WEST PHYSICS

June 21, 2013

U.S. Nuclear Reguhj.tory Commission, Region III

CONSULTING Daniel P. Leddy

3825 Paces Walk Atlanta, GA 30339

404-593-9074 (cell) 770-456-5283 (fax)

Materials Licensing via fax- 630-515-1078

Attention: Tori SiQtmons

Re: Amendment ftr License No. 10-29283-02

Dear Tori:

In response to your phone call of 1/23/2012 regarding a license amendment request submitted for the referenced license on 1/16/12, I offer the following:

The amendment request is twofold as follows:

1. Please add the fl'dlowing Authorized User:

Salim Shamino, M.D.

I have included a cqpy of a recently terminated Wisconsin Radioactive Materials License lsiting Dr. Shammo.as an authorized user.

2. Please change the RSO from Catherine Anderko to Zubair Abbasi. The supporting information for Mr. Abbasi from a South Carolina RAM license is attached.

Thank you for yourimmediate attention to this matter.

Sincerely,

Daniel P. Leddy, M.S. HP Medical Physicist/RSO West Physics Consl!lting~ LLC

Dennl• G. Smith Secretary

May 31,2012

Digirad Imaging Solutio.bs, Inc. Attn: Daniel Leddy, RSO 3825 Paces Walk SB, Suite 250 Atlanta, GA 30339 .

Dear Mr. Leddy: .

. Stata of Wleconein

Department of Health Services

DIWIION Oil PUBUC H!AL TH

1 WUT WIL80N 8TREET P0BOXZIII58

MADISON WI $3701·2851

801-287 -47rl7 FAX! 1101-287-311811

dhs.wiseonaln.gov

Enclosed is Amendment09 to Radioactive Material License No. 133-2003-01, with the changes pr~ted in bold !etten.

Please read the Hcense ~arefully :u you will be re1ponsible for its contents. Your operation~ will be subject to routine inspections by the State of Wisconsin, Department of Health Services

. for compliance with Chapter DHS 157 'Radiation Protection' and the conditions of your license. These inspections. may be unannounced or scheduled.

If you have any addition,al questions concerning your license please feel free to contact me at 608-266-7384 or emily.~ggers@wi.gov.

Sincerely,

~ ..... OM~~.~ Emii;'~9 i "

Nuclear Engineer . Radioactive Materials Px'ogram

Enc.

STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES

i RADIOACTIVE MATERIALS LICENSE

Under s.2.54.36S, Wi11comin St.tutesi and Chapter DHS 1S7, Wisconsin Administratlve·Code, and in reliance on statements and Rpi"OICIDtidion~ macle by ~ liQ~D~ee,i a llceuseis Issued au~ma tbe lklllilee to rece!vet acquire, poaae .. and. trlnlfer radioactive mllterial designated beloW; to use the material for IP.e Pl.DpOIO(s) and at thO place(a) designated below; and to deliver or tranafer the material to persO!IS ~ to receive it in accordtnoo with Chapter DHS 1S71 Wiaccmam Ad.minittratiw Code. This liccme is subject to all applicable rules and orders of the WiKonsin Department of Health Services (DHS) including ChapteJ

· DHS 157. W"liQOnsin A~ln1atratlve1Code now or horelftv in ~ IIDd to any conditlonsapecified below. . .

. '

LiceDSee Name ana Addre$a bl aec:ordanc:e with fac:aimlle dated May 01, 201Zt I 3. Lioenae Number: 133-2003-01 \ I le amended !nits eotlreti:tO read as follows:

1. Digirad Imaging Solutions, Ip.o. 4. Amendmmt No.: 09 ;

2. 3825 Paces Walk SB, Suite~50 A~lant.a, GA 30339 !

!1. Bxptratlon :Date: August 31, 201S

)

6. Radioactive 7. ~al and/or 8. ·Maximum amount of 9. Authorized U1e: .materlal: phy~qal form: 'radioactiv~:rmateriala that the

licenJ~ee may posiUII at aliy tme ! tbne undel' thia licenae:

. '

A. Any radioactive A. Any !

A.Atneedecl A. Any imqiDaiD.d material radiOJibannaceutical locallza'lion proeedure permitted by permi~d by DHS permhtedbyDHS DHS 1S7.63(2) 1S7.6,(2). l$7.63(2) •..

CONpiDONS I I' ' •

10. · · A. Licensed ma~ may be received and stored incident to mobile nuclear medicine activities at the

B. licensee's faciliti~sloaatad at 2600 S. 162nd Street. Naw Berlin.

LictDSed mater~l inay be received and Used at temporary job eites anywhere in Wisconsin where DHS maintairis jlu;.sdiotion for regulating the use of licensed material. j ! 0 I

11. The Radiation Safety Qfftcer for tbillicense il Daniel P. Leddy. ,i

12. LiceD.Hd material i11 onbf authorized for lJ:SCI by, or under the supervision of: I •

A. Individuals p~itted to work as an authOrized user in accordance with DHS 1 57.13(5)(b) aDd DHS 157.13(5)(c).

1

B. The following iddividuals are authorized users for medioal use as indicated:

DPH 4S018 (07/03)

Pg 6A9 &AlAS 12:45 pro

DPH 45018 (07/03)

RADIOACTIVE MATERtALS . License Number: 133-2003;.()1 LICENSE 1

SUPPL ,.,u.,...,....,. AR'Y' SHHHil' Amendment No: 09

Authoriz;ed Users:

2500 W Layton Ave, ~ui~ 200, Milwaukee

Parag A. Madhan~. M.D, .

Salim Shammo, ~D. '

2600 N Mayfair Rd, S~ite 950, Wauwatosa i

Material ~md Use '

DHS 157.63(2).

DHS 157.63(2).

Patag A. Madh~, M.D. . DHS 157.63(2).

Salim Shammo. rt.t.D. DHS 157.63(2). i

• I ,

2801 W Kinnickinnic Juver #925, Milwaukee

ParagA. Madh~, M.D. DHS 157.63(2). I

Salim Shammo, *.D. DHS 157.63(2).

3077 N Maytkir R.d, ~lwaube !

Paras A Ma~ M.D. Salim Shammo, ~.D.

PHS 157.63(2).

DHS 157.63(2).

Page2 of3

13. The Hce:nsee· is authorlzec,l to tnmaport lioensed material in accordance with the provisions of Chapter DHS 157, 'RadiationProtectioljl', Subchapterxni, 'Transportation' •.

' .

14. · In addition to the pos&R&~on limits in Item B, the_ licensee shall further restrict the possesaion of lioen• . :tnaterial to quantities belfw the minimum limit ~pecified in DHS 157.15 for establishing decommissioning· financial assurance. ! •

IS.

A.

B. ·C.

D. E.

SIGNATURE

License Number: Amendment No: 09

nm·lllid~~d otherwise in this lioen~, the licen11ee Bhall conduct' ita program in accordance repJr~elnta:tiollll. and procedUres contained in the doe~nts, including any enclosures.

chang~ in the medical use radiation safety proeeclures as provided ID DHS 'Radiation Protection' shall govern unless the statements, representations, and

license~~~ application 8Dd conupondence are more restrictive than the rule.

attaLOI'plnents (to include 'Delegation of Authority' letter)t dated June 1, 2010 and signed

Letter. with atta~~:len1ts, dated December 9, 2010 and signed by Daniel P. Leddy ..

a"'ch1111en1tsf dated January 24,2011 and signed by Daniel P. Leddy.

•ttlll~mellltl!lt dated May 2.5, lOll and signed by Dairlel P. Leddy.

6/ L\ II~ DATE

,.

ng pm

0:

ReQuelted Authortzation(s) The ·

04.35 ~37 0 4.58 (teM«herapy)

pm

RADIATION SAFETY OfFICER llltAINING AND EXPERIENCE AND PRECEPTOR ATTESTAl10N

[DHEC -· 81-13. Part IV)

04.56 0-4.68 (1'8m0te .~r)

0-4.88( )

PART t - TRAINJNG AND EXPERtENC£ ($McfOtUJ of the four 1M~ Hlow}

"'Ttainlng and &parienc:le, induding board oel1ibtion, mu1t h81te been obtained within the 7 )'Mt$ preceding the dam of •pplcaUon Ot ·the lndiYiduaf A"WJit have obbline<i oontinuing educatiOn and expen.I"'Q since the reqU'frtd tltaining and expertenee VIM completed. PnMde datel, dooltion, end~ on of continuing llldUctltlon and experienoe related 'to the uMa checked above.

~.IQiai9M'ftsdpn ~ ' a. Provide a copy d the board aJif'tific;ation.

b. Ute Table 3.c. to dea«iba . iring ir'l radiation safety, regulatory h&soes. and ~ ~ faf 1111 types of l'rl8dtcilill ..... on 1he 11cen .

c. Skip to and complete Part II Precep~or Attastation. OR

OR

Location of Ttlllnfng

~ .perialnlng to 'lheueeand~ d~

Total HOUI"$1$ Training: DHEC: 08140 (0312001) SOUTH CA OLINA DEPARTMENT OF HEA..LTH AND ENVIRONMENTAL CONTROL

. 0: 11axema t1 630-515-1078 From West PhYSICS GOilSUit1Tl9 Pg lH/1~ Hti/Zl/lJ 11:45 pm

RADIATION SAF1ETY OF PlCiiiR TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (contln..cl)

3.. :llfw!o•MI....t ,,_~ -· .... Jl...t.l!v Offlc8r (eontinued)

' b. Supervised Radiation s.t~ s ~periance (If more than one suparviling I 1.6.w. .... l is n~ry to dooument supetvised work e.~CP~trienoe, pn:Mde mulliple copies af thi8 Mdion.)

Oetcription af &pertance Location ofT'*"'ingl Lk:enM or Pwmlt Nul'rlber of Fdity o-. or nalning*

Shipping, 11101Mng, and performing reaated radiation 8Uf\leYS

Uemg and~ dlec:b for / proper opetallon of instruments UMd to detemlin& the 8CllMiy of ctougea, :IIUfVItY meter~, and lnsltumenta ulled to measure radionucf~

Sacwing 8nd ctYltrglllng radioactive material

Vsng adrni1ilttrattve controta to avoid miataklta In admii"'IICradon ot radioadiwt matllilrttll

_ ...... -. MIMIM I' ,._ ..

U$ing procedl.lftMI to pre'lllf11 or minim~• r'8CIICMICtN8 contarrinlltian .nd UISing proper decont.amln~ procedures

;

U.tlo anaganey ~to

I conb'QI radlo.adi.Ve matMal

DiapOSinQ of f1tdioacliW mahMial I UcenMd I'NtllriBJ used / {e.g. 4.35. 4.37, etc.)+

...... 4 ..

+ ChcloM -.11 appicable section$ of [ HEC Reg. 81-63, Tit'- A, Part IV to dee<:ribe ~ cld qu~ used: 4.35, 4.37, 4.40, 4.416, ... 6$, 4.58 f1tmofe ill~ l.l ~. 4.58 ._.lherapy ..nt.. 4.58 gamma sttrotacfic ~ untts, emerging~ (provide list of device$).

OHEC 081-'0 (~2001) P-s-2

I

·o: 163051510~@ 630-515-HHH trOI ft Physics umsulting 1'9 II/1M 01>/11/lJ l'Z:q::> pal

RADIA110N SAF!TV-1

• ·--·- 'mAINIHG AND EXPERIENCI! AND PRECEPTOR AT'T'DTA110N (continutMtJ

3. _, .. -- ........ - ~- I S:llfMv Ofl'lc.ar {continued) b. SupeNINd Radiation Safely ==:::v doalme . (If more thin one supeMI!Mng ·- Ia neceqery to m: $UpeMeed work el(peflence, provide ~

copies of thla MOtion.)

Supenrieing fndMdual ~Number 118Ung SUPfl'\'i$ing as a Radimion Safety OfJioer

I

Thi• licenH authorizlllfl the :.;;.:~ '"'medical uaet:

0-4.35 04.37 04.<40 o•.46 04.58 0·'-158, ~m afterioadar) .D 4.58 (telo1herapy)

0 ... 68 (gamma .Wreolactlc ,_.. l'"'"""''lii..,.J'I 04.88(- )

c. Describe tnlllnmg In ~at+on s afety, regulak'>ry iiSues, and emefVency proeedutes fOil' atl typea ot meclcul1 uses on the lloente.

Dacription ofTnmtng Training Provided By Dates of Training"

Radlatk.w'l Mlr.ly, NQUiillltory -.,., ~ uJ. _6'et[r~ tVts;j h., 1). 1 ~ Ch ~ :u.m-7-~ procedUt'Mfor .. ,35, -1.3

f!qr~Nr. and4.Muut rtcJ1J:'I t/MF /f)Gt)fQ/t.- -'!'~: v . ~. 1 . . • ~f/t,~ Cnts-t~l;,;..., -Mfefy, fegUa.tafy -., ~ /

emergrl8nCY Pf'OCI'di,JNI!I for 4.40 UMI

serety, •7 i~, l ~ emergenc:.v procedurn for 4.<46 .....

Radiation safety, n~~QUiatOIY is ... , I !nd emergency prooeGU*for -4.58 .. t~UM&

Radiatir.1n safety, .-.guiMory 1..-...... ~ ~ ........-gency praoec:tures fot -4.5& - rer~ aftarloadet Ute$

Radiation~. regulatory~·~ ind ~ procedun!IB for 4.58 ~ lil""' ....... ttereoblclic ndosutgery use.

Rldiation Nfery, reguiaby lnoea, • ~ emergency Pf'OC*dul'ft for 4.88, .,. use(a):

lltiiCC ~140 ·~ Pege3

Pg IZ/Il:l Ht>/Zl/lJ 11:'1:> pi

RADtATION SAFETY OFF14 ~R TRAINING AND I!XPER1ENCE AND PRECEPTOR ATTE8TA110N (continued)

3~ .. 1 "-" -· -" - •• bfalv -· (oontmued) e. Training in radiation safety regulatory iesues, .and emefVeney pmoedu"'s for au types of medical uses on 1tle

license (continued)

4..~it Number UeUng &upertliting individual

;tJ-;-?HJ-0-;_ if::f-r 3. Uoense/Permit lists supervi11tr; individuel 86:

~on Safety Offk:er 0All1horized u.., OAuthorized Nuclear P~ 0 AuttloriDd Medical Ph)!sk:lst

.Authorized as RSO. AU, A.NP or AMP for the following medicul utM:

04.35 (1'(4.37 04.40 04.4(1

0 "-:56 0 4.5$ (remote at .... 0 4,58 (teletherapy}

0 4.88 (,_ _____ _.)

d. Skip to Md crJmplete Part II ... -.. AttestatiOn.

OFt

a, PRWide llcanM number. b. Use ttl$._ in Mdlon3.c. to r--"'.!'.... ttalning In radiation :i&llfaty, regulatory l~tUM, andemergwtey procedureS for all type• of

medical use en the license. c. Skip to and complete Part II Pi~Ot Attestation.

PART II- PRECEPTOR AT'I"ESTAnQN

Note: Thll pan must be c:ompleted ~.'!he Individual's precaptor. TN pl'll!IC8ptof' doM not h.we to be \he 8upef\lteing indMdu_. along • the .. or a.wovldn, directs, or v.rlfleG training and e.peri•nce required. lr more than one ~ il necesaary tc d .... _ ........ experience, obtain a MPerate p~ lltJUment from each.

F .... ts.ctlon Check one or u... fo8owlno;

RHA-4.20.1.1.1 and 4.20.1 1.2; or RHA4.20.1.2.1 and4,20.1.2.2; or RHA4.20.3"

OR

2. :!ll+w ............ &:.4 •. ' - ...... '!llar.N --

0 I etbMt that -~---+--~~----~~-hilt$ Mtisfactorily c:crnpleted a I!WtJr.ltUI'al eduCIIIional N~ or Pr1~ Rlld~n s.M~ Officer

program ·~ttina of both 20C hout't of daslfOOft'l and ~ lnlining and one yer.r or fuN-time radiation safBty experience

as ~uln.d by RHA 4"20..2.

OR

OHEC 0114D to31200t)

PRECEPl'Of« ATTI!STATION 1·1.". bl'lti!i'IUi!ld'l

PINt $M;:tlon (eondnued) Chtek OM of 1he folowf_..:

3. ~J.IQQILAiidblldrlllialuiLBI.IUD.Jidltt:.alliat 0Authoriled UMr

0 I Mbiat that -;;.;;;;;p;;;;tfR;tdiaj;;n;w;t;Cii;:---ls Ill 0Authortled Nudear ~acisl Ntiime ot Rad'*liol'l Safety Oftlcw

OAU!harized Medical Ph~l

idet'IUfied on tM licen~~ea'•

radloeetlve ~al for

and hat Ctxperieonce with .,. l1ld1aUon safety atpedll of similar type ar ~.~~e of

the- irldMdual has Radiation Safety Officer ,...pons~blfftiH ..

AND SeoOI'MI s.cdon CO.p.t. for ... (ciHH:k all that

ra"'i dtttttMt -~~()~~t;;dit~~&;i;;Q;b;~ha lnlining In the radiation s.afety, ~ IMun, and Nama at

~ proc:edures

Third Section

04.35

~.37 Adflrlihi!l!Mtlon ot leu than or aqu•l to 33 millieu"el of sodium iodide 1-131, for which 8

dii'IM*-Is reqUired

0 4.40 ~ oral adr1n!M•tr:ation of g1'811tar th.-. 33 millicuriM of sodium iodidl& 1-131

0 4 • .0 - adminiatnllliOrl of .any biN-emifter, or a photon-emitting tadlonudide with • photon energy of than 150 keV for whk::h a Written di~ Is :required

0 4.40 ~ .,_.ntAti'SII admlniatration of any other r~udide for whfc:tl a Wl'lten dl~ Ia required

0 4.4e

o•.GG 0 4.58 - remote ~wklifllder untt.

0 4 .. 58 • talftlhM:IIdlt

0 4.68 - gamma et)M1eotidco nadiolt.lrgety units

0 4.!51 - emerging indudlng: __________________ _

AHO

C~forALL

1(1 attest 1hal .-=M.;~~~;;di~~;Sa:t:Oii;;;-- hat achieved a level of radiation aafaty knowledge R•dia1ion Slfety Oft'lcw

indl~tpefttentlv u a Radiation Safety Offloef tor e medklal use licensee.

Tetephone Number

770-~3):9JSt J.-~-13 s

pm

Page 1 of! Page

SOUTH '-'Aau.LIJJ.~'~ DEPARTMENT OF HEALTH AND ENviRONMENTAL CONTROL Radioactive Material License

Pigirad Imaging Solutions, Inc. 3825 Paaes Walk SB Atlanta, OA 30339

Supplementary Sheet

License No. lli, Amendment No. 06

In aeoordance with letter dated F~AJI..,.na·rv 8, 2013, signed by Daniel P. Leddy, S.C; Radioactive Material License No. 929 is hereby.AMENDED:

Condition 11.

11. Radiation Safety Officer: '9tPU'Y" .o~liil'ooo~'"' Alternate Radiation Safirt:I#JCIIBCF.D.~~~:.:. .

DHEC 812 (11/81)

For the South Carolina Department

ofHealm::~:=taiJ.Sr.o::.ntro:.:-1---BY:~~

Aaron A. Gantt, Chief Bureau ofRadiological Health

Catherin11 B. Tempkton, DIEeet<~r A-fm~o~nng .,.rJ /rtJtt&ting tiN ht111th fl/ tht publk •ruJ rh~ mr~;ro,.mm'

February 19, 2013

DanielP. Leddy,AR.SO Digirad Imaging Solutions, c 3825 Paces Walk SE Atlanta, GA 30339

Dear Mr. Leddy:

In accordance with your t request, your s:c. Radioactive Material License No. 929 has been amended. Enclosed is Lice e Amendment No. 06.

If you have any questions garding your license, please do not hesitate to contact our office at (803) 545-4400.

Very truly yours,

ames K. Peterson, Directo Division of Radioactive terial Licensing and Compliance Bureau of Radiological th

!ami

Enclosure

SOUTH CAROLINA DE ARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL . 2600B Street. • Columbia,SC29201• Phone:(80!)898-MB2 • www.scdhec.gov

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Facsimile Transmittal

FAX To: 163051 51 078@maxemallsend.com From: West Physics Consulting

Company: Date: 06/21/2013

Fax Number: 163051 51078 Pages: 19 (including cover page)

Re: Digirad RAM license amendment request

Comments:

Dear NRC eap1a,yee(•)

P~•aa• a•• atta~.

SJ.nee.re~y,

John A. Ban-ey, Ph.D Medical and. Health Pl: ¥8:I.O:I.8t we•t Ph~•:Lo• Con•u1~ nq, :r.:r.c