Training for Use of Unsealed Byproduct Material for Which a Written Directive Is Required

Except as provided in 105 CMR 120.528, the licensee shall require an authorized user of radioactive material for the uses authorized under 105 CMR 120.552 to be a physician who: (A) Is certified by a medical specialty board whose certification process has been recognized by the Agency, Nuclear Regulatory Commission or an Agreement State and who meets the requirements in 105 CMR 120.556(B)(1)(b)6. The names of board certifications that have been recognized by the Agency, Nuclear Regulatory Commission or an Agreement State are posted on the NRC's Medical Uses Licensee Toolkit Web page. To be recognized, a specialty board shall require all candidates for certification to: (1) Successfully complete residency training in a radiation therapy or nuclear medicine training program or a program in a related medical specialty. These residency training programs must include 700 hours of training and experience as described in 105 CMR 120.556(B)(1)(a) through (b)5. Eligible training programs must be approved by the Residency Review Committee of the Accreditation Council for Graduate Medical Education, the Royal College of Physicians and Surgeons of Canada, or the Committee on Post-graduate Training of the American Osteopathic Association; and (2) Pass an examination, administered by diplomates of the specialty board, which tests knowledge and competence in radiation safety, radionuclide handling, quality assurance, and clinical use of unsealed byproduct material for which a written directive is required; or (B)(1) Has completed 700 hours of training and experience, including a minimum of 200 hours of classroom and laboratory training, in basic radionuclide handling techniques applicable to the medical use of unsealed byproduct material requiring a written directive. The training and experience must include: (a) Classroom and laboratory training in the following areas: 1. Radiation physics and instrumentation; 2. Radiation protection; 3. Mathematics pertaining to the use and measurement of radioactivity; 4. Chemistry of byproduct material for medical use; 5. Radiation biology; and (b) Work experience, under the supervision of an authorized user who meets the requirements in 105 CMR 120.528, 120.556 or equivalent Agreement State, or Nuclear Regulatory Commission requirements. A supervising authorized user, who meets the requirements in 105 CMR 120.556(B), must also have experience in administering dosages in the same dosage category or categories (i.e.,105 CMR 120.556(B)(1)(b)6.) as the individual requesting authorized user status. The work experience must involve: 1. Ordering, receiving, and unpacking radioactive materials safely and performing the related radiation surveys; 2. Performing quality control procedures on instruments used to determine the activity of dosages and performing checks for proper operation of survey meters; 3. Calculating, measuring, and safely preparing patient or human research subject dosages; 4. Using administrative controls to prevent a medical event involving the use of unsealed radioactive material; 5. Using procedures to contain spilled radioactive material safely and using proper decontamination procedures; 6. Administering dosages of radioactive drugs to patients or human research subjects from the three categories in 105 CMR 120.556(B)(1)(b)6. Radioactive drugs containing radionuclides in categories not included in 105 CMR 120.556(B)(1)(b) 6. are regulated under 105 CMR 120.589. This work experience must involve a minimum of three cases in each of the following categories for which the individual is requesting authorized user status: a. Oral administration of less than or equal to 1.22 gigabecquerels (33 millicuries) of sodium iodide I-131, for which a written directive is required; b. Oral administration of greater than 1.22 gigabecquerels (33 millicuries) of sodium iodide I-131 [Note: Experience with at least three cases in category (b) also satisfies the requirement in category (a)]; c. Parenteral administration of any radioactive drug that contains a radionuclide that is primarily used for its electron emission, beta radiation characteristics, alpha radiation characteristics, or photon energy of less than 150 keV, for which a written directive is required; and (2) Has obtained written attestation that the individual has satisfactorily completed the requirements in 105 CMR 120.556(B)(1) and is able to independently fulfill the radiation safety-related duties as an authorized user for the medical uses authorized under 105 CMR 120.552 for which the individual is requesting authorized user status. The attestation must be obtained from either: (a) A preceptor authorized user who meets the requirements in 105 CMR 120.528, 120.556, or equivalent Nuclear Regulatory Commission or Agreement State requirements and has experience in administering dosages in the same dosage category or categories as the individual requesting authorized user status; or (b) A residency program director who affirms in writing that the attestation represents the consensus of the residency program faculty where at least one faculty member is an authorized user who meets the requirements in 105 CMR 120.528, 120.556, or equivalent Nuclear Regulatory Commission or Agreement State requirements, has experience in administering dosages in the same dosage category or categories as the individual requesting authorized user status, and concurs with the attestation provided by the residency program director. The residency training program must be approved by the Residency Review Committee of the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada or the Council on Postdoctoral Training of the American Osteopathic Association and must include training and experience specified in 105 CMR 120.556(B)(1).