36C26125Q0589_1.docx

SUBJECT*

Testing and Inspection Services by Medical Physicist

GENERAL INFORMATION

VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO) 21 3237 Peacekeeper Way, Bldg 200 Suite 204 McClellan Park CA 95652

POINT OF CONTACT*

Contract Specialist Durell Salaz durell.salaz@va.gov None None

ADDITIONAL INFORMATION

DESCRIPTION

See attached See attached document: SOW Medical Physicist Services - DRAFT.

This is an intent to sole source notice for commercial items prepared in accordance with FAR Subpart 5.2, Synopses of Proposed Contract Actions. This announcement constitutes the only notice of intent to sole source and synopsis of proposed action.

The Department of Veterans Affairs, VHA, Network Contracting Office (NCO) 21 intends to negotiate/award a sole-source contract to John T. Stalp, LLC. The contract will be a one-year contract with an option of extending the service for an additional six-month period. The statutory authority for this non-competitive acquisition is FAR 13.106-1(b)(1)(i) as implemented by FAR 6.302-1.

The North American Industrial Classification System (NAICS) code for this procurement is 541380, with a small business size standard of $19 Million, and the FSC/PSC is H365.

The Department of Veterans Affairs intends to solicit and award a sole source bridge contract to provide Medical Physicist Services for the San Francisco Veteran Affairs Medical Center (SFVAMC). The current contract expires June 9, 2025, and services are still required. This one-year contract will ensure services continue past the current contract expiration and will allow adequate time for the long-term contract to be competed and awarded.

THIS NOTICE IS NOT A REQUEST FOR COMPETITIVE PROPOSALS OR QUOTATIONS. A SOLICITATION WILL NOT BE POSTED.

Interested persons may identify their interest and capability to respond to the requirement by 10:00 AM PST June 5, 2025, via email to durell.salaz@va.gov. All responses received by the closing date specified herein will be considered by the Government, any response to this notice must show clear and convincing evidence that the responding company can provide the same services by the required date. However, a determination by the Government to not compete is solely within the discretion of the Government.

Special Notice Special Notice

Special Notice

B.3 PERFORMANCE WORK STATEMENT

1. GENERAL

1.1. The Contractor shall furnish all materials, supplies, equipment, labor, and qualified personnel to provide on-site diagnostic medical physics support or services for the San Francisco Veterans Affairs Health Care System (SFVAHCS), under the terms and conditions stated herein, and must adhere to 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, which have the potential to adversely impact the facility radiation workers or patients, to the Radiation Safety Officer (RSO) immediately upon discovery.

2. PERFORMANCE

2.1. All work shall be performed by a qualified diagnostic medical physicist. A qualified diagnostic medical physicist is a person who is certified by the American Board of Radiology, American Board of Medical Physics, or the Canadian College of Physicists in Medicine. For mammography, a qualified medical physicist can have state licensure to perform mammography inspections in lieu of board certification. For diagnostic computed tomography (CT), nuclear medicine, PET, or MRI, a qualified medical physicist can meet the following requirements in lieu of board certification:

2.1.1. A graduate degree in physics, medical physics, biophysics, radiologic physics, medical health physics, or a closely related science or engineering discipline from an accredited college or university

2.1.2. Formal graduate-level coursework in the biological sciences with at least one course in biology or radiation biology and one course in anatomy, physiology, or a similar topic related to the practice of medical physics

2.1.3. Documented 3 years of clinical experience in CT, nuclear medicine, PET, or MRI. The physicist must document the 3 years of experience for the modality being inspected.

3. MANDATORY SERVICES TO BE PERFORMED

3.1. The qualified diagnostic medical physicist shall perform imaging equipment (x-ray equipment, nuclear medicine cameras, PET/CT cameras, ultrasound units, and MRIs) inspections to ensure compliance with the current American College of Radiology (ACR) and Mammography Quality Standards Act (MQSA) requirements. Any deficiencies or non-conformances discovered during the inspection shall be verbally communicated to the service supervisor or RSO, prior to the qualified diagnostic medical physicist leaving the facility. Deficiencies or non-conformances which represent unsafe conditions with the potential to adversely impact the facility radiation workers or patients shall be reported to the RSO immediately upon discovery. A written report of the results shall be provided to the service supervisor or RSO within 5 working days after completion of the inspection.

3.2. All imaging equipment (except ultrasound, which is semi-annually, and nuclear medicine cameras and PET, which are quarterly) shall be inspected at least annually, not to exceed 14 months.

3.3. 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 or MQSA requirements. Any deficiencies or non-conformances discovered during the inspection shall be verbally communicated to the service supervisor or RSO prior to the qualified diagnostic medical physicist leaving the facility. Deficiencies or non-conformances which represent unsafe conditions with the potential to adversely impact the facility radiation workers or patients shall be reported to the RSO immediately upon discovery. A written report of the results shall be provided to the service supervisor or RSO within 5 working days after completion of the inspection.

3.4. The qualified diagnostic medical physicist shall perform a full inspection of imaging equipment after repairs or modifications that may affect the radiation output or image quality. The inspection shall be completed within 48 hours after the facility contacts the contractor. Any deficiencies or non-conformances discovered during the inspection shall be verbally communicated to the service supervisor or RSO prior to the qualified diagnostic medical physicist leaving the facility. Deficiencies or non-conformances which represent unsafe conditions with the potential to adversely impact the facility radiation workers or patients shall be reported to the RSO immediately upon discovery. A written report of the results shall be provided to the service supervisor or RSO within five (5) working days after performing of the inspection. The qualified diagnostic medical physicist shall provide consultation for additional services as needed, i.e., safety training, personal protection equipment (PPE) issues.

3.5. The qualified diagnostic medical physicist shall review CT protocols at least annually.

3.6. The qualified diagnostic medical physicist shall provide shielding design calculations for each new, replaced, or relocated x-ray imaging system. The calculations for each system shall comply with the National Council for Radiation Protection and Measurements (NCRP) Report No. 147, and, for dental units, the NCRP Report No. 145, and shall be documented in a written report which includes a diagram showing adjacent areas. The qualified diagnostic medical physicist shall perform a shielding survey to verify the structural shielding was installed per the shielding design report and complies with the design goals. A written report of the shielding survey shall be provided to the RSO within five (5) workings days after the shielding survey has been completed.

3.7. 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. The qualified diagnostic medical physicist shall review at least annually the QA program. A written report of the results shall be provided to the service supervisor or RSO within five (5) working days after performing the inspection.

3.8. The qualified diagnostic medical physicist shall perform a follow-up inspection to verify compliance of any necessary corrective action performed to correct deficiencies found.

4. EQUIPMENT INSPECTIONS

4.1. The Contractor shall conduct equipment inspections or quality control surveys of the imaging equipment listed below. The Contractor 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.

5. ESTIMATED QUANTITIES AND LOCATIONS

* Patient dose evaluation is included

San Francisco, CA 94121

Eureka, CA 95501

Santa Rosa, CA 95407

Oakland, CA 94612

6. RADIOGRAPHIC AND FLUOROSCOPIC EQUIPMENT

6.1. 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. The performance of each radiographic and fluoroscopic unit must be evaluated at least annually. This evaluation should include, but not be limited to, the following tests (as applicable):

6.1.1. Integrity of unit assembly

6.1.2. Collimation and radiation beam alignment

6.1.3. Fluoroscopic system spatial resolution

6.1.4. Automatic exposure control system performance

6.1.5. Fluoroscopic automatic brightness control performance (high-dose-rate, pulsed modes, field-of-view [FOV] variation)

6.1.6. Image artifacts

6.1.7. Fluoroscopic phantom image quality

6.1.8. kVp accuracy and reproducibility

6.1.9. Linearity of exposure versus mA or mAs

6.1.10. Exposure reproducibility

6.1.11. Timer accuracy

6.1.12. Beam quality assessment (half-value layer)

6.1.13. 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.)

6.1.14. 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.)

6.1.15. Image receptor entrance exposure

6.1.16. Equipment radiation safety functions

6.1.17. 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, the displays of cumulative air kerma and, if available, DAP.

6.1.18. Display monitor performance

6.1.19. Digital image receptor performance

6.1.20. Grids used with portable x-ray units shall be imaged for uniformity

6.1.21. 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.

7. COMPUTED RADIOGRAPHY (CR) AND DIGITAL RADIOGRAPHY (DR)

7.1. Physics 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 Photo-stimulable Storage Phosphor Imaging Systems. The performance of CR and DR must be evaluated at least annually. This evaluation should include, but not be limited to, the following tests (as applicable):

7.1.1. Component and Imaging Plate Physical Inspection and Inventory

7.1.2. Imaging Plate Dark Noise and Uniformity

7.1.3. Exposure Indicator Calibration

7.1.4. Linearity and Auto-ranging Response

7.1.5. Laser Beam Function

7.1.6. Limiting Resolution and Resolution Uniformity

7.1.7. Noise and Low-Contrast Resolution

7.1.8. Spatial Accuracy

7.1.9. Erasure Thoroughness

7.1.10. Aliasing/Grid Response

7.1.11. IP Throughput

7.1.12. Positioning and Collimation Errors

8. CT SCANNERS

8.1. The physics inspection shall conform to the 2012 ACR Computed Tomography Quality Control Manual. The performance of each CT scanner shall be evaluated at least annually. This evaluation should include, but not be limited to, the following tests (as applicable):

8.1.1. Review of Clinical Protocols

8.1.2. Scout Prescription and Alignment Light Accuracy

8.1.3. Image Thickness – Axial Mode

8.1.4. Table Travel Accuracy

8.1.5. Radiation Beam Width

8.1.6. Low-Contrast Performance

8.1.7. Spatial Resolution

8.1.8. CT Number Accuracy

8.1.9. Artifact Evaluation

8.1.10. CT Number Uniformity

8.1.11. Dosimetry (the scanner displayed CTDIvol values must be within +/- 20% of the measured CTDIvol values)

8.1.12. Gray Level Performance of CT Acquisition Display Monitors

9. DENTAL

9.1. The physics inspection shall conform to the Conference of Radiation Control Program Directors (CRCPD), Quality Control Recommendations for Diagnostic Radiography Volume 1 Dental Facilities July 2001. The performance of dental x-ray inspections shall be annually or every 2 years. This evaluation should include, but not be limited to, the following tests (as applicable):

9.1.1. Collimation

9.1.2. Beam quality (half value layer)

9.1.3. Timer Accuracy and Reproducibility

9.1.4. kVp Accuracy and Reproducibility

9.1.5. mA or mAs Linearity

9.1.6. Exposure Reproducibility

9.1.7. Entrance Skin Exposure Evaluation, with comparison to published diagnostic reference levels and achievable doses (e.g., NCRP Report No. 172)

9.1.8. Technique Chart Evaluation

9.1.9. Image uniformity (artifact evaluation)

10. DENTAL CBCT ACCEPTANCE AND PERFORMANCE TESTING

10.1. Acceptance Testing. Acceptance testing and measurements of air kerma at the isocenter for each kVp station for a range of clinically used mAs settings will performed 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.

10.2. Performance Testing. Each CBCT unit shall undergo periodic quality control tests to ensure 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.

10.3. 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, then the manufacturer’s machine-specific QA tests shall be performed in addition to the QA tests in this SOW.

11. ACCEPTANCE AND ANNUAL PHYSICS TESTING FOR DENTAL CBCT

11.1. Radiation output Repeatability. Make four measurements of the air kerma at the isocenter at a clinically used setting. The measurements should be less than +/-5% of the average of the five measurements and the measurements should be less than +/- 5% of the previous year’s measurement.

11.2. 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.

11.3. kVp Accuracy. Measure the kVp at all clinically used settings. The measured kVp should be +/-5% of the selected kVp.

11.4. kVp Repeatability. Make five kVp measurements each for two clinically used kVp settings. All measured values should be +/-5% of the mean kVp.

11.5. kVp Reproducibility. Measure the kVp at all available kVp settings. The measured values should be +/-5% of the baseline.

11.6. 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.

11.7. 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.

11.8. 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.

11.9. Accuracy of Linear Measurements. Using images of an appropriate phantom, assess the accuracy of distance measurements.

11.10. Accuracy of Patient Dose Metric Indication. Assess the accuracy of the indicated dose metric (typically DAP).

11.11. 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)

11.12. 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.

11.13. Display Monitors. Perform a visual analysis of the SMPTE test pattern.

11.13.1. 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.

11.13.2. Examine the pattern to confirm that the gray level display in the imaging console is subjectively correct.

11.13.2.1. Review the line pair patterns in the center and at each of the corners.

11.13.2.2. Review the black-white transition.

11.13.2.3. Look for any evidence of “scalloping” (loss of bit depth) or geometric distortion.

11.13.3. Use a photometer to measure the maximum and minimum monitor brightness (0% and 100% steps)

11.13.4. Measure additional steps within the pattern to establish a response curve.

11.13.5. Measure the brightness near the center of the monitor and near all 4 corners (or all 4 sides, depending on the test pattern used).

11.14. Viewing Conditions. Assess the viewing conditions for the area in which the monitor used to evaluation the CBCT studies is located.

12. MAMMOGRAPHY

12.1. The qualified diagnostic medical physicist inspecting mammography equipment must meet the qualifications outlined in the MQSA and shall provide the facility with up-to-date documentation demonstrating the qualified diagnostic medical physicist is MQSA qualified. Inspections of mammography equipment must comply with the latest requirements posted on the ACR Web site for the manufacturer of the digital mammography unit being inspected. Inspection items may include:

12.1.1. Mammographic Unit Assembly Evaluation

12.1.2. Collimation assessment

12.1.3. Artifact evaluation

12.1.4. kVp accuracy and reproducibility.

12.1.5. Beam quality assessment – HVL measurements

12.1.6. Evaluation of system resolution

12.1.7. Automatic Exposure Control (AEC) function performance

12.1.8. Breast entrance exposure, AEC reproducibility, and average glandular dose

12.1.9. Radiation output rate

12.1.10. Phantom image quality evaluation

12.1.11. Signal–to–noise ratio and contrast–to noise ratio measurements

12.1.12. View box luminance and room illuminance

12.1.13. Review Workstation (RWS) tests

13. MRI.

13.1. The physics inspection shall conform to the 2004 ACR Magnetic Resonance Imaging Quality Control Manual. The performance of each MRI scanner shall be evaluated at least annually. This evaluation should include, but not be limited to, the following tests (as applicable):

13.1.1. Magnetic field homogeneity

13.1.2. Geometric accuracy

13.1.3. Inter-slice RF interference

13.1.4. Slice position accuracy

13.1.5. High-contrast resolution

13.1.6. RF coil performance

13.1.6.1. Volume coils’ signal-to-noise ratio

13.1.6.2. Volume coils’ image uniformity

13.1.6.3. Volume coils’ ghosting ratio

13.1.6.4. Phased array coils' signal-to-noise ratio

13.1.6.5. Surface coils’ signal-to-noise ratio

13.1.7. Slice thickness accuracy

13.1.8. Low-contrast detectability

13.1.9. Soft copy displays

13.1.10. Technologist’s QC program

13.1.11. Site phantom inventory

13.1.12. Site RF coil inventory

14. PET

14.1. The physics inspection shall conform to the ACR PET Phantom Instructions for Evaluation of PET Image, ACR Nuclear Medicine Accreditation Program PET Module. The performance of each PET scanner shall be evaluated at least quarterly. For PET/CT units the CT must be inspected at least annually per Item C above. This evaluation should include, but not be limited to, the following tests (as applicable):

14.1.1. Uniformity

14.1.2. Spatial resolution

14.1.3. SUV analysis

15. NUCLEAR MEDICINE

15.1. The physics inspection shall conform to the ACR annual performance tests for nuclear medicine cameras. The qualified diagnostic medical physics shall also perform the quarterly testing as outlined by the ACR. The performance of each nuclear medicine scanner shall be at least annually. This evaluation should include, but not be limited to, the following tests (as applicable):

15.1.1. Intrinsic Uniformity

15.1.2. System Uniformity

15.1.3. Intrinsic or System Spatial Resolution

15.1.4. Relative Sensitivity

15.1.5. Energy Resolution

15.1.6. Count Rate Parameters

15.1.7. Formatter/Video Display

15.1.8. Overall System Performance for SPECT

15.1.9. System Interlocks

15.1.10. Dose Calibrators (Geometry, if applicable, Accuracy)

15.1.11. Thyroid Uptake and Counting Systems

16. ULTRASOUND

16.1. The physics inspection shall conform to the ACR performance tests for ultrasound. On an ongoing basis (at least semiannually), the following tests should be done for each ultrasound unit. Testing should be done using two transducers commonly used with any unit employing more than one transducer. Data should be taken from testing of the transducers which are used for the most frequently occurring examination(s) at the site. It is recommended that these be of different scan formats such as one linear (or curvilinear array), and one sector (mechanical, phased, or vector).

16.1.1. System Sensitivity/Penetration

16.1.1.1. This test should be done with the following settings:

16.1.1.1.1. Maximum transmit power

16.1.1.1.2. Proper receiver gain and TGC that allows echo texture to be visible in the deep region

16.1.1.1.3. Transmit focus at the deepest depth

16.1.1.2. The maximum depth of visualization is determined by comparing the gradually weakening echo texture to electronic noises near the bottom of the image.

16.1.2. Image Uniformity

16.1.2.1. Adjust the TGC controls and other sensitivity controls to obtain an image as uniform as possible.

16.1.2.1.1. Vertical or radially oriented streaks?

16.1.2.1.2. Dropouts?

16.1.2.1.3. Reduction of brightness near edges of the scan?

16.1.2.1.4. Brightness transitions between focal zones?

16.1.3. Electrical and Mechanical Safety and Cleanliness

16.1.3.1. Are all cords and cables intact (no frays)?

16.1.3.2. Are all transducers intact without cracks or delamination?

16.1.3.3. Are the transducers cleaned after each use?

16.1.3.4. Are the image monitors clean?

16.1.3.5. Are the air filters clean?

16.1.3.6. Are the wheel locks in working condition?

16.1.3.7. Are the wheels fastened securely to the US unit and do the wheels rotate easily?

16.1.3.8. Are all accessories (VCR, cameras, etc.) fastened securely to the US unit?

16.1.4. Gray Scale Photography (if applicable) – Do either (a), (b), or (c).

16.1.4.1. For Scanners with a Discrete Bar Patter

16.1.4.1.1. Count the number of distinct gray bar steps on the viewing monitor. Then count the number of steps visualized in the gray bar on the hard copy image.

16.1.4.2. For Scanners with a Continuous Gray Bar Pattern

16.1.4.2.1. Use calipers to measure the length of the black-to-white transition of the gray wedge on the viewing monitor. If the relative length of the black-to-white transition on the hard copy image is less, document how much is missing.

16.1.4.3. For Laser Imager (Hard Copy Device)

16.1.4.3.1. Prior to filming any images, an SMPTE test pattern created by the Society of Motion Picture and Television Engineers (SMPTE), should be printed using the appropriate window width (WW) and window level (WL). If you are unfamiliar with this procedure, you should review Gray et al., “Test pattern for video display and hard-copy camera,” Radiology 145:519-527 (1985), and then contact your local service engineer for assistance. When printed, the 95% density patch within the 100% square and the 5% density patch within the 0% square should be visible, and there should be no notable distortions or artifacts present. If these criteria are not met, contact your service engineer for laser camera calibration before proceeding with any filming.

16.1.4.4. Hard Copy Output Quality Test (Digital) (if applicable)

16.1.4.4.1. This test, or a similar test specifically recommended by the hard copy equipment manufacturer.

16.1.4.5. Required Test Equipment

16.1.4.5.1. Densitometer

16.1.4.5.2. SMPTE Test Pattern or another similar test pattern or phantom image having a wide range of gray scales.

16.1.4.5.3. The same test image should be used each time.

17. DISPLAY MONITORS

17.1. The annual performance evaluation conducted by the diagnostic medical physicist includes testing of image acquisition display monitors for maximum and minimum luminance, luminance uniformity, resolution, and spatial accuracy. The image acquisition display monitors for nuclear medicine, PET, CT, and MRI units shall be tested.

(END OF PERFORMANCE WORK STATEMENT)

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