Diagnostic Medical Physics Support 695-16-4-6110-0066
Added: Aug 23, 2016 11:55 am Statement of Work (SOW) for Diagnostic Medical Physics Support Contracting Officer's Representative (COR) Name: Cis Kloiber Section: Occupational Safety & Health Address: 5000 West National Ave, Milwaukee, WI 53295 Phone Number: (414)384-2000 ext42627 E-Mail Address: Cis.Kloiber@va.gov DESCRIPTION OF SERVICES The Contractor shall furnish all labor, material, supplies, equipment, and qualified personnel to provide on-site diagnostic medical physics support or services, including annual on-site radiation compliance testing and performance monitoring services of indicated equipment for the Clement J. Zablocki VA Medical Center, 5000 W. National Ave., Milwaukee, WI, and the John H. Bradely VA Outpatient Clinic, 10 Tri-Park Way, Appleton, WI. The Contractor shall adhere to the VHA Handbook 1105.04, Fluoroscopy Safety, dated July 6, 2012. The Contractor shall comply with radiation protection standards in 29 CFR 1910.1096 and immediately report any unsafe conditions with the potential to adversely impact the facility radiation workers or patients to the Contracting Officer Representative (COR) and/or Radiation Safety Officer (RSO). GENERAL REQUIREMENTS 1. Performance All work on site must be performed by a qualified diagnostic medical physicist - no technician work allowed. A qualified diagnostic medical physicist is defined as a person who is certified by the American Board of Radiology in Diagnostic Medical Physics. The qualified diagnostic physicist must provide continuing experience of at least ten Computerized Tomography (CT) units and ten Magnetic Imaging Resonance (MRI) units within the past two years. The qualified diagnostic medical physicist must have the ability to operate units - a facility technician will not operate the units for the physicist. Identified training and experience documentation must be available for review upon request and at initial bidding for this contract. 2. Mandatory Services to be Performed a. The qualified diagnostic medical physicist shall perform annual inspection and testing of imaging equipment (x-ray equipment, fluoroscopy equipment) nuclear medicine cameras, CT cameras and MRI inspections to ensure compliance with the current American College of Radiology (ACR) requirements. The qualified diagnostic medical physicist shall verbally communicate any deficiencies or non-conformances discovered during the inspection to the service supervisor, Contracting Officer's Representative (COR), and Radiation Safety Officer (RSO) prior to the qualified diagnostic medical physicist leaving the facility. The qualified diagnostic medical physicist shall report deficiencies or non-conformances, which represent unsafe conditions may potentially adversely affect the facility radiation workers or patients, to the service supervisor, COR and RSO immediately upon discovery. Provide a written report of the results to the COR within fifteen calendar days after completion of the inspection. Inspect and test all imaging equipment annually, plus or minus thirty days from the last inspection date. b. The qualified diagnostic medical physicist shall perform a full inspection to imaging equipment after repairs or modifications that may affect the radiation output or image quality. The qualified diagnostic medical physicist will be available to complete this inspection within 48 hours of notice. The qualified diagnostic medical physicist shall provide a verbal status condition prior to departure. Provide a written report of the to the COR within fifteen calendar days after completion of the inspection. c. The qualified diagnostic medical physicist shall perform acceptance testing of all new or relocated imaging equipment prior to first clinical use. The acceptance testing shall comply with ACR requirements. The qualified diagnostic medical physicist shall verbally communicate any deficiencies or non-conformances discovered during the inspection to the service supervisor, COR and RSO prior to the qualified diagnostic medical physicist leaving the facility. The qualified diagnostic medical physicist shall report deficiencies or non-conformances, which represent unsafe conditions may potentially adversely affect the facility radiation workers or patients, to the service supervisor, COR and RSO immediately upon discovery. Provide a written report of the results to the COR within fifteen calendar days after completion of the inspection. The physicist will be available to schedule acceptance testing within one week of notice. d. The qualified diagnostic medical physicist shall assist in the development of a comprehensive technical quality assurance (QA) program (e.g., technique charts, repeat/reject analysis monitoring, monitoring of exposure indices to radiographic image receptors, QA program for display monitors, QA for CT, monitoring of dose metrics from fluoroscopy studies), which complies with ACR recommendations, for all modalities. e. The qualified diagnostic medical physicists shall perform quarterly audits of the diagnostic imaging program (all modalities) including QA/QC. Provide a written report of the results to the COR within fifteen calendar days after completion of the audit. f. The qualified diagnostic medical physicist shall perform a review of patient skin doses for maximum possible and likely peak skin doses when procedure doses (single or cumulative) are at or exceed 5 Gray (3 Gray for procedures when the beam is in one position). The report will provide information on clinical follow-up needed. The report will be available within 5 business days of notification of high dose. g. The qualified diagnostic medical physicist shall provide phone and email consultation on radiation safety and related compliance issues as needed. 3. Authority of Operators: Only those certified in Diagnostic Medical Physics by the American Board of Radiology may perform required services under this contract. Diagnostic medical physicists must bear the Contractor's signed designation. On each visit, the qualified diagnostic medical physicist shall report to the COR or his/her designee prior to performing any work. 4. Authorized Service: Only those services specified within the contract are authorized under this contract. Before performing any services of a non-contract nature, the COR and RSO must be advised of the reasons for these additional services. If appropriate, the Contracting Officer, or his/her designee, may authorize the additional services under separate purchase order. Only the Contracting Officer may authorize additional services under this contract; the Government will not reimburse the Contractor for additional services without prior authorization. 5. Special Conditions: No later than ten calendar days after notification of award, and prior to the start of services, the Contractor shall provide the COR a listing of personnel certified in Diagnostic Medical Physics by the American Board of Radiology, their schedules, and information regarding a contact person for this contract. 6. Compliance with the General Safety Regulations: A. All Contractors and Subcontractors performing services for the Government shall comply with all Occupational Safety and Health Administration (OSHA), Nuclear Regulatory Commission (NRC), National Health Physics Program (NHPP), State, County and Municipal Safety and Occupational Health Standards, and any other applicable rules and regulations. Also, all Contractors and Subcontractors shall be held responsible for the safety of their employees and any unsafe acts or conditions that may cause injury or damage to any persons or property within and around the work site area under this contract. B. All ladders, scaffolding, tools, equipment, personal protective equipment, etc. shall be OSHA compliant. Contractor shall use caution signs as required by OSHA Regulations. Caution signs shall be on-site on commencement of Contract. C. The Contractor shall purchase and issue all chemicals in their original containers. Materials that require precautionary warnings shall have affixed to all containers such labels or markings as are prescribed by law, regulatory agencies or this Contract. Any violation of OSHA may be subject to default action. D. Contractor shall furnish to the COR for approval two copies of Safety Data Sheets (SDS) for all products proposed for use, a minimum of seven days prior to beginning service. Contractor must update copies of the SDS on an annual basis. In addition, each time a new chemical product is proposed, Contractor shall provide a copy of that product's SDS to the COR for approval prior to the product being used at the facility. 7. Security Requirements: Contractor personnel shall obtain identification badges and physical access cards from the VA, subject to passing background investigation. Contractor is responsible for ensuring his employees where VA-issued identification badges at all times when on VA property to in order to properly identify his operators. The Contractor shall establish and implement methods of making sure all VA-issued identification badges and physical access cards issued to the Contractor are not lost, misplaced, or used by unauthorized persons. The Contractor shall develop procedures covering VA-issued identification badge and physical access card control. Such procedures shall include turn-in of any VA-issued issued identification badges and physical access cards keys by personnel who no longer require access. The Contractor shall immediately to the COR report any occurrences of lost VA-issued issued identification badges and physical access cards. The nature of required services does not require connection to VA information systems. The VA's Credit and Authorization (C&A) requirements do not apply, and a Security Accreditation Package is not required. 8. Hours of Operation: Contractor shall schedule services primarily during the VAMC normal working hours, 8:00 AM CST until 4:30 PM CST, Mondays tough Fridays, to the maximum extent possible. Contractor shall confirm the service with the COR prior to the first working day of the calendar month. VAMC may give some latitude to complete inspections according to location and scope of service provided. Federal Holidays observed by the VAMC are: New Years' Day Labor Day Martin Luther King Day Columbus Day Presidents' Day Veterans' Day Memorial Day Thanksgiving Day Independence Day Cistmas Day 9. Other Services Provided as Needed: None 10. Equipment Inspections The qualified diagnostic medical physicist shall conduct equipment inspection, testing, and quality control surveys of the imaging equipment listed below. The qualified diagnostic medical physicist shall ensure the imaging equipment's compliance with applicable Federal regulations and ACR recommendations, and shall include, but not be limited to, monitoring the following basic performance characteristics. A. Radiographic and Fluoroscopic Equipment Physics inspections of radiographic and fluoroscopic equipment shall comply with the ACR Technical Standard for Diagnostic Medical Physics Performance Monitoring of Radiographic and Fluoroscopic Equipment. Evaluate the performance of each radiographic and fluoroscopic unit annually. This evaluation shall include, but not be limited to, the following tests (as applicable): (1) Integrity of unit assembly. (2) Collimation and radiation beam alignment. (3) Fluoroscopic system resolution. (4) Automatic exposure control system performance. (5) Fluoroscopic automatic brightness control performance (high-dose-rate, pulsed modes, field-of-view [FOV] variation). (6) Image artifacts. (7) Fluoroscopic phantom image quality. (8) kVp accuracy and reproducibility. (9) Linearity of exposure versus mA or mAs. (10) Exposure reproducibility. (11) Timer accuracy. (12) Beam quality assessment (half-value layer). (13) Fluoroscopic entrance exposure. Fluoroscopic entrance exposure rate (or air kerma rate). Maximum output and output using a phantom representing a standard size patient for all clinically used settings. [The mode of operation [e.g., magnification mode, frame rate, and any other mode selected) must be documented for each measurement.] (14) Fluorographic (image recording) entrance exposure rate (or air kerma rate) for cine imaging, if performed and entrance exposure (or air kerma) for spot images (if performed). Maximum output and output using a phantom representing a standard size patient for all clinically used settings. [The mode of operation (e.g., magnification mode, frame rate, etc.) must be documented for each measurement.] (15) Image receptor entrance exposure. (16) Equipment radiation safety functions. (17) Patient dose monitoring system calibration. This includes, for radiographic systems, the metric of dose to the image receptor (IEC Exposure Index or proprietary index) and, for fluoroscopy systems, and the displays of cumulative air kerma and, if available, DAP. (18) Video and digital display monitor performance. (19) Digital image receptor performance. (20) Grids used with portable x-ray units shall be imaged for uniformity. (21) For radiographic units, measurement of entrance skin exposure (or air kerma) for a standard size patient for common radiographic projections and comparison to published diagnostic reference levels and achievable doses (e.g., ACR practice parameter. Note: The information on entrance exposure rates (or air kerma rates) from fluoroscopy and from fluorography, in Items (13) and (14) above, for each fluoroscope, shall be in a format suitable for providing to the physicians who operate the fluoroscope. B. Computed Radiography (CR) and Digital Radiography (DR) Inspections of CR and DR equipment shall comply with the American Association of Physicist in Medicine (AAPM) Report Number 93, Acceptance Testing and Quality Control of Photostimulable Storage Phosphor Imaging Systems. Evaluate the performance of CR and DR annually. This evaluation shall include, but not be limited to, the following tests (as applicable): (1) Component and Imaging Plate Physical Inspection and Inventory. (2) Imaging Plate Dark Noise and Uniformity. (3) Exposure Indicator Calibration. (4) Linearity and Auto-ranging Response. (5) Laser Beam Function. (6) Limiting Resolution and Resolution Uniformity. (7) Noise and Low-Contrast Resolution. (8) Spatial Accuracy. (9) Erasure Thoroughness. (10) Aliasing/Grid Response. (11) IP Toughput. (12) Positioning and Collimation Errors. C. CT Scanners Inspections shall conform to the 2012 ACR Computed Tomography Quality Control Manual. Evaluate the performance of each CT scanner annually. This evaluation shall include, but not be limited to, the following tests (as applicable): (1) Review of Clinical Protocols. (2) CT Protocol Optimization (2) Scout Prescription and Alignment Light Accuracy. (3) Image Thickness - Axial Mode. (4) Table Travel Accuracy. (5) Radiation Beam Width. (6) Low-Contrast Performance. (7) Spatial Resolution. (8) CT Number Accuracy. (9) Artifact Evaluation. (10) CT Number Uniformity. (11) Dosimetry (the scanner displayed CTDIvol values must be within +/- 20% of the measured CTDIvol values). (12) Gray Level Performance of CT Acquisition Display Monitors. D. Dental Inspections shall conform to the Conference of Radiation Control Program Directors (CRCPD), Quality Control Recommendations for Diagnostic Radiography Volume 1 Dental Facilities July 2001. Evaluate the performance of dental x-ray equipment annually. This evaluation shall include, but not be limited to, the following tests (as applicable): (1) Collimation. (2) Beam quality (half value layer). (3) Timer Accuracy and Reproducibility. (4) kVp Accuracy and Reproducibility. (5) mA or mAs Linearity. (6) Exposure Reproducibility. (7) Entrance Skin Exposure Evaluation. (8) Technique Chart Evaluation. (9) Image uniformity (artifact evaluation). E. MRI The physics inspection shall conform to the 2004 ACR Magnetic Resonance Imaging Quality Control Manual. Evaluate the performance of each MRI scanner annually. This evaluation shall include, but not be limited to, the following tests (as applicable): (1) Magnetic field homogeneity. (2) Geometric accuracy. (3) Inter-slice RF interference. (4) Slice position accuracy. (5) High-contrast resolution (6) RF coil performance. (a) Volume coils' signal-to-noise ratio (b) Volume coils' image uniformity (c) Volume coils' ghosting ratio (d) Phased array coils' signal-to-noise ratio (e) Surface coils' signal-to-noise ratio (7) Slice thickness accuracy (8) Low-contrast detectability (9) Soft copy displays (9) Technologist's QC program (11) Site phantom inventory (12) Site RF coil inventory F. Nuclear Medicine The physics inspection shall conform to the ACR annual performance tests for nuclear medicine cameras. Evaluate the performance of the nuclear cardiology scanner annually. This evaluation shall include, but not be limited to, the following tests (as applicable): (1) Intrinsic Uniformity (2) System Uniformity (3) Intrinsic or System Spatial Resolution (4) Relative Sensitivity (5) Energy Resolution (6) Count Rate Parameters: fail criteria (7) Formatter/Video Display (8) Overall System Performance for SPECT (9) System Interlocks (10) Dose Calibrators (Geometry, if applicable, Accuracy) (11) Center of Rotation (12) Thyroid Uptake and Counting Systems G. Display Monitors The image acquisition display monitor evaluation shall include testing of image acquisition display monitors for maximum and minimum luminance, luminance uniformity, resolution, and spatial accuracy. Evaluate image acquisition display monitor performance annually. H. Dental CBCT Acceptance and Performance Testing 1. Acceptance Testing. Perform acceptance testing and measurements of air kerma at the isocenter for each kVp station for a range of clinically used mAs settings, initially when the CBCT unit is installed, and following any move of the CBCT to another area inside or outside the initial clinical site. This testing is to ensure that the equipment performance is in agreement with the manufacturer's technical specifications. 2. Performance Testing. Each CBCT unit shall undergo periodic quality control tests to insure that the performance of the machine has not significantly deteriorated and is operating within the manufacturer's technical specifications. This performance testing is performed by a qualified expert annually, at intervals not to exceed 14 months, and after repairs to the CBCT unit that may affect the radiation output or image quality. 3. Some manufacturers provide a phantom and procedures to perform machine specific quality assurance (QA) tests. In cases where the manufacturer provides a phantom and procedures to perform specific tests, but the tests are not included in this SOW, perform the manufacturer's machine-specific QA tests in addition to the QA tests in this SOW. Parameters for Acceptance and Annual Physics Testing for Dental CBCT (1) Radiation Output Repeatability - Make four measurements of the air kerma at the isocenter at a clinically used setting. The measurements shall be less than +/-5% of the average of the five measurements and the measurements shall be less than +/- 5% of the previous year's measurement. (2) Radiation Output Reproducibility - Measure the air kerma at the isocenter for each kVp station and a range of clinically used mAs setting. Compare the results to the baseline values established at the initial acceptance testing. The values should be +/-5% of the baseline. (3) kVp Accuracy - Measure the kVp at all clinically used settings. The measured kVp should be +/-5% of the selected kVp. (4) kVp Repeatability - Make five kVp measurements each for two clinically used kVp settings. All measured values should be +/-5% of the mean kVp. (5) kVp Reproducibility - Measure the kVp at all available kVp settings. The measured values should be +/-5% of the baseline. (6) Beam quality - Measure the half value layer (HVL) for aluminum. The minimum shall comply with Section F.4.d of the Suggested State Regulations for Control of Radiation, Conference of Radiation Control Program Directors. (7) Radiation field of view (FOV) - Measure the width of the radiation field at the isocenter. The width of the beam should be 3 mm or 30% of the total nominal collimated width. (8) Image Quality - Image the phantom provided by the manufacturer or another suitable phantom. Assess high contrast spatial resolution, uniformity of transaxial images, and image noise. Imaging uniformity shall be assessed over the entire range of axial images. (9) Accuracy of Linear Measurements - Using images of an appropriate phantom, assess the accuracy of distance measurements. (10) Accuracy of Patient Dose Metric Indication - Assess the accuracy of the indicated dose metric (typically DAP). (11) Patient Dose Assessment - From a scan or scans using the facility's standard techniques, record the dose metric (typically DAP) and compare to achievable levels and diagnostic reference levels (if available) (12) Review of the technical QA program - The qualified expert shall review the technical QA program. The review shall include a trend analysis of the QA data. The results of the technical QA program review shall be included in the written report. Any trends that identify problems shall be included in the report along with recommended corrective actions. (13) Display Monitors - Perform a visual analysis of the SMPTE test pattern. 1. Display the test pattern on the imaging console. Set the display window width/level to the manufacturer-specified values for the pattern. Do not set the window/level by eye; doing so invalidates the procedure. 2. Examine the pattern to confirm that the gray level display in the imaging console is subjectively correct. a. Review the line pair patterns in the center and at each of the corners. b. Review the black-white transition. c. Look for any evidence of "scalloping" (loss of bit depth) or geometric distortion. 3. Use a photometer to measure the maximum and minimum monitor brightness (0% and 100% steps) 4. Measure additional steps within the pattern to establish a response curve. 5. Measure the brightness near the center of the monitor and near all 4 corners (or all 4 sides, depending on the test pattern used). (14) Viewing Conditions - Assess the viewing conditions for the area in which the monitor used to evaluation the CBCT studies is located. I. Documentation/Reports The documentation shall include detailed descriptions of each piece of equipment tested, all procedures performed, and the results. Deliver reports to the COR in electronic portable document file (pdf) format via e-mail, CD-ROM, or DVD-ROM. Equipment Inventory All equipment is located at the Milwaukee VAMC except for EE54411, which is located at the Appleton CBOC. No MRI unit is currently listed in the inventory - that area is currently under construction and will be added via contract amendment in the future. EE # Manufacturer Model Serial Category Location 68520 SIEMENS ARTIS ZEE 147103 R/F SYSTEMS: ANGIO/INTERVENT 2436-111 74591 SIEMENS AXIOM ARTIS DBA 154093 R/F SYSTEMS: ANGIO/INTERVENT 2434-111 90292 SIEMENS ARTIS Q ZEN BIPLANE123035 R/F SYSTEMS: CARDIOVASCULAR 5535A-111 54585 SIEMENS AXIOM LUMINOS DRF1789 R/F SYSTEMS: GENERAL-PURPOSE 2445-111 74597 PHILIPS MULTIDIAG ELEVA 38 R/F SYSTEMS: GENERAL-PURPOSE 2161-111 49606 SIEMENS ARCADIS AVANTIC31332 R/F UNITS: MOBILE B0287-111 52005 SIEMENS ARCADIS AVANTIC31435 R/F UNITS: MOBILE G17-144 53165 SIEMENS ARCADIS VARIC 11267 R/F UNITS: MOBILE 4225-111 56073 GENERAL ELECT OEC 9900 ELITE ES-0884 R/F UNITS: MOBILE 2441-111 59076 SIEMENS ARCADIS ORBIC 22177 R/F UNITS: MOBILE 4231-111 68625 ORTHOSCAN ORTHOSCAN 1000 HD5F0326 R/F UNITS: MOBILE 2228-111 70405 SIEMENS ARCADIS AVANTIC33063 R/F UNITS: MOBILE 2228-111 74792 SIEMENS ARCADIS AVANTIC33153 R/F UNITS: MOBILE 2228-111 48615 SIEMENS MULTIX TOP 8260 RADIOGRAPHIC SYSTEMS 1175-111 49430 SIEMENS AXIOM ARISTOS MX1954 RADIOGRAPHIC SYSTEMS: DIGITAL 2445-111 54411 SIEMENS AXIOM MULTIX MT 1403 RADIOGRAPHIC SYSTEMS: DIGITAL 152I-AP 84431 SIEMENS YSIO 23147 RADIOGRAPHIC SYSTEMS: DIGITAL 2460-111 46500 PLANMECA INC INTRA 1XRF063128 RADIOGRAPHIC UNITS: DENTAL 8648-111 46501 PLANMECA INC INTRA 1XRF063112 RADIOGRAPHIC UNITS: DENTAL 8600-111 46502 PLANMECA INC INTRA 1XRF063124 RADIOGRAPHIC UNITS: DENTAL 8652-111 46503 PLANMECA INC INTRA 1XRF062678 RADIOGRAPHIC UNITS: DENTAL 8654-111 65678 PLANMECA INC INTRA 1XRF89992 RADIOGRAPHIC UNITS: DENTAL 8619C-111 65679 PLANMECA INC INTRA 1XRF89993 RADIOGRAPHIC UNITS: DENTAL 8633-111 65680 PLANMECA INC INTRA 1XRF89756 RADIOGRAPHIC UNITS: DENTAL 8606-111 65681 PLANMECA INC INTRA 1XRF89247 RADIOGRAPHIC UNITS: DENTAL 8607-111 65682 PLANMECA INC INTRA 1XRF89279 RADIOGRAPHIC UNITS: DENTAL 8611-111 65683 PLANMECA INC INTRA 1XRF89248 RADIOGRAPHIC UNITS: DENTAL 8613-111 65684 PLANMECA INC INTRA 1XRF89278 RADIOGRAPHIC UNITS: DENTAL 8615-111 65685 PLANMECA INC INTRA 1XRF89249 RADIOGRAPHIC UNITS: DENTAL 8617-111 65686 PLANMECA INC INTRA 1XRF87983 RADIOGRAPHIC UNITS: DENTAL 8630-111 65687 PLANMECA INC INTRA 1XRF89244 RADIOGRAPHIC UNITS: DENTAL 8650-111 65688 PLANMECA INC INTRA 1XRF89250 RADIOGRAPHIC UNITS: DENTAL 8647-111 65689 PLANMECA INC INTRA 1XRF89242 RADIOGRAPHIC UNITS: DENTAL 8548-111 65690 PLANMECA INC INTRA 1XRF89246 RADIOGRAPHIC UNITS: DENTAL 8619B-111 65691 PLANMECA INC INTRA 1XRF89245 RADIOGRAPHIC UNITS: DENTAL 8614-111 90777 PLANMECA INC PROMAX 359137 RADIOGRAPHIC UNITS: DENTAL 8651-111 32857 GENERAL ELECT AMX-3 414257MCP RADIOGRAPHIC UNITS: MOBILE B139-70 65423 SHIMADZU SCI MOBILEDART EVO 410001B15001 RADIOGRAPHIC UNITS: MOBILE AL4-144 75463 SHIMADZU SCI MOBILEDART EVO 410001B2A018 RADIOGRAPHIC UNITS: MOBILE 1188-111 75464 SHIMADZU SCI MOBILEDART EVO 410001B2B002 RADIOGRAPHIC UNITS: MOBILE 1188-111 86808 SIEMENS MOBILETT MIRA 2541 RADIOGRAPHIC UNITS: MOBILE B0269B-111 46367 GENERAL ELECT LIGHTSPEED VCT 64 SLICE 1098211 SCANNING SYSTEMS: CT 2472-111 49027 SIEMENS SOMATOM EMOTION 6 SLICE44318 SCANNING SYSTEMS: CT B0413-111 59969 SIEMENS SOMATOM DEFINITION FLASH73120 SCANNING SYSTEMS: CT 1191-111 37170 GENERAL ELECT MILLENNIUM VG 10534 SCANNING SYSTEMS: GAMMA CAMERA10505-111 39826 GENERAL ELECT INFINIA 16081 SCANNING SYSTEMS: GAMMA CAMERA10505-111 47817 SIEMENS E.CAM 10027 SCANNING SYSTEMS: GAMMA CAMERA10512-111 57577 SIEMENS ULTRASOUND SYMBIA S1414 SCANNING SYSTEMS: GAMMA CAMERA10510-111 VA69D16Q1204 Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 12
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