07/ 23/ 2 0 8 5 SARA L A R R Y S I W S C \ PAGE E2

CHRISITIANACARE HEALTH SVSTEM

22 July 2005

Sandy Gabriel Senior Health Physicist Medical Branch-NRC Region I 475 Allendale Road King of Prussia, PA 19406- 14 I 5 6 10-337-5006 610-337-5269 fax < sla2@nrc.g= >

License No. 07- 12 153-02

Reference Mail Control tt - 136985

Dear Ms Gabriel.

This is followup to your request for further information as regards to our request to amend our NRC license.

1. At tach ent A, provides the documentation, confirming Novoste’s receipt of IVB Sr-90 endovascular sources 1 1/22/04.

2, I should be listed as the non-medical authorized user for storage of the Sr-90 eye applicator which has been withdrawn from clinical use.

3. As regards our request to add Abhirup Sarkar, M.S , as AMP on our license: 3.a Attachment E is a copy of the transcripts from Univ of Pennsylvania, documenting granting MS degree in Medical Physics on 19May2003. 3.b. A description of his program, including clinical experience at UPenn, 19May2003-Jan2004 is found as Attachment C. 3.c. Attachment D is letter from me, certifving that he has completed one year of full time experience including the applicable tasks listed in 10 CFR 35.961(c).

Since our request for these amendments were sent to you, we have , on medical staff, a new Radiation Oncologist, Dr. Jon Strasser, who has just completed his residency at Harvard Medical School. We request that he be added to OUT NRC license as medical Authorized User Attachment E is a letter from his Harvard program director attesting to his training together with logfiles of his patient experiences. . Attachment F is my summary, from his logfiles, of his LDR and HDR clinical experience in training.

If you need further information or clarification please contact me: 302-545-3870 voice 302-623-4850 fax

< LSimDson@ChristiaaCare.org >

Sincerely,

Lany D. Simpson, Ph.D. Director, Medical Physics

Cc: Joseph Solge, RSO Pat Grusenrneyer, VP

A. 1 @ Novoste

Date: 30 June 2005

To: David Jacob / Larry Simpson

From: Patricia Blute

Subject: Confirmation of Receipt of Radioactive Sources

This letter is being senr royou as conjrrnaion of receipt by Novosre of thefollowing active sourcesfTom Chrrisriana Cure Health in Newark, Delaware. A 11 mtive sources have been returned.

RST ZB624 in Transfer Deuice 92750 on 11/22/04 RST ZA742 in Transfer Device 92588 on 11/22/04

Regards,

Patricia Blute Rad Lub Supervisor No voste Corporation 770.638.5480 pblute@nvvoste. corn

SARA LARRY SIMPSON .._ 05

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. . This is transcript request # 1 of 3 allowed per day

Admitted From: I N D I A N INSTITUTE OF TECHNOLOQY

School: ARTS & SCIENCES Divieion: GRADUATE ARTS & SCIENCES

Degree Program: MASTER OF MEDICAL PHYSICS Graduate Group: PHYSICS AND ASTRONOMY

05-19-03 MASTER OF MEDICAL PHYSICS

Fall Z O O 1 QRADWATP ARTS (I SCIBNCIS PHYS 521 ADVANCED LAB 1.00 CU A PHYS 561 ELECTROMAGNETISM I 1.00 cu E PHYS 5 8 2 MEDICAL RADIATION ENG. 1.00 CU A-

Term StatiBtics: 3.00 CL' cumulative: 3.00 cu

Spring 2 0 0 1 GUDUATL ARTS t SCIENCES PHYS 562 ELECTROMAG I1 1.00 CU A PHYS 5 8 2 MEDICAL RADIATION ENG. 1.00 CU A- PHYS 999 INDEPENDENT STUDY 1.00 CU B+ PHYS 999 INDEPENDENT STUDY 1.00 CU A -

Term Statiscics: 4.00 cu Cumulative: 7 . 0 0 cu

Swmsr 2 0 0 2 QRADUATE ARTS & SCIXNCLS 1.00 CU A PKYS 999 INDEPENDENT STUDY

Term Statistics: 1.00 C'J

https://sentry.isc.upenn.edulintouch/ngmOOO 1 02/2 112005

Universiry Transcript

Pall 2 0 0 2 MATH 584 PHYS 580 PHYS 999

Spring 2 0 0 3 BMB 581 PHYS 999

Page 2 of 2

GJ- Cumulative: 8.00 cu

GRADUATt ARTS C SCItNCES MATH OF MED IMAG&MEASURE 1.00 CU BIOLOGXCAL PHYSICS 1.00 cu INDEPENDENT STUDY 1.00 cu

Term Staciatice: 3.00 cu Cumulative : 11.00 cu

GRADUATE ARTS br SCIENCES TECH MAGN RES IMAGING 1.00 cu INDEPENDENT STUDY 1 . 0 0 cu

Term Statistics: 2.00 cu Cumulacive: 13.00 CU

Equivalent Credit: 2.00 cu Total credic: 15.00 CU

B B+ A

B- A

+ P E W BQWIVALENT CRKDIT * *

Excernal T r a n s f e r Credit: INDIAN INSTITUTE OF TECHNOLOGY GENERAL CRE 2.00 cu

Total Penn Equivalent Credit Awarded: 2.00 cu

Final Exam for Entrance i n t o Pre-Certification "Residency" Training passed: 05-05-03; Topic: "Studies of Motion d u r i n g Radiotherapy using an Electronic Portal Imaging Device" d

* * NO ENTRIES BEYOND THIS POINT * *

Comments to: Office of the Univcrsity Registrar Room 22 1 Franklin Building 3451 Walnut St Philadelphia, PA 19 104-629 1 Phone: (215) 898-7511 FAX: (215) 573-2076 ~ ~ & o b o x .wenn.edu

Document: 0201

0212 1 /2005 T9ZL598ZL6 PS :90 5 0 0 Z I E Z I L 0

FaIl’Ol Aug - Dec

Took courses full time at UPenn including basics of radiation-physics and dosimetry calculations

Spnng’O2 Jan - May

In addition to taking courses which included basics of dosimetry and treatment planning.. .worked with Dr. Indra J. Das and Mike Bieda on an independent project on the possibility of finding a single OD to dose calibration curve over a useful range of depth, field size and orientation.. ..the study also compared the depth and field size dependence of EDR and XV films

Startcd working on an independent study with Dr P. Bloch on evaluation of irradiated lung area due to respiratory motion in breast patients and its comparison to daily treatment set-up vaxiations..results using the EPID

Fa11’02 Sept - Dec

Courses on anatomy, physiology and CT reconstruction algorithms.. .worked with Dr A. Kassaee on an independent study on comparison of coplanar and non-coplanar IMRT plans for pediatric posterior fossa tumors using diffcrent planning algorithms and effect of MLC leaf size on optimization results.. .continued work on the study with Dr,Bloch.. .spent around 10- 15 hrs per week in dosimetry learning different planning aspects of tumor sites.. .helped with monthly and annual QA on machines.. .TLD annealing and irradiation..prostate seed implant pre-planning and needle loading

Spring’03 Jan -May

Course work included basics of CT and MR imaging.. .worked on an independent study with Dr. Bloch finishing up the breast study studying dose distribution throughout breast and quantify inter and intra-fraction lung and heart motion due to respiration and set- up.. .also worked with Dr. Kassaee on a study involving cornpatison of dosimetric characteristics of small photon fields with rnicro-$xm&sqy$...odes .. .continued above- mentioned clinical duties ? $1 4 UJ & =

June’03 - Jan’04 Junior Physicist

Helped dosimetry with planning.. .did H&N IMRT plans on Oncentra.. .prostate seed pre-plans on Variseed.. .monthly and annual QA.. .IMRT QA and film analysis.. .chart checks.. .helped with commissioning of a machine.. .commissioning of new stereotactic cone systcm from Raidionics..worked with Dr.Kassaee on comparison of CT and MR image registration accuracy of manual (Helax) and automatic (Radionics) techniques.

ZQ 39Vd NOSdWIS A t i W l W’tlVS

3 cHRIsI?ANAcARE HEALTH SYSTEM

SARA LARRY SIMFSC'. - . -- , - A u t 2 ;

610-337-5269 fax < slpr2@mc,fzov >

License No. 07- 12 153-02

Reference Mail Control Z+I - 136985

Dear Ms Gabriel:

As regards our request to add Abhirup Sarkar, M.S. , as AM7 on our license:

I certify that he has completed more than one year of full l ime experience under my supervision in his work with both LDR- and HDR- applicable tasks listed in 10 CFR 35.961(c).

SpecificaIly :

He has direct clinical physics experience in over 200 LDR prostate seed implants and source safety and management.

He completed K 3 day course of training at the Nucletron facilities in Columbia, MD for the Nucletron mHDR unit and the Plato HDR Brachy Planning system.

He participated in the commissioning of the mHDR unit last year. He has attended and completed the annual refresher safety and emergency training for 2004 and 2005 on our mHDR unit.

He has shared in the Daily QA, source change-out calibrations, and treatment planning for the mHDR in its use for over 400 HDR fractions involving Mammosite breast intracavitary, vagnal/cervical intracavitary, and prostate interstitial patient applications. He has been key in working with physicists at UCSF Med School to implement improved mathematical optimization of weighted dwell points for interstitial prostate planning and treatments.

If you need further information or clarification please contact me: 302-545-3870 voice 302-623-4850 fax

< LSimDson@ChnstianaCare.org =. Sincerely,

Larry D. Simpson, Ph.D. Director, Medical Physics

Cc: Joseph Solge, RSO Pat Grusenmeyer, VP

June 30, 2005

L o r r y D. Simpson PhD 4 701 Ogle t own-S tan t on Road Radiation Oncology, Sui te 1124 Newark, DE 19713

Fax. 302-623-4850

To Whom I t May Concern

This l e t t e r IS in response t o your request t o conf i rm that Or. Jon Strasser ha5 completed'

1 A s t ruc tu red educational program in basic radionuclide techniques applicazle '0 t h e use o f a sealed source in a therapeut ic medlcal uni t that includes,

I.

mathematics pertaining t o t h e use and measurement o f radioact iv i ty, and radiat ion biology 1 1

200 hours of classroom and lab training in radiat ion physics and instrumentat on radiat ion protect ion.

500 hours o f work experience under t h e supervision o f an author ized user

2. Has completed 3 years o f supervised cllnrcol experience In radiat ion therapy, under an author ized user

as p a r t o f t h e formal t ra in ing program approved by t h e Residency Review Comtn t+ee f o r Radiation Oncology o f the Accredi ta t lon Council f o r Graduate Medical Educotlon

3. Has received training in device operation. safety procedures and clinical use for t he types o f use f o r which authorizatron is sought by receiving training supervised by on author ized user o r author ized medical physicist, as appropriate, who 1s author ized f o r t h e type($) o f use f o r which t h e nd vidual I S seeking aut hor izat Ion

J o n Strasser , M.D , en te red our training program on 7/1/01 and completed o b r program on 6/30/05 a t t h e Joint Center f o r Radiation Therapy (JCRT) now known a5 the Harva rd Rodia+ion Oncology Program (HROP) and has achieved a level o f competency suffrctent t o function independent as an olrthorized user o f each type of therapeut ic medical unit f o r which t h e individual IS requesting author ized user s ta tus

Resiaency Program D i rec to r

Jon F. Strnsner For l'rocudureo In All Ymm For MI Resideat R o b

For All Typcs in All and All Groups Of 6/16/2005

Rndiatlon O o c o l o ~

Ex Beam - aon-metnshtic Benlgn: Hetnotopic Bone

Benign: Eye Benlgn: Other BondSTS

Breast: Intact

Breast: Post-Mastdomy

CNS End ocrlnc

Htnd & Neck: Intact

Head & Neck: Post4)perAlivc

C;astminlestinnl: Esophagus Gastrnintatlnal: Stomach C a s h in ter d n * I : Pan crca s

Gashintestinal: tirpalnhiliary

CrsbnintaGnnl: Colon Gutminttstinal: Rectum

Gar boin tcs dn rl : Anus Gastruhbestinal: O t h a

Genitourinary: Prostate Genitourinary: Bladder

Cenitourlnory: Tat=

Ccn I tou rl n ary : 0 th er

Gynecologic: Cervix Intact

C yn ecologic: Ceni x Post-H ystcrecto my

Gymemlogic: Uterus

Cyneonlodc: Othrr

H odgkins Lymphoma Non-Hodgldns Lymphoma l,tukmia/Mydoma Other Hematologic M a l i g n a n a s Lung/hlallastinum: SmaY Cell Lung Canccr

L u n f l c d l n s t i n u m: N o n S moll I ,u ng Can aer

L u n f l d i a s t i n u m : Other

Skin Unknown

0

0

0

1 0

0

1

0

21

8 3

2 2

0

0

4

0

0 23 0 0

10 4

0

6

5

0 0 1

0

1 2

0 0 0

Total

0 0

0

1

0

0

1

0

21

8 3 2

2 0

0

4

0

0

23 0

0

10 4

0 6

5

0

0

1 0

1

2

0

0 0

94 94 Ex Beam - non-mctastatrc

ram ID: 430241 I131 IVogmm Name: Hdgham mnd Women’s Hospihl/Massnchuscdb G m d H O 6 p i m W l r d M o d i d school Ptl at All [osdtuter Jon F. Strarser

For All T y p a in AI1 Areu and All Groups As Of 6/16/2005

For I’rouxjures in All Years For All Resident R o b

bd ia t ioo Onarlogy Obrenal Performed TOM

Ex Beam - rntsastatlc SacondRry SI& 18 1u

Ex Darn - metarbtic 18 18

Pediatlic Lcukemia 0 19 19 Mcdulloblnstoma 0 3 3

C N S (non-medulloblasbma)

Hodgkins Lymphoma 0

0

7 0

7

0

Noo -tl od gld a s I, y mp h o ma 0 1 1 RhnbdomyosarwmdSTS ( I 1 1

Ewings Samm;a/Bone T o i n o r 0 2 2

h’cu roblastom 1) 2 2

Retinoblastoma 0 0 0

Wilms Tumor

Other 1 3

1

3

Pcd i atric 0 39 39

S t e r e ~ t a d i c radiosurgery Bmln OtbW

3 3 0 0

Stemtactic radioru rgcry 0 3 3

Breast - Low Dose Rate 0 0 0 Breast - High Dose Rate I1 1 1 Soft Tissue Sntwma - Low I)oar UtC. 0 1 1 Soft Tissue S a w m a - Uigh Dose R Y ~ C 0 0 0 Head L Neck - L o w Dose Itatl. (1 1 1 H a d & N a k - Hlgh DOSC Kate ( I 0 0 Prostate - LOW Dose Rate (I 9 9 Prostate - High I)osc R a e II 0 0 GYNIPdws - Low Door &+ 0 1 1

Otha- Low Dose Rate 0 0 0 O t b a - High Dose Rate (I 0 0

Brachytherapy - In terstitinl

GYNlPolvis - Hleh DOSC J b t t 0 6 6

Brachythcrupy - Interstitial 0 19 19

2

- ~ -c *aG= 2 : SARA Law+ SIMPSON - _ E 7 / 2 3 / 2 9 0 5 06: 54 9728627261

d' Resident bperience Report 5 4 ram ID: 4302411131 Program Name: Brifhnm and Women's tIuspihURlassachuretCr G m e 4 H o s p i t n W ~ . r d M e d i d School Pn

at All Instinttee Jon F. Stmuser

For All Typcs la All hreps and All Groups For P m c r d u ~ In All Y a m For All b i d a t Roles

AS or 6/16/2005

Radiation Oac~lofy Observed Pedomed Total

CervlXIUmr - L ~ B W h s c Rate 0 0 0 CerVi~lULau~ - High Dose Wntc n 106 106 Endovascular - Low Dose Rate 0 0 0

Endovascular - High Dose 12lltt 0 0 0

Endobmnrhlal - )Iigh Dose Hrtc Q 0 0

Esophagus - Low Dose Rate 0 0 0 Esophagus - High Dose Rrtc If 0 0 Bllr Dud - Low Dore Rate 0 0 0 Bile Duct - High Dose Rate 0 0 0

Other - Low Dose FLte n 0 0

Other - High Dose Rate 0 1 I

Brrchytbwapy - Intmavitvry

Endobmnchlrl - Low Dose l L t e n 0 0

Brrchytherupq - I n h w v l t r r y 0 107 107

t:ndovascular hsert ionr En dovascular I nsertioas 0 1 1

~

Endovascular I n s c h o n s

Unsealed S o u w 1-13; O d P-32 Collold

S R-89

1 I

0 0

0

0 0

0

SM-153 n 0 0

OthfY 0 0 0

Unsenled Sourca 0 0 0

Rndiolabdcd Dmgs 0 0 0

Rad iatioa OOCOIO~Y 0 281 28 1

3

@ 7 / 2 3 / 2 0 0 5 06: 54 9728627261 SARA LAFEY 5:bFSGm FJZE 3

Resident Exprience Report 6 f Z"'-(

Tym ID: 4302411131 Program Nunc: Hiigham and Women's l l ~ s p i t a l / M ~ s a c b u s ~ ceaeral HoapitrUHarvani M e d i d S c h O O l h at All [nseitutcs ,Ion F. Strasser

For All T y p e Ln All Areas and A)] Groups AJ Of 6/16/2005

For I ' r o c c d u ~ in All Ymn For hll Resident Roles

4

Resident Experience Report 6' -am ID: 430241 I131 P r o g r a m Name: Brlgham and Women's HospitaVMassachusetts Genera l HospltaL/Harverd Medlcsl School Pri

at All Institutes J o n F. Strnsser

F o r All Types In All Areas e n d All G r o u p s As Of ll6l2004

For Procrdures In All Years For All Resident Roles

Rsdlat lon Oncology Ex Beam - non-metastatic

Benign: Heterotoplc Bone Benign: Eye Benign: Other Bo n elSTS Breast: In tac t B re as t : Po s r- M aster I o my CNS Endocrine Head 6, Neck: Intact

Head 61 Neck: Post-Operative Gastroinrestinal: Esophagus c; 3 s I i 'oi n t e s r i n u I : S to nra c h

(;a cr roi 11 res final : I' An crcas

(.;asrrointestinal: I4cpitobiliary Gastrointestinal: Colon Gastroiritestinel: Rctritni C a s t roin tcs f in al: A ri V I

C;astrointestinal: Other Genirourinary: Prostafe Genitourinary: Bladder Geni tourinary: Tester Genitourinmry: Other Gynecologic: Ccrvlx Intact

Gynecologic: Ccrvlx Post-Hysterectomy

Gynecologic: Uterus Gynecologlc: Other Hodgklns Lymphoma Yon-Hodgklns Lymphoma Leu kemialMyelorna O t h e r Hematologlr Mallgnancles

Lunf led las t lnum: SmalACell Lung C a n c e r LunglMedlastlnurn: Non-Small L u n g C a n c e r LungRMedlartinurn: Other Sun Unknown

Observed Pcrfo rrned

0

0 0 0 0 0

0 0

0

0 2 I

I

0 0 2

0 0 IO 0 0 0 0 0 0

0 0 0

0

0 I

I 0 0 0

Tota l

0 0

0 0 0 0 0 0 0

0

2 1

1

0 0 2 0 0

I O

0

0 0

0

0

0 0 0 0

0

0

1

1

0 0 0

Ex Beam - non-rnctesratlc 18 18

7 6 2 0 0 4 I I M U M

I

Resident Experience Report @ -am ID: 430241 1131 Program Name: Brigham and Women's HospitaUMassrchuset~s General HospiteUHarvsrd Medical School Prr

at All lnstitutes Jon F. Strassor

For All Types In All Areas and All Groups As Of 7/6/2004

For Procedures in All Years For All Resldent Roles

Radiatlon Oncology

Secondary Site Ex Beam - metastatic

Observcd Performed Total

7 7

Ex Berm - metastatic 7 7

Leu ke mi 3 0 0 0 bled u ilo blasro mn 0 0 0 CNS (non-rnedulloblasroma) 0 0 0

Hodgkinr Lymphoma 0 0 0 F' on-H odg kl ns Ly mp ho ma 0 0 0

Rha bdomyosarcoma/STS 0 0 0 Ew i n 6s S a rcoma/Bone Tumor 0 0 0

Pedlatrlc

Ycuroblastoma 0 (I 0 I1 c t i 11 n blas to ma 0 0 U

\ V i l m s Tumor 0 0 0

Vfhcr 0 0 I)

Pediatric 0 0 0 -

Stcrcotac t ic radiosurgery Brain 0 1 I Other 0 0 0

Stereotactic radiosurgery 0 I I

Brachytherapy - Interstltlal Breast - Low Dose Rate Breast - High Dose Rate

Soft Tissue Sarcoma - Low Dose Rate Sort Tlssue Sarcoma - Hlgh Dose Rate Head & Neck - Low Dose Rate

Head & Neck - High Dose Rate Prostate - Low Dose Rate Prostate - Hlgh Dose Rate 0 0 0 CYN/Pelvlo - Low Dose Rete 0 0 0 CYNIPelvis - Hlgh Dose Rate 0 1 I Other - L o w Dose Rate 0 0 0 Other - High Dose Rate 0 0 0

Brachytherapy - tntrrrrltlnl 0 6 6

2

- - - ~ - - --.- z ,5227261 SARA L A R R Y SIMPSC~ =&E 1, - . . I - - E - & _ L _ _ _ 1 5 : 5 4

t u r 7

Resident Experience Report

*am m: 430241 113 1 Program Name: Brlgham nnd Women's HospltnVMassachusctts General HospitnVHnward Mcdlcal School Pr( et All Instltutrs Jon F. Strarser

For All Types in All Arens and All Groups As Of l l 6 I 2 0 0 ~

For Procedures In All Years For All Resident Roles

Radlation Oncology Brachytherapy - Iatracavltary

CervixNterus - Low Dose Rate Cerviflterus - High Dose Rate Endovmculnr - Low Dose Rate Endovarculrr - Hlgh Dose Rate Endobroncliinl -Low Dose Rate

Endobronchial - High Dose Rare Esophagus - L o w Dosc Ratc Esophagus - High Dose Rate

R i l e Duct - Low Dose Rete Bile Duct - High Dose Rare Other - Low Dose Ratc Other - High Dosc Itntc

Observed

0 0 0 0 0 0 0

0 0 0

0 0

Performed

0

0

0

0

0

0 0

0 0 0

( I

0

f0t.1

0

0 0 0 0 0

0

0 0

0 0 0

~~

Brachyl herapy - l n ( r a c ~ v i t a r y 0 r j 0

I l rid0 v asc ular I nser t iorw E n d o \.a sc u la r 1 ns r r lions n I

Endovnscular fnserflons 0 L _I - I

I .' 11 s L'II led Sources 1-131 Oral P-32 Colloid

SR-89 SM-153 Rndiolabeled Drugs Other

1

Unsealed Sources 0 0 0

Radiation Oncology 0 33 33

3

-am ID: 430241 113 1 Program Name: Brigham and Women's H o $ p i t a ~ ~ s r a c h u r c t t S General HoopltaUHanrrd Medlcal School Pr( nt AJI Institutes Jon F. Strasrer

For All Types In All Areas and All Groups As Of 7/6/2004

For Procedures in Al l Y e s n For All Resident Roles

Signarurc o f Resident. Signarure of Program Dlreclor

' .

4

SARA LARRY SIMP53

RADIATION ONCOLOGY RESIDENT EXPERIENCE LOG

The completed form should be given to the Program D i r e c t o r by July 1, 2 0 0 3 .

To be completed by the Program Direccor:

Program # : - 4 3 0 2 4 1 1 0 4 2 - Inetitution Name:-Joint Center For Radiation Therapy-

Program Director Signature: hct txb+-

City/State:-Boston, MA-

T C be completed by the Reeldent:

Resident Name: , .

9 igna tu r

Time period covered by log: from

L i s t inatitutions ueed for outside rotations: Dates : F r o m - To

~

Adult :rrsdiated: Primary Sice (Non-Metastatic Disease) :

1 cases

$ X Z V i i r e a s t . I n c a c c +ln-) _I..-_- Breast: Post-Mascecromy

I

Bone/Soft T t s s u e Sarcoma

Central Nervous system

Head/Neck: i n c a c c

Head/Neck: Posc-Operative

Gastrointestinal: Esophagus

Gastrolntestlnal: Coioreccal

Gaetrointeetlnal: Other

Genitourinary: Proetate

Genicourinary: Bladder

Genitourinary: Testes

Gfnicourinaty: Ocher

Gy-Iece L q : c Cer:.-u : -1t3ci

Gyrlecologi 2 Ce rv x Scs t - P y s c e r e c c o ~ ~ v

Gynecologic 'Jcerus

Gynecologic Ocher L.

--.

-- --

F l d ) i Lyrnphoret icular Hodgkin's Lympham3 *c+rtH.r

Lyrnphorccrcular SeuHodgkin's

Lymphoma +w- 1 1

Lymphoret icular. O c h e r

Skin

T h o r a x : Small Cell Lung Cancer

1 1

"' Thorax Non-small Cell Lung Cancer

Thorax Ocher

A l l Other6 (Give Examples)

Total Primary Site Adult Irradiated (total of both C O ~ ~ ~ S above)

Total Secondary (Mntcetdclc) Adult Irradiated W V sytttt+-Irtr-cs-t+-Uw 4P- Not Covered Above Under Primary S i c e

Total Adult Irradiated Caees (Primary Plus Secondary) ( C 8Oual6 total caees a D l U S b)

2 . Pediatric Irradiated:

Leukemia

Medulloblascorna

CNS (Non-Medulloblastoma)

WCasefj: Primarv Xru3t icu t lOn fi C a s e s : Oucside I r w t r t u t i o n

0

3

0 D Hodgkin’s Lymphoma

Non-Hodgkin‘e Lymphoma 0

Rhabdornyoearcorna/STS b

Ewings Sarcorna/Bone Tumor

Ne u r o b 1 as t orna

Retinoblastoma

3 3

wi l m s ’ Tumor A Ocher: Describe case ( 9 ) for

Primary or oche r insticution Other Cases-Primarv I n s t i c u c i o n Other Cases-3ucside ! n s c i t s u c i c n

- --_

< R r ac h y t herapy

I;L..rCace App1ica:ions ~ n ~ u l d s , piaque, Sr-90)

: i ) R InCrdCsViKary Number pat~encs Number insertions

Number pacrencs Number insertions

Number patients

L 3 R Intersticial (Including seede)

H 3 R lncrscavitary

Number insercions HDR Incerstitial

Number pa t Lents Number i n s e r t ions

Uneealed Sources ( e . g . I-131 oral, P-32 colloid, SKroncium 89)

P r i m a r v Inscituc ;on #Cases HCases

Observed Per Eorrned

.-

I

I Z ! - I 2

c--

L - Y

4 . Specific Radiqtherapy r e c h i p e e : Cases he Primary Reeident in treatment Planning

#Case0 per; formed

B- C r a n i o s p l nal o

RADIATION ONCOLOGY RESIDENT EXPERIENCE LOG

The completed form ehould be given to the Program Director by July 1, 2002.

To be completed by the Program D i r e c t o r : '

Program #: -4302421042- Institution Name:-Joint Center Fox Radiation Therapy- City/State:-Boston. U.4

Program Director Signature I ._ -

To be completed by the Resident:

Reeident Names *Ton 5 - f f h G e r -_ - S i g n a t u r e :

Time period covered by log: from - --

Liat institutions used for outside rotations:

_. .. . . ._._ - ..._ . 2 .

Dates : From - To

_ _ - _ _ . - - --. .-.-- ... . .-

._ --.-.

- ~

1. A d u l t I r r a d i a t e d : P r i m a r y S i t e (Non-Metastatic Disease):

,J cyric(:(>l \ ' q : r ' ute1.a:: -- C.' Bone/Soft 1'Lss:ie coma . .--. da;p Ls C e n t r a l Nervous sI?tcrn i' G'frlQc f> I '>\J 1 r 0:' 110 I

6 HeadINeck: I n t a c t 1,ymphol 0 1 i " ' i : a r ' I l ; ~ d g k \ n ' S Lyrnpl?e+ii 9

@ I L y f n p h o i . e t i c u ! a r ~Jori.Ifodgkiri's --- > Head/Neck: P O S C Oper a t i v e

L ymphoni , )

5 Gastrointestinal Er;op:iagufi Lyrvphocec icu lar ' O t t i e r

3 Gastrointescinal: Colorectal 3 Skin

8 Genitourinary: Prostate 84 T h o r a x : N o n - s m a l l C e l l Lung Cancer

e Genitourinary: Bladder T h o r a x : Other 0 Genitourinary: Testes A l l Ochers ( G I V F : Examples1

Gastrointestinal: O t h e r Z Thorax: s m l ! cell Lung cancer

1s Genitourinary: O t h e r 7 PdlL lLJ - --... _,

. .

a) - lob To,cal Primary s i t e A d u l t Xrradiated (total of both columns above)

b) - 63 Total Secondary (Metastatic) Adult Irradiated Not Coverad Above Under Primary Site

c ) - '" Total Adult I r r a d i a t e d Case8 ( P r i m a r y Plus S e c o n d a r y ) ( C equa le total case6 a plus b)

2 . P a d i a t r i c Irradiated: Leukemia

&fasee : Primary I m i t u t i o n - 0

Mcdulloblastorna

CNS (Non-Medulloblsscoma)

c? u

Hodgkin's Lymphoma

Non-Hodgkin's Lymphoma

Rhabdornyosarcoma/STS

Ewings Sarcoma/Bone Tumor

Neuroblastoma

Retinoblastoma

i;

U .-.-

Other: Describe case I n ! f : ) ) '

, - , - - . . . . .. . . .... -_ . . _

.. . .

3 . Br ac hy the r apy

Surf ace Applizat 1 o n s (moulds, plaque. SC-90) LDR Intracavitary

Number patients Number insertions

Number patients Number inserrions

Number patients

LDR Interstitial (including seeds)

H D R Intracavitary

Number insertions HDR Xnterstitial

Number p a ~ i e n t s Number ineertions

--- 3 L'

Unsealed Sources (e.g. 1-131 oral, P - 3 2 colloid. Strontium 891 --- L'

4 . Specific Radiotherapy Techniquee: Cases Ae Primary Resident in Treatment Planning

BCasea Per Eormed . . Mantle 3

3 Craniospinal c-

NOSdWIS A t i t l W l WtlWS T9ZLZ98ZL6 T0:fQ S 0 0 z / E Z / ~ 0

SARA L1;7;7Y SIMPSOh

LJJ? (fncludino SQ sdsl 31 4 5 12 0 0 1 1 0 2 7 113

H DR (endevasc u led

- . -- -*at e-.

52 - 4 is

2

Dr. Jon Strasser

LDR, HDR Patient Summaw PO#& 68 Redd ent

LDS 200507 16