 PANCRS/.S NAGING n[ N/# etsisRmRAr:4Y In-lll DTPA 3- '

.t--r

BLOOO FLC7J STUDIES AN"'uDIES 152.g i g33f ; - j 8U L*.tC'J .. 'd - FUNCTIO ** h ve

+.j O THE R ~y,

jh* MAIN IV A |tNG g4L

-, -

5 CARDI AC .. .E GING 400.

! a,I THYROID st/ACelNG

*

80!

g SALIVARY GLANO IMArilNG ]

!l.' q.PY9997?JJ/M9'pp ca'rdiac Imaat'**'" 'so

;.'

; 4 ., .v:r m, . . x Au zATiOx o; 3 ;_ ._.

; .t-, ,

k-. ...

[ LIVER AN ) *SLEEN '\tA9NG pgg2... ..'

"I ' L.'.NG IC ' * NG'

120 *

q , .. - .

',i :me in:: <G 304

'. CTHER Thallium Imaging . |208i .b ,- -_.

". r Ru nnC. isu.su>: r .tEur 8 ' "" W M MM /j~ ". tt'l f.e a=* .1 '. ' ..

' , , ,s't

~ '. . - - .

r~ .

s. -

k .. ' g g+- -

, ,

PRECEPTOR STATE: MENT (Continued) .

2. Cf.lNICAL TRAINING ANO EXPERIENCE OF ABOVE NAMED PHYSICIAN (Continued) | j.

fuNUMBER OFI a' CASES INVOLVING COMMENTS .h,

' "

ISOTCPE * CONDITIONS DIACNOSED OR TREA1ED' PERSONAL (Act'It/osef /nformation cr wrunenu may be 5 ':{'PARTICIPATION submitardia Asplican on secarste sheerb f,'

*t!

,g_ A 8 C D ';s,.

q[' s P s2 TREATMENT CF POLYCYTHEMBA VEF:A. J' (SCA#blef LuMEMIA, AND 80NE METASTASES 0 '

3.i

^ k.,'

IATRACAVITARY TREATMENT 0. gg,, 4f,,,

, .

| 'I.131'

TRE ATMENT CP THYROID CARCINOl% 0t .

'-- ,

{ TREATMENT CP HYPERTHYROlO,lSM , 7 , | {.1*

# -

. ,c.. -1~

:D4 * AJ 196 l .*RACAV:TARY TRE ATMENT 0 -.

i;.;

!N ! Cs .:3 INTERSTITI AL. TREATMENT 0(; !,3 t --.

...g Cr. .* T . IN1 AAJAVe raRV TR* ATMENT 0 q' 'x*

j-

j. .. iu- , ..

.

j or it.'fCMST111A6 TREATMENT .Q b. i., .

, .

4~? Ir. **;*) 4y..,*Tr% ',*A- .M''- *e. , , ,. .g or Th.ETHERAPY TREATMENT 0 -

!-* -

cs.s.n , ,;. .

Se es TR* ATMENT OF EYE OfSE ASE O*

-

]I R AOIOPHARMACEUTICAL PRdPARATION.

*-

, 8( ;'- -

. .

fe$ GE JER ATCh {

'

I, .\ y.,* ;1/.

| GENERATOP,*

).. ( e,,,,gy,,2

.,14--

.

0 , (. 7. Om | REA 3ENT <lTS '

.

T ??

3. O t.er ir' 99mTc DTPA

.'

b 99mTc MAA 8;

99mTc Osteolite |[-,

i 99mTc Glucoheptonate 10

I.'D 99mTc Sulfur Colloid -

, ,

t .

, d,1, *.-

a. :j<.

[E[T F.3.tND TOTAL. NUMBEF OF HOURS PECEIVED IN C'JNICAl. RADIO!SO10PE TRAINING ;t'i

L 650 Hours !I L

f'lAori: 1980 -

I'''. .,

May 1980 *

- July 1980.

I Fnh 1481__ .

-

4. THE TRAINING AND EXPERIENCE INDICATED ABOVE 5 PRECEPTOR'S SIGNA TURE**

V/AS OBTAINED UNDER THE SUPERVISION OF:'

],I = ~4ua ce surenvason - - .

Robert E. Henkin,M.D. [ -!i. PRECEPTOR S NAME Peemse type orannt)

_

,

; a urue or iusrituriou i

|| Loyola University Med.Ctr. Nuclear Medicine '

;-,

r. | univua ooness Robert E. Henkin,M.D. j-,

4' | 2160 South M rst Avenua'

-

) a. Ci T Y 8. DATE -

h . te.ATERiAus ucENsa NUsaERisi !*

Maywood. IL 60153'--

FI , g6 gy. i. .

nar _19_ingn_nte

eoe u esac.. iia.*sveruusur a 2j CONTROI. t10 .0 5 6 7'*-"' "

- .- .

.

, x. ,

- .:.. ,,

|l, : Pige 7 - ' *~,,

~,.

7

-,: ., ,,

,

(_ ~ ~ ~

[ --......__.. _ . . . . . . . . - . . - _ - . . .--. ...,

Ce sin- -.,. .

.

;c:M NRC 313M SUPPLEMENT A U.S. NUCLEAR REGULATORY COW.5IUitlii*i

'U*TRAINING AND EXPE.RIENCE

AUTHORIZED USER OR RADIATION SAFETY OFFICER -

,i. .

9 *!A8M OF AUTHORIZED USER OR RADIATION SAFETY OFFICER ' 7 c t /. I t .

Y. i.4:e . t '. .fo iO j.David GibsOn FR ACTICE IMC.CINi

3. CERTIFICATION ~[ ,, , , ,

SPECIALTY BOARD CATEGORY MONTH AND YEAR CERTertEt' [j

A B C j{3. . . . _

:!

RADIOLOGY Eligible June 1981 !;

=

4. TRAININC RECEIVED IN BASIC RAOlOISOTOP! HANDLING TECHNIQUE 3 .

TY.'E ANL5 LENGTH OF T R/.15'5''8'*

.ECiuss El I SUPEl' * 5*.''FIELO OF TRAININO LOCATION AND DATE(S) OF TRAINING LA80RATO4Y LABORMQ'h

*

A B COURSE 9''' /XPE7t* ,

(Hours) (Hono*el |*

C n .

-

p_ _ _

LoyOla University Medical Ctr. '

c "*D~d'0"'HYS N D 7/1/78 to 7/1/FA 75 30 !IP%TRL'MCJ s~ AT'ON ;

e..- -

. . _ - - . .,

_

D. RADIATION PROTECTION

!.. . . ..__

c. MATHEMATICS PERTAINING TOTHE USE AND MEASUREMENTOF RAOlOACTIVITY 20 5 .

"i

j_ .__

f. .d RADIATION BIOLOGY " 20 0

._ ,_

.

.

e. HAOf 0PHARMACEUTICAC "10 20CHJMISTRY .

5. EXPERIENCE W|TH R ADIATION. (Actualtose of Radioisotopes or Entrivalent Experience)

ISO TOPE MAXIMUM AMOUNT WHERE EXPERIENCE WAS O AINED DURATION OF EXPERIENCE TYPE OF USE_

_

TC-99m 25 nC1 LoyOla University Med Ctr 4 months Bone, Lung, Brain,Li velB1 OOd POO1 & Thyrt idi

I XG.133 20 mci Lung' "

I-131 150 uCi ThyrOld CA Rx, Ret* "

Function-

Deep Vein Thrcmbt" "| I-125 100 uC1 .

In-111 500 uC1 CysternOgraphy" "

T1-201 2 nCi Infarct Heart' " ",.

rM NRC 313M Supplement # L . .. . ! . } } $_ MAR _3 0J98h

( - . . . . . . . . . . _ . .

*. .

'

O= 0.. .., . . .

.. -.. .

/orw NHC 3 h.17thPLEMENT F U. S. NUCLEAR REGULATORY COMMIS$10N'ts.nl'

*; PRECl!PTOR STATEMENT-t2o-

4 1

_i t Supplerncn* 2 rnust.*n completedtoy the applicar'tphysiciars'sprepto?. Ilent;re than suepreceptorisnecessselv so of' onent ]* ,y experrert. *, obtain a separsar staarrnen t from each..

- 1

jG 1. APPLICA"T PHY18CI AN'S NAMF AND ADOR.MS j KEY *''O COi.UMN C.

'!

* * ~ ~ ip.jg p;augPERSON AL PARTICI''AllON KHOUI.D CON 31f.T 01 t

.

loupemsed esamination c,f pa*3ents to d? term ne the svi*a8pfery fori >

radioisoloswa d aptosis and/or treatenent anct recornmendateon for'

David Gibson.M.D. p''*C*itz d oosage.j sTnsa r 49onass

, ,,c ,c,, ,,,,,,,,, ,,,, ,.,,,,,,,,;,,,,,, ,,,,.,,, ,,m; ,;,,,,,,,, ,,,,,,,*,5 . to (Me* snatsertt IACIUt>Pp Catculatoon of th / 'J *e ste39 (*0;e, *e '.itedi ! , Mar.KeA UinDJ.u k. trwasure rrwe**$ arid plott ce; of d.ata,i i*

I I ClTy|

I STATE I4mCook i I*AO'wliaJte s"*rsed of Ira.oing to *Ntate phys.catr* to mase,'t e.)diow! ",

!, p.stier*ett and follow pat *wnts th'ov.an dia.Jnom '1dfor ;oe*ta* 9fstru trip'ot., o

j .m__-- - "g . |T11apq <

- . .v s

j CLINICAL TRAINING AND EXPERIENCE OF A80VE NAMED PHYS.CIANiy~

..' * __ ..

| NUMsEut Ot-* ' '

| CASES INS'OLVING COMAlENTS:+ ISOTOPE CONORTIONS DIAGNOSEO OR TRE ATEO PE R$GNAL tAddet,anat desoamerion or cocemee J marPARTICIPATtON

tw suoneitstr*.e d.asulocost on sener *r sheeros * I'

A B C O!.

I ! - -. ; .-D'AGNOS 3 Od' THYRO O FUNCTION 55

,

I- CETEM*.'IN AflON OF SLOOD ANO |1

j eLOoD PLArda votuME 23 is

-.

5 '| 1 131 L:*.*ER FIA:: TION STUDIES IIi =i . ., -

I'

;2' RAT ASSOPP*:ON STUDIES | |.

< .s' -

; KIONEY FL'*40 TION STUDIES 1, -

.

5 3._-, ,

,j It: VITRO STilOIES.

r.;.

-

| .:THE R |ie

1 | || 1 12S DETECTION OF THROMeOsl8 ]

fj j"

l.isi H < Roto iM AGING (r--a ".32 8*''E TUMOR LOCALIZAflONg

0 I4.

n. .t l''* M PANCRE AS s'4 AGING 0 II

|} g ]]) . CISTE RNOGR APHY | 13 .

v. t *. . I BLOOD FLOF.* STUOlES A*fD g) [.JLMC'IA3 ' FUNOTIOr. I IUDIES 70

*

| DTHER .

v

'

8*

- I 9**A:N I.'.*AG.NG 121*

.

CARDIAC IM AGINGe

, I 481 (A11Ci rdiaC):1 - ! THYRolo IMACdNG 103n .

.

SAUVARY GLANO IMAGING

) I'* 8LOOO POC,L IMAGING

f'p _

: F.tN f A L*)CALt2ATIO.N{

) LIVER Anis."*,'LEEN IM AG8NG 304 . !{: ; . .

.; | LUNG IMAGING ?. 3

_J _gg g.

, , _.

j ! . .222.. Ccn'.ro' Pa.0 4 6 384 ,''"''**C''G g~

'

i | OTwER ,

'l . . .

I' ..o=,.M. NRo.aiw.sur tu-r

..

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'-,_ --

. .-

* PRECEPTOFi STATEMENT (Contin"),, ,

[ 2. CLINICAL TRATNING AND EXPLiRIENCE OF ABOVE NAMEMlYSICIAN (Conti<. M/**

d -

,

7 NUOllER O'F ,OASES INVOLVING COMMENTE

ISOTOPE CONDITIONS DIAGNOSED OR tress?ED PE RSON AL (Add,tionsiin/ arm enian ar ca...ueta ir y avPARTICIPATION submatard e,*,s*/cas on . .,<,v s se rs /

A 8 C D .

P.32 TREATMENT OF POLYCYTHEMIA VERA,Asasu6kJ

',LEUKEMIA, AND BONE METASTASES |

If*

INTRACAVITARY TREATMENTf

, fj

1

TRE ATMENT OF *.'HYROID CARCINOMA 3 ;'

i.131 -|

TPEATMENT OF HYPEF.THYPOlalSH |

)Au 198 INTRACAVITARY TREATMENT

<Ce605 . INTE RSTITI AL TF.E ATMENT

(Co,.,1,37,, {9@ ordi j'

|INTRACAVITARY TREATMENT .

'

I,,I,,,, i..i,dINTERSTITIAL TREATMENT.

4 TELETHERAPY TREATMENT*'

(Co.137

e'. 5e40 TREATMEP.TOF EYE DISEASE *

|.,* R ADIOPHAFMACEUTICAL PREPARATION*

,

|

[[M GENERATOR

.f,,, GENERATOR

T*99m REAGENT KITS 35 ,'our '*

, .t- .

L

|i * Didactic Training :. .

j

!|| | J

: s.

9

1 3. DATES AND TOTAL NUM8ER OF HOURS RECEIVED IN CLINICAL RADIOISOTOPE TRAINING'

-

650 Hours Septernber 1979.- hs.r. March 1980 *

y? August 1980T .+ March 1981

. I. .

h 4. .JME TRAINING AND EXPERIENCE INDICATED AllOVli 6. PRECEPTOR 3 StGNATURE, S.WAS O8TAINED UNDER THE SUPERVISION OF: ;; j ,

mama or suranvison y'Rober1 E,itantin_M.n. // .

< --!

'

.-

7. PAECEPTOR'S 4A?AE A*, vase goe wannt) 1E NAME ce 'NSTITUTION

,' '

NuC15ar Medicine-Loyola Univ.Med.Ctr. '.-s. MAluNG ADDRESS R0bert E. Henki.1.r. 0. :<

2160 South First Averue 's C4TV

-

8. DATE,

Maywood, IL 60153

/7 h ;s. uATERi ALs ucENsE NuMeaRm

uDr n mm_n4._f o4M hnC4iJt,eluPrL iMI NT 4 .<s.m , . - .

C21 No.O 4 6 3 4. . ..

Page7-

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