Application for Use of Radionuclides in Vertebrate Animals (Form 99a)

FORM 99A Refer to the University Radiation Safety Regulations, or call a Health Physicist at the Environment, Health & Safety Department (2-3600) for assistance completing this application.

New radionuclide applicants must also submit Form 99, APPLICATION FOR POSSESSION AND USE OF RADIONUCLIDES

RADIONUCLIDES IN VERTEBRATE ANIMALS (Form 99A)

"*" indicates required fields

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This field is for validation purposes and should be left unchanged.

PI Name*

First Last

College/Department/Division*

Building

Office Room Number

Phone Number*

Fax Number

Email Address

RARC Approval - Before this application can be processed, you must have obtained approval from the Research Animal Resources Center (RARC) for the intended animal use.

RARC project number

RARC project title*

RARC number is held by (other than applicant)

Uses - Complete table for each radionuclide animal procedure

1-Isotope and Physical Form*

1-Animal*

1-Maximum Activity Per Animal*

1-Number of Animals Per Experiment*

1-Time Interval Between Isotope Use and Sacrifice*

2-Isotope and Physical Form

2-Animal

2-Number of Animals Per Experiment

2-Maximum Activity Per Animal

2-Time Interval Between Isotope Use and Sacrifice

3-Isotope and Physical Form

3-Animal

3-Number of Animals Per Experiment

3-Maximum Activity Per Animal

3-Time Interval Between Isotope Use and Sacrifice

4-Isotope and Physical Form

4-Animal

4-Number of Animals Per Experiment

4-Maximum Activity Per Animal

4-Time Interval Between Isotope Use and Sacrifice

If you have more than 4 Isotopes, please add to the text box below

Procedure

For each RARC protocol, briefly describe each procedure, include an overview, labeling procedure, administration, use, disposal and any anticipated excretion of radioactivity and the experimental goal*

Rooms

List room(s) and building(s) where animal(s) will be housed for the experiment*

In authorized user's laboratory -- List room(s)/building in text box below

In animal care facility -- List room(s)/building in text box below

Other

Personnel

Who will provide care for the animal(s) during the experiment?*

Laboratory personnel

Animal care personnel

Other

Training

What training, safety guidelines and instructions will you provide and implement?*

I will implement all applicable requirements and safety guidelines for work involving unsealed sources of radioactive materials in animals specified in Appendix A (see below).

I will implement all applicable requirements and safety guidelines for work involving radioactive sealed sources in animals specified in Appendix B and C (see below).

Other

Sealed Source Inventory

What precautions will be taken to assure that implanted sources are not lost during animal moves?*

Animal will remain in the same room, cage during the entire experiment.

I will implement the Source Inventory System for Radioactive Implants in Animals Appendix C (see below).

Not applicable, sources are not implanted.

ALARA

What precautions will be taken to minimize radiation exposures to personnel when the animal(s) contain radioactive material?*

Time spent in animal room will be controlled.

Cage or animal will be behind appropriate shielding

Not applicable, low energy beta (3H, 14C, 35S) use only.

Other

Contamination Control

What precautions will be taken to control contaminated urine and feces?*

Contaminated waste is collected in bottom of cage (automatic flushing cages are not allowed).

Not applicable, sealed sources or waste will not be contaminated.

Other

Airborne

What precautions will be taken to control radioactive airborne excretions?*

Calculations show airborne radioactivity is within NRC limits (call a Health Physicist).

Airborne excretions will be exhausted to outside air through (the Office of Radiation Safety) approved vent system.

Appropriate absorbing materials will be placed in cage.

Not applicable, no airborne radioactivity is anticipated.

Other

Radiation Surveys

Specify survey methods and frequency, including survey of cage(s).*

Monthly

After each experiment

Meter Surveys (specify meter make/model/detector type in text box below)

Wipe testing and Liquid Scintillation Counter/gamma counter (specify Bldg/Rm # of counter in text box below):

Meter make/model/detector type

Building/Room Number

Radioactive Waste

How will radioactive waste carcasses and waste be stored until prepared for the Office of Radiation Safety pickup (Tuesday - Friday, PM).*

Stored in laboratory freezer

Stored in building freezer

Other

Appendix A: Requirements and Safety Guidelines for Work Involving Unsealed Radioactive Materials in Animals

1. When administering high energy betas or gamma emitters, perform meter survey in rooms where the animal is housed to determine the count rate and exposure levels for appropriate labeling of the room (e.g., Radiation Area).

2. When administering high energy betas or gamma emitters, perform meter surveys to assure that radiation exposure in all adjacent areas will be within legal limits, less than 100 mrems per year and 2 mrems per hour.

3. Animal waste, urine, feces, and blood contaminated dressings must be considered as radioactive until the kinetics of all radionuclides are known.

4. Provide lab personnel to care for the animals. If this cannot be done, animal care personnel must:

a. Take Radiation Safety for Radiation Workers (both parts are required)

Part I is an on-line training class with a quiz at the end.

Part II is an in-person training.

I agree to abide by all applicable items listed above.

Please add any additional comments in the text box below:

Appendix B Requirements and Safety Guidelines for Work Involving Radioactive Sealed Sources in Animals

For each protocol involving the use of sealed sources in animals, the authorized user must:

1. Maintain an adequate source inventory system to account for all sources.

2. Perform meter survey in rooms where the animal is housed to determine the exposure levels for appropriate labeling of the room(e.g., Radiation Area).

3. Perform meter surveys to assure that radiation exposure in all adjacent areas are within legal limits, less than 100 mrem per year and 2 mrem per hour.

4. Survey animal waste before disposal, or hold the waste until the end of the experiment when all the sources have been accounted. Survey all materials before they are removed from the animal housing room to insure no sources have been dislodged.

5. Survey animals with a sensitive survey meter after the sources have been removed as a double check.

6. Provide lab personnel to care for the animals. If this cannot be done, animal care personnel must:

a.Take Radiation Safety for Radiation Workers (both parts are required)

Part I is an on-line training class with a quiz at the end.

Part II is an in-person training.

b. Be shown a dummy or "dead" source.

c. Inform the authorized user and the Office of Radiation Safety if sources seem/become loose, if animal is bleeding, etc.

d. Be shown how to care for the animal and what they may and may not do.

e. Be shown how to use a radiation survey meter.

7. If animal is moved to a different authorized room/area/cage, survey the vacant room/area/cage to confirm that no sources have been left in the old room/area/cage.

8. The animals must be marked until the sources are tested for leakage. If the sources are found to be leaking, the animal must remain marked (radioactive) and must be disposed of through the O.R.S. upon death or sacrifice.

I agree to abide by all applicable items listed above.

Appendix C Source Inventory System for Radioactive Implants in Animals

The sources must be counted and inventoried at least each time the animal(s) are moved from one room/area/cage to another room/area/cage while the sources are still in the animal.

If the sources are not visible while they are in the animal, the sources should be inventoried as follows:

a. At the time the animal is to be moved, position the animal or survey meter so that the sources are facing the radiation survey meter. Survey meter must be sensitive to the radiation emitted.

b. Measure the exposure or count rate at a specific distance from the sources. Record the exposure or count rate, the distance, and the position of the animal with respect to the meter. Other sources in the room should be shielded or positioned away from the meter so there is no interference that they do not interfere with the meter readings.

c. Repeat the above steps immediately after the animal has been moved to another room/area/cage. Record the results and compare the meter reading before and after the move. If the exposure or count rate has decreased or changed significantly (5 - 10%), a source may have been dropped. Secure all areas where the animal has traveled through and immediately notify the Office of Radiation Safety.

I agree to abide by all applicable items listed above.

Please add any additional comments in the text box below:

Signature*

Date*