Office of Radiation Safety

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 Authorized User Application Forms

Medical Use
 

 


 

The use of radiation and radioactive material at MCW and FMLH must be done with the prior approval of the Radiation Safety Committee.  Clinicians wishing to apply for authorization to use radiation or radioactive material should read the Clinical Guidelines for the Use of Radioactive Materials and Radiation-Producing Machines, complete the appropriate form from the list below and submit the application to the Office of Radiation Safety.

Not sure which form is appropriate for your needs?  Go to the Radiation Safety Application Process Flowchart for information. 

Need a dosimeter? Film Badge Application Form

 

 

Medical Authorized User

The basic application form for the medical use of radiation and radioactive materials.  This form needs to be accompanied by one of the forms below.

Instructions, T & E Instructions for completing the Medical Authorized User Training and Experience Forms
Training & Experience, Medical AU - Unsealed Diagnostic (no written directive)

Physicians applying for the clinical use of unsealed radioactive material for which a written directive is not required.  (Diagnostic Nuclear Medicine, Nuclear Cardiology)

Training & Experience, Medical AU - Unsealed Therapy

Physicians applying for the clinical use of unsealed radioactive material for which a written directive is required.  (I-131 therapy, Sr-89/Sm-153, Y-90, etc. 

Training & Experience, Medical AU - Manual Brachytherapy

Physicians applying for the clinical use of therapeutic manual brachytherapy sources.  (Ir-192, Cs-137, I-125, GliaSite, Sr-90)

Training & Experience, Medical AU - HDR, GSR, Cobalt

Physicians applying for the clinical use of the High Dose Rate Remote Afterloader or the Gamma Knife.

Training & Experience, Medical AU - Radiation Therapy Machines Physicians applying for the clinical use of radiation machines - linac, tomotherapy, etc.
Medical AU - Research

Physicians applying for non-routine clinical use as a part of an IRB protocol or use new to the institution.

Medical Physicist (Therapy) The basic application form for Authorized Medical Physicists.  This form must be accompanied by the form below.

Training & Experience, Medical Physicist

Application for Radiation Oncology Authorized Medical Physicist

 

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