I resnonse " vour e-ma lest or . J m C . 4 - . ,

[ember L a man

on trai

Mr. King hrs spat 24 years at the H@ey Radiation Safety OfKcer undcr my supervision, EZc in over I50 patient radioiodine

trkatmeuts durha that time where and measured hundred of of radioiodine. He has of radioisotope .

laboratmies and tauaht hundreds of authorized users and laboratory workers during th ia

radioactive material

lechved in excess of one

Mr. King has 24 publications on u th physics t o i i u 6nd o v a 100 presentations on similar topics. H sively certified in Health Physics by the American Board of Health Physi Physics by the American Board of Medical Physics. He ation panel for ABMP certification in Medical Heal g and experiences are cxtcwive and he is W e n t l y

I t , ~ p e j f ~ ft aS 70 for-research @iodio'soto ; 1 p"""f"'

Re: Title of Dr. Faz and confirmation that he represents executive management: 1 Harold Pi, MS. is Senior Vice ~ n s ~ d e n t to f fiedth " ~ ~ a i n , D m of the College o f Medicine and Chief Executive Officer of the enn State Hershey Medical Center. Thus, he is the sader of executive management of e Penn State Hershey Medical Center. t f Re: A copy of Mr. King's diploma from of New Yo& at Buffalo:

I I I ! ?

A copy of his diploma is enclosed.

Radiation Safkty Officer 1

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STATE UNIVERSITY OF NEW YORK p.. f 6 . . i

ON THE RECOMMENDATION OF TI-IE FACULTY AND BY VIRTUE OF TIiE AUTHORITY VESTED

IN THEM THE TRUSTEES OF THE STATE UNIVERSITY OF NEW YOl lK

IiAVC CONFERRED ON

STEVEN HAROLD KING

THE DEGREE OF

MASTER OF ARTS

AND HAVE GRANTED THIS DlPLOMA AS EVIDENCE THEREOF ON

SEPTEMBER 1,1983

STUDENT MME AND HOME ADDRESS:

STUDENT NO.: 360067 SECoND**Y 5GHooL:PERSONAL INFORMATION WAS REMOVED

BY NRC. NO COPY OF THIS INFORMATION LOCATION:

GRA*UAT'oN *ATE: WAS RETAINED BY THE NRC.

EMESTER T O T A L S : QP&=I I .~O(:

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Q U A T J C E C O L O G Y

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DEGREES HELD FROY OrHEil INSTITUTIONS:

E M E S T E R TOTALS QPA'4 -00

S E M E S T E R T O T A L S QPA='J.OQ

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SEE ATTACHED SLIEET FOR EKPLAIdATION Of GflADJNG SYSTEM, ABBREVIATIONS, AND SPECiAC GODLNGS.

71115 STUDENT IS 1N GOOD STANDtNQ UNLESS OTHERWISE NOTED. - - ' - ' 1 ffn*'#lnlbS1.Y LM?OSED WtflCtI t1AVF BEEN SATfSFACTORtCY . -

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From: To: Date: Subject: Request for Additional lriforma ion for Amendment to Change RSO

Licensee: Penn State Milton S. L.N. 37-13831-01 1 D.N. 030-03203 Mail Control 141284

Mr. Miller,

TO support the request to name Mr. King as R ~ O on your NRC fn"owing additional informatic -

A separate amendment request for L.N. 37-1 d a m o n Irma Ian --TT r. King's training and exp rience ith

any hands-on training. 4) A copy of Mr. King's diploma from the StatelUniversity of New York at Buffalo.

You may fax the additianal information Control No. 141284 in your response.

Penny Lanzisera US NRC, Region 1

Mail

t

PENNSTATE Milton S. Hershey Medical Center College of Medicine Administration

Mail Code H142 P.O. Box 850 Hershey, PA 17033-0850 (717) 531 8802 Tel (717) 531 4162 Fax smancuo@usu.edu

Steven C. Mancuso Administrator

October 30, 2007

U S . Nuclear Regulatory Commission Region 1 475 Allendale Road King of Prussia, PA 19406-1 41 5

h) y

Attn: Medical Licensing Division -3 %@3

&a (3

Re: License No. 37-1383 1-01 and replacement of Radiation Safety Officer

Kenneth L. Miller, CHP, CMHP, Director of Health Physics and Radiation Safety Officer has indicated his intention to retire from the Penn State Hershey Medical Center on December 3 1, 2007.

Steven H. King, CHP, CMHP, has been appointed as the new Director of Health Physics and Radiation Safety Officer, beginning January 1,2008.

Steven King has been at the Penn State Hershey Medical Center, in Health Physics, since 1983 where he has served in various capacities, including Associate Director of Health Physics and Associate RSO. Mr. King has been preceptored as a Radiation Safety Officer by Kenneth L. Miller (copy enclosed). This preceptor has been reviewed and approved by both our Subcommittee on the Human Use of Radioisotopes and our Radiation Safety Committee. Both Committees supported the recommendation that Steven H. King be appointed as the new Director of Health Physics and Radiation Safety Officer. Harold L. Paz, M.D., Senior Vice President for Health Affairs, Dean of the College of Medicine and Chief Executive Officer of the Perm State Hershey Medical Center has appointed Steven H. King to be RSO beginning January 1,2008 and Steven King has accepted the assigned responsibilities, in writing (copy enclosed).

We trust that the above will meet with your approval. If you have any questions regarding this appointment, please contact, immediately, our Radiation Safety Officer, Kenneth L. Miller, at (7 17) 53 1-8027.

Sincerely,

Steven $iancus{ Administrator

cc: Kathleen D. Eggli, M.D. Edward Podczaski, M.D. Laurence M. Demers, Ph.D. Steven H. King

2

PENN STATE Ahlton S. Hershey Medical Center w College of Medicine

Tel: (717) 531-8323 Fax: (717) 531-5351 Email: hpaz@psu.edu

Harold L. Paz, MD. Senior Vice President for Health Affairs Dean, Penn State College of Medicine Chief Executive Officer Penn State Milton S . Hershey Medical Center

Mail Code HI62 500 University Drive, P.O. Box 850 Hershey, PA 17033-0850

Steven H. IGng Senior Instructor, Radiology Associate Director, Health Physics

October 16, 2007

Dear Mi. King:

Upon recommendation fiom Kathleen D. Eggli, M.D. and Kenneth L. Miller, 0, CMHP, and a review of your qualifications and experience, it gives me great pleasure to appoint you as Radiation Safety Officer for the Penn State Hershey Medical Center, effective January 1, 2008.

By accepting this appointment, you provide a commitment to conduct an effective radiation safety program for the Penn State Hershey Medical Center. In general, your responsibilities will be as defined in the RADIATION SAFETY MANUAL. In particular, you will have the responsibility to take whatever action is necessary to protect the employees, patients, visitors, and the facility from untoward radiation exposure or contamination. This authority includes the direction of personnel in all aspects of the regulations of the U. S. Nuclear Regulatory Commission and the Commonwealth of Pennsylvania, specific license conditiclns, and good radiation safety practice. In carrying out this function; you shall have ?he mthority to enforce these requirements and to terminate any unsafe operations involving the use of licensed material or radiation producing equipment.

If you accept this appointment as Radiation Safety Officer, please sign the acceptance below and return the original to me and copies to Kathleen D. Eggli, M.D. and Kenneth L. Miller.

Sincerely,

I accept the appointment as Radiation Safety Officer and provide assurance that I will conduct an effective radiation safety program, including but not limited to the functians listed above

NRC FORM 313A (RSO) U.S. NUCLEAR REGULATORY COMMISSION (2-2007)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION

[ I O CFR 35.501

I a 35.100 35.200 35.300 35.400 a 35.500 35.600 (remote afterloader)

~~~~~~~~f~ N0.3i50-0"

35.600 (teletherapy) 35.600 (gamma stereotactic radiosurgery) 35.1000 ( Zevalin Y-90) )

PART I --TRAINING AND EXPERIENCE (Select one of the four methods below)

*Training and Experience, including board certification, must have been obtained within the 7 years preceding the date o application or the individual must have obtained related continuing education and experience since the required training and experience was completed. Provide dates, duration, and description of conbnuing education and experience related to the uses checked above.

1. Board Certification

a. Provide a copy of the board certification.

b. Use Table 3.c. to describe training in radiation safety, regulatory issues, and emergency procedures for all types of medical use on the license.

c. Skip to and complete Part II Preceptor Attestation.

OR f"J 2. Current Radiation Safetv Officer Seekinq Authorization to Be Recognized as a Radiation Safety

Officer for the Additional Medical Uses Checked Above

a. Use the table in section 3.c. to describe training in radiation safety, regulatory issues, and emergency

b. Skip to and complete Part I I Preceptor Attestation.

procedures for the additional types of medical use for which recognition as RSO is sought.

OR

I Clock 1 Hours Description of Training Location of Training Dates of Training*

Radiation physics and instrumentation

I

State Unv. of New York at Buffalo 811 gao-im 980 Basic Radiation Science and lab Gradua te 1"' 1 1 11 983-511 983 1 Isotopic tracer techniques and lab decree I Radiation protection

i Mathematics pertaining to the use and measurement of radioactivity

Radiation biology

i

(Radiation dosimetry

State Unv. of New York at Buffalo

R a d i a t i o n P r o t e c t i o n and l a b

State Unv. of New York at Buffalo calculus, statistics, gen Chemistry, basic radiation

811 977-511 978 811 980-1 21 980

science, ai1 982-1 a State Unv. of New York at Buffalo Radiation Biology and lab

State Unv. of New York at Buffalo Radiation Protection and lab Radiation Biology

1 00

811 980-1211~80 111 982-511 982 111 983-511 982 I R a d i a t o n P r o t e c t i o n

RC FORM 313A (RSO) U.S. NUCLEAR REGULATORY COMMlSSlOC -2007)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

- Location of Training/

License or Permit Number of Facility Description of Experience Dates of Training

Using and performing checks for proper operation of instruments used to determine the activity of dosages, survey meters, and

Penn State Milton S. Hershey Medical Center 911 983-812007 37-13831-01; 37-13831-04

Using administrative controls to avoid mistakes in administration of byproduct

I911 983-812007

Penn State Milton S. Hershey Medical Center 911 9a3-8/2007 37-1 3831 -01 I

Using procedures to prevent or minimize radioactive contamination and using proper decontamination procedures

Penn State Milton S. Hershey Medical Center 37-13831-01

Penn State Milton S. Hershey Medical Center ~ 911 963-812007 -icensed Material Used (e.g., 35.1 00, 35.200, etc.)+ 35.100,35.200, 35. 300 1 37-1 3831 -01

Using emergency procedures to control byproduct material

75.hnn sterPntan ti u

75.1000 - - i ' r 1 -

Choose all applicable sections of 10 CFR Part 35 to describe radioisotopes and quantities used: 35.100, 35.200, 35.300, 35.400, 35.500, 35.600 remote afterloader units, 35.600 teletherapy units, 35.600 gamma stereotactic radiosurgery units, emerging technologies (provide list of devices).

Penn State Milton S. Hershey Medical Center 37-1 3831 -01 ; 37-1 3831 -04

911 983-812007

Disposing of byproduct material Penn State Milton S. Hershey Medical Center 911 983-812007 37-1 3831 -01

NRC FORM 313A (RSO) U.S. NUCLEAR REGULATORY COMMlSSlOh (2-2007)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

3. Structured Educational Program for Proposed Radiation Safety Officer (continued)

b. Supervised Radiation Safety Experience (continued)

[If more than one supervising individual is necessary to document supervised work experience, provide multiple copies of this section.)

~ w g Individual i LicenselPermit Number listing supervising individual as a j Radiation Safetv Officer

IKenneth L. Miller I

1 37-1 3831 -01; 37-1 3831-04 1 .................................................................................................................................................................... .............................. - - - - - - ..... ..... This license authorizes the following medical uses:

35.100 35.200 a 35.300 35.400

35.500 35.600 (remote afterloader) 35.600 (teletherapy)

Radiation safety, regulatory issues, and Penn State Milton S. Hershey Medical Center 911 983-912007 emergency procedures for 35.1 00, 35.200, and 35.500 uses

37-13831 -01

Radiation safety, regulatory issues, and emergency procedures for 35.300 uses

Penn State Milton S. Hershey Medical Center 37-1 3831 -01

911 983-912007

Radiation safety, regulatory issues, and emergency procedures for 35.400 uses

Penn State Milton S. Hershey Medical Center 37- 1 3831-01

911 983-912007

Radiation safety, regulatory issues, and

teletherapy uses

Penn State Milton S. Hershey Medical Center 911 983-311986 emergency procedures for 35.600 - 37-1 3831 -01

Radiation safety, regulatory issues, and Penn State Milton S. Hershey Medical Center 3/2004-912007 emergency procedures for 35.600 - remote afterloader uses

37-13831-01

Radiation safety, regulatory issues, and Penn Slate Milton S. Hershey Medical Center 112006-912007 emergency procedures for 35.600 - gamma stereotactic radiosurgery uses

37-13831-01

Radiation safety, regulatory issues, and Penn State Milton S. Hershey Medical Center 812002-912007 emergency procedures for 35.1000, specify use(s):

37-13831-01

i

J 35.600 (gamma stereotactic radiosurgery) lo I ' I C. Describe training in radiation safety, regulatory issues, and emergency procedues for all types of medical

use on the license.

Description of Training Training Provided By Dates of Training*

I ' I

IRC FORM 313A (RSO) U.S. NUCLEAR REGULATORY COMMlSSlO 1-2W7)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

3. Structured Educational Proqram for Proposed Radiation Safetv Officer (continued)

c. Training in radiation safety, regulatory issues, and emergency procedures for all types of medical use on the

Supervising Individual If training was provided iy supervising 1 License/Permit Number listing supervising individual RSO, AU, AMP, or ANP. (If more than one supervising individual is : necessary to document supervised training, provide multiple copies o f ; this page.)

license (continued)

Kenneth L. Miller i37-13831-01; 37-13831-04

LicenselPermit lists supervising individual as:

Radiation Safety Officer

Authorized Medical Physicist

Authorized as RSO, AU, ANP, or AMP for the following medical uses:

a 35.100 35.200 35.300 35.400

Authorized User CT] Authorized Nuclear Pharmacist

35.500 35.600 (remote afterloader) 35.600 (teletherapy)

35.600 (gamma stereotactic radiosurgery) 35.1000 ( Zevalin Y-90 )

d. Skip to and complete Part II Preceptor Attestation.

OR

Authorized User. Authorized Medical Physicist. or Authorized Nuclear Pharmacist identified on the licensee's license

a. Provide license number.

b. Use the table in section 3.c. to describe training in radiation safety, regulatory issues, and emergency procedures for all types of medical use on the license.

c. Skip to and complete Part II Preceptor Attestation.

1 4.

PART li - PRECEPTOR ATTESTATION

3te: This part must be completed by the individual's preceptor. The preceptor does not have to be the supervising individual as long as the preceptor provides, directs, or verifies training and experience required. If more than one preceptor is necessary to document experience, obtain a separate preceptor statement from each.

rst Section heck one o f the following:

1 1. Board Certification

I attest that has satisfactorily completed the requirements in Name of Proposed Radiation Safety Officer

10 CFR 35.50(a)(l)(i) and (a)( l)(ii); or 35.50 (a)(2)(i) and (a)(2)(ii); or 35.50(~)(1).

OR 1 2. Structured Educational Proqram for Proposed Radiation Safety Officers

I attest that Steven H. King has satisfactorily completed a structural educational Name of Proposed Radiation Safety Officer

program consisting of both 200 hours of classroom and laboratory training and m e year of full-time radiation safety experience as required by 10 CFR 35.50(b)(1).

OR PAGE

NRC FORM 313A (RSO) U S . NUCLEAR REGULATORY COMMISSION (2-2007)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

'receptor Attestation (continued)

%st Section (continued) :heck one of the following:

3. Additional Authorization as Radiation Safety Officer

is an -

I attest that Name of Proposed Radiation Safety Officer

0 Authorized User c] Authorized Nuclear Pharmacist

0 Authorized Medical Physicist

identified on the Licensees license and has experience with the radiation safety aspects of similar type of use of byproduct material for which the individual has Radiation Safety Officer responsibilities

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 9 1 ~ ~ ~ ~ ~ ~ ~ . ~ ~ - 9 . - - ~ 9 - - - ~ ~ - ~ - - - - ~ - - - - 1 - - - - - -

AND econd Section omplete for all (check all that apply):

I attest that

emergency procedures for the following types of use:

Steven H. King has training in the radiation safety, regulatory issues, and Name of ProposedRadiation Safety Officer

35.100

35.200

35.300

35.300

35.300

35.300

35.400

35.500

a 35.600

35.600

35.600

35.1000

oral administration of less than or equal to 33 millicuries of sodium iodide 1-1 31, for which a written directive is required

oral administration of greater than 33 millicuries of sodium iodide 1-131

parenteral administration of any beta-emitter, or a photon-emitting radionuclide with a photon energy less than 150 keV for which a written directive is required

parenteral administration of any other radionuclide for which a written directive is required

remote afterloader units

teletherapy units

gamma stereotactic radiosurgery units

emerging technologies, including: (Zevalin Y-90) n

NRC FORM 313A (RSO) U.S. NUCLEAR REGULATORY COMMISSIOb (2.2007)

RADIATION SAFETY OFFICER TRAINING AND EXPERIENCE AND PRECEPTOR ATTESTATION (continued)

Signature Telephone Number Kenneth L. Miller (717) 531-8027

Third Section Complete for ALL

Date

BI17l2007

AND

I attest that Steven H. King has achieved a level of radiation safety knowledge Name of Proposed Radiation Safety Officer

sufficient to function independently as a Radiation Safety Officer for a medical use licensee.

Fourth Section Complete the following for Preceptor Attestation and signature

I am the Radiation Safety Officer for Penn State Milton S. Hershey Medical Center Name of Facility

Q

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