RADIOACTIVE MATERIAL USE PERMIT APPLICATION

Environmental Health and Safety

HOW TO GET STARTED USING RADIONUCLIDES

Overview

A license to possess and use radioactive materials (RAM) has been issued to UTMB by the Texas Department of Health. Under the terms of this license, the Radiation Safety committee (RSC) is delegated the responsibility for authorizing qualified individuals to use radioactive materials.

The Principal Investigator is DIRECTLY responsible for all aspects of radiation safety associated with his/her possession and use of radioactive materials.

Things to Know

The use of radioactive materials at UTMB requires specific authorization from the UTMB-RSC. Because the application and authorization process can take several months, Principal Investigators who plan to use radioactive materials should apply to the RSC well in advance of the anticipated date of use.

Principal Investigators moving to UTMB from other institutions should contact Environmental Health and Safety prior to arriving at the UTMB campus for information and guidance. One of the RSC’s requirements is that a letter of recommendation accompany an application and it may be easier to arrange for this before leaving one’s present institution.

Radiation Safety staff members will assist researchers with the completion of this application.

Investigators wishing to bring radioactive materials to the UTMB campus from their present institution must contact OEHS (prior to the shipment of radioactive materials) and make arrangements to meet all legal requirements.

For Further Information:

Contact Environmental Health and Safety/Radiation Safety Program at (409) 772-2279 (mail route F-33) for additional information and assistance concerning radioactive materials usage.

INSTRUCTIONS FOR COMPLETION OF “APPLICATION FOR RADIOACTIVE MATERIALS USE PERMIT”

  1. Complete name and campus mailing address of the applicant (s). Please be sure to include building, room number and telephone number. The Authorized User (s) will be responsible for the direct supervision and required training for the technical staff that actually performs studies with the radioactive material. Each Authorized User must be fully qualified by training and experience to use or supervise the use of each radioactive material for which he is approved. Please list the Permit Administrator as the first Authorized User. This individual shall be responsible for ensuring that all appropriate records are kept in accordance with UTMB Policies for the control of radiation, shall inform the Radiation Safety Committee when any Authorized user leaves UTMB or ceases using radioactive material, and shall be the individual to whom correspondence regarding the permit will be addressed. Each Authorized User should complete Supplement A for Non-Human Use or Supplements B and C for Human Use. Two or more individuals who use the same location (s) should submit only one application.
  1. For each radionuclide listed in item 5, list those letters that correspond to those radionuclides the Authorized User will use.
  1. Self-explanatory. If this is to be an amendment or renewal to the permit, a Supplement A must be attached for each Authorized User.
  1. List building and room number where radioactive materials will be used and stored.
  1. Describe the radioactive material to be used, including the material’s chemical and/or physical form, number of millicuries to be kept in your inventory, maximum number of millicuries per experiment, and the purpose for which the material will be used (in-vitro, in-vivo, or human).
  1. Attach a list of technical staff.

The technical staff is composed of those individuals who use radioactive materials to conduct research or perform clinical procedures under the direct supervision of an Authorized User. The technical staff should be named in the application and shall be instructed in the health protection problems associated with exposure to radiation, precautions to minimize exposure, emergency procedures, and applicable State and UTMB regulations. (Supplement A does not have to be submitted for technical staff who are not to be Authorized Users.) The Permit Administrator must notify the Office of Environmental Health & Safety of any changes in the technical staff.

  1. Supplement A must be attached for each Authorized User. If human use is involved, Supplements B and C for each user must be attached.
  1. Instrumentation available (information should be supplied on Supplement D furnished with the application.) Describe the type of instrumentation and the frequency and method for calibration of measurement instruments. Survey instruments will be calibrated by the Office of Environmental Health and Safety semi-annually.

*9.On the attached form, (Supplement E), provide a diagram of the laboratory in which radioactive material will be used and stored, with the radioisotope work area identified. Describe storage facilities, fume hoods, special shielding, sink used for liquid waste disposal and any other information pertinent to the discussion of the application.

*10. Attach a copy of your rules for the safe use of radioactive material.

The set of rules prepared should be included in your safety manual or posted prominently in your laboratory area (s). You should review these rules with all employees after they are prepared, with each new employee, and with all employees at least annually.

*11. Attach a copy of your emergency procedures.

These procedures should include the names and telephone numbers of key lab personnel as well as the Radiation Safety personnel to be contacted in case of emergency, and shall be posted prominently in work areas where radioactive materials are used. You should review these procedures with each new employee, and with all employees at least annually.

*12. Describe the frequency and methods for routine area surveys. Weekly and monthly wipe test services will be provided by Radiation Safety. Daily surveys, if required, are the responsibility of the authorized user.

*13.Attach a description of methods to be used for waste disposal. Include approximate amounts to be disposed of through sewage or to be transferred to drums for contracted disposal at a burial site.

*14.Provide detailed procedures and necessary precautions in handling animal excreta, bedding, carcasses or live animals during and after administration or radioactive material.

*15.This is a statement signed by the individual named as Permit Administrator, certifying that the information presented is true and correct.

*16.Signature of Division Head/Department Chairman of individual named as Permit Administrator.

*Environmental Health & Safety will assist with these items. Complete a rough draft of page 1 of the application and mail it to EHS. Upon receipt, the Radiation Safety Specialist will schedule a consultation with you to assist in completing these items.

UTMB

APPLICATION FOR RADIOACTIVE MATERIALS USE PERMIT

1. Authorized User (s) / 2. Authorized Use (s) / 3. This is an application for
a.__ New Permit #_____
b.__ Renewal of permit #____
c.___Amendment to permit #___
Changes:
4. Usage and storage locations

5. RADIOACTIVE MATERIAL INFORMATION

Radionuclide / Form / Maximum
mCi/experiment / Maximum mCi
in Inventory / Intended
Use
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
  1. Technical staff (list attached)
  1. Training and experience (check one)

Supplement A attached for each Authorized User

Supplement B & C attached for each Authorized user (human use)

  1. Instrumentation and Calibration Procedures (information attached)
  1. Facilities and Equipment (description & diagram attached)
  1. Rules for the safe use of radioactive materials (rules attached)
  1. Emergency procedures (procedures attached)
  1. Area survey procedures (procedures attached)
  1. Waste disposal (information attached)
  1. Procedures and precautions for the use of radioactive material in animals (detail information attached)
  1. CERTIFICATE: I certify as an Authorized user that this application is prepared in conformity with the UTMB Radiation Safety Programs and that all information contained herein, including any supplements attached hereto, is true and correct to the best of my knowledge and belief.

APPLICANT (Signature) ______

NAME (Type or Print) ______

DATE ______

  1. RECOMMENDATIONS

A. PERMIT ADMINISTRATOR______

(Signature)

NAME (Type or Print) ______

DATE ______

For approval  For disapproval

  1. DEPT. CHAIRMAN/DIVISION

HEAD ______
(Signature)

NAME (Type or Print) ______

DATE ______

For approval  For disapproval

SUPPLEMENT A: TRAINING AND EXPERIENCE HISTORY – NON-HUMAN STUDIES

1. NAME OF APPLICANT

2.TRAINING

Field of
Training / Location and Date (s)
of Training / Type and Length of Training
Lecture & Supervised
Laboratory Laboratory
Courses Experience
(Hours) (Hours)
a. Radiation Physics
and Instrumentation
b. Radiation Protection
c. Mathematics Pertaining
to Use and Measurement
of Radioactive
d. Radiation Biology
e. Radionuclide Techniques

3. EXPERIENCE (Actual Use of Radionuclides or Equivalent Experience)

Radionuclide / Maximum Amount per Experiment / Where Experience was Gained / Duration of Experience / Type of Use
  1. RECOMMENDATION (Submit a letter of recommendation from one of the individuals under whom you were trained or the Radiation Safety Office of the last employer where you worked with radiation.)
  1. I certify that the above information is true and correct to the best of my knowledge and belief.

______

Signature of Applicant

INSTRUCTIONS FOR COMPLETING SUPPLEMENT A TRAINING AND EXPERIENCE HISTORY: NON-HUMAN USE

A faculty member who wishes to be authorized to use or supervise the use of radionuclides for animal or invitro studies at UTMB should have training in basic radionuclide handling techniques and their procedures commensurate with the type and quantities of radioactive material being requested.

Each applicant for authorization to use radioactive material for non-human studies should complete Supplement A to document such training and experience.

  1. Self-explanatory.
  1. For each subject, list the institution where training was obtained, the date (s) of the training, the number of actual classroom hours (for didactic portion) and the number of hours of supervised laboratory experience.
  1. Self-explanatory.
  1. Submit a letter of recommendation from an individual who has first-hand knowledge of your training and/or experience. The letter should outline the types and quantities of material used, types of operations, evaluation of your ability handle radioactive material safely, your ability to perform and evaluate contamination surveys, your knowledge of applicable rules and policies, your length of experience and any knowledge of formal training you have received. The letter of recommendation may also come from the Radiation Safety Office (or its equivalent) of the last institution at which you were authorized to use radioactive material or radiation-producing devices.
  1. Self-explanatory.