RC Form 12-1 Page 1 of 4 TEXAS Health and Human Services Texas Department of State Health Services Pursuant to the Texas Radiation Control Act and Texas Department of State Health Services (Agency) regulations on radiation, and in reliance on statements and representations heretofore made by the licensee, a license is hereby issued authorizing the licensee to receive, acquire, possess and transfer radioactive material listed below; and to use such radioactive material for the purpose(s) and at the place(s) designated below. This license is subject to all applicable rules, regulations and orders of the Agency now or hereafter in effect and to any conditions specified below 3. License Number L06949 -; LCENSEE 1. Name THE UNVERSTY OF TEXAS AT AUSTN DELL MEDCAL SCHOOL ATTN STANSLAV SPRDONOV MD 4. Expiration Date. July 31, 2028 2. Address PO BOX 7729 AUSTN TX 78713-7729! Amendment Number 00 ; \ This license is issued in accordance with correspondence dated March 9, 2018. 5. Radioisotope 6. Form of Material 7. Maximum Activity 8. Authorized Use A. Any radioactive A. Any radiopharma- A. As needed A. Any uptake, dilution and excretion study material permitted ceutical form, permitted by 25 TAC 289.256(ff). by 25 TAC except gas. f. 289.256(ff) B. Any radioactive B. Any radiopharma- B. As needed B. Any imaging and localization study material permitted ceutical form, permitted by Title 25 TAC 289.256(hh).!.: by 25 TAC except gas -... -... 289.256(hh) C. Any radioactive C. Any radiopharma- C. 600 millicuries C. Research and education, including animal material with ceutical form,. studies.,. < atomic number 1 except gas - through 83 with a.... ha f-life less than 120 days, except as otherwise specified!
RC Form 12-1 Page 2 of 4 5. Radioisotope 6. Form of Material 7. Maximum Activity D. Carbon-14 D. Any D. No single source to exceed 1 millicurie E. Fluorine-18 E. Liquid E. 100 millicuries F. Hydrogen-3 F. Any 1 F. No single source to exceed 1 millicurie G. odine-125 G. Any G. No single source to J., exceed 1 millicurie ; i Total 20 millicuries H. Phosphorous-32 H. Any H. No single source to.. exceed 1 millicurie Total 30 millicuries. Phosphorous-33. Any t,.. No single source to t,.., exceed 1 millicurie... t :lf, J. Sulphur-35. J. Any J. No single source to,. \.. exceed 1 millicurie.. LCENSE NUMBER L06949 00 8. Authorized Use D. Research and education, including animal E. nstrument calibration and reference. F. Research and education, including animal, \ G. Research and education, including animal H. Research and education, including animal 1 i. Research and education, including animal..... J. Research and education, including animal.. 9. Radioactive material shall only be stored and used at: Site Number 000 Location Austin - 1601 Trinity Street (Main Site) 1701 Trinity Street 10. This license is issued in accordance with Title 25 Texas Administrative Code sections: a. 289.252(h), "Specific Licenses for Broad Scope Authorization for Multiple Quantities or Types of Radioactive Material for Use in Research and Development"
RC Form 12-1 Page 3 of 4 10. (Continued) LCENSE NUM BER L06949 00 b. 289.256(o), "License for Medical and Veterinary Uses of Radioactive Material with Broad Scope Authorization." 11. The individual designated to perform the functions of Radiation Safety Officer (RSO) for activities covered by this license is Stanislav Spiridonov, M.D. 12. Radioactive material shall only be used by, or under the supervision of, individuals designated by the Radiation Safety Committee, W. Scott Pennington, MS, CHP, Chairperson. The licensee shall maintain records of individuals designated as users for 3 years after the individuals last use of radioactive material under the license. 13. The licensee shall not open sealed sources containing radioactive material or remove sources from source holders. 14. nstallation or exchange of sealed sources in medical imaging equipment shall be performed only by the device manufacturer or other persons specifically authorized to perform such services by the Agency, the U. S. Nuclear Regulatory Commission (NRC) or another Agreement State. 15. The licensee is authorized to analyze tests for leakage or contamination from sealed sources in accordance with procedures identified in the application July 2, 2018. 16. The use of licensed material in or on humans shall be by an authorized user as defined in 25 TAC 289.256(c). 17. ndividuals designated to work as authorized users, as defined in 25 TAC 289.256(c), shall meet the training, experience, and recentness of training criteria established in 25 TAC 289.256, and shall be designated, in writing, by the licensees Radiation Safety Committee. 18. Experimental animals administered radioactive materials or their products shall not be used for human consumption.
RC Fo rm 12-1 Page 4 of 4 LCENSE NUMBER L06949 00 19. The licensee is authorized to discard radioactive material authorized in Conditions 5, 6, 7 and 8 and listed in 25 TAC 289.202(ggg)(7), whose half-lives do not exceed 300 days, in a Type municipal solid waste site in accordance with the provisions of 25 TAC 289.202(fff)(4) and procedures identified in the application dated July 2, 2018. 20. Except as specifically provided otherwise by this license, the licensee shall possess and use the radioactive material authorized by this license in accordance with statements, representations, and procedures contained in the following: Application dated July 2, 2018, and Letter dated July 6, 2018. Title 25 TAC 289 shall prevail over statements contained in the above documents unless such statements are more restrictive than the regulations. VJD:vjd FOR THE DEPARTMENT OF STATE HEALTH SERVCES Date July 24, 2018 #; /5. Scott Kee, Program Coordinator Medical and Academic Licensing Program
TEXAS Health and Human Services Texas Department of State Health Services John Hellerstedt. M.D. Commissioner TO: FROM: DATE: All Radioactive Material Licensees Karl Von Ahn, Manager Radioactive Materials Licensing Business Filing and Verification Section January 3, 2018 SUBJECT: New License Format We have made significant changes to the format and wording of the radioactive material licenses. The changes made include updating the agency logo, font type and size and other formatting changes to conform to the Department of State Health Services and the Health and Human Services document guidelines. To better accommodate the new font size, the license is now in landscape format. A watermark has been added as a security feature to make it tamper evident. n addition, we have also updated and revised standard license conditions used on the licenses. The license conditions for medical licensees have had the most noticeable changes. License conditions 5 and 8 have been amended to authorize use of radioactive material in accordance with the authorizations in rule. For example, a license which formerly authorized "all diagnostic uses of radioactive material" will now authorize "uptake, dilution, and excretion studies" and "imaging and localization studies" in accordance with the corresponding sections of Title 25 Texas Administrative Code Section 289.256. Certain authorizations, such as for positron emitters, technetium-99m aerosol, and technetium-99m for preparation of reagent kits, will no longer appear as individual line items. License condition 12 has been amended to list authorized users alphabetically by last name and the uses by rule reference for which each user is authorized. Please review the license carefully and contact us with questions at 512-834- 6688 ext 2861 or RAMLicensing@dshs.texas.gov. P.O. Box 149347 Austin, Texas 78714-9347 Phone: 888-963-7111 TTY: 800-735-2989 dshs.texas.gov