PWS - Medical Physicist.pdf

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Statement of Work

Medical Physicist Services

Cheyenne River Health Center

Section 1: General Information

1.1 General: This is a non-personal services contract to provide medical physics services for the

Cheyenne River Health Center (CRHC). The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.2 Period of Performance: Will be one year from date of award

1.3 Place of Performance: Cheyenne River Health Center

PO Box 1012 Eagle Butte, SD 57625

1.4 Hours of Operation: All work shall be performed during business hours of 8:00 AM to 5:00 PM. If a service has begun during regular business hours and it must be completed before any patients can be imaged according to the American College of Radiology (ACR), The Joint Commission (TJC), or the

Mammography Quality Standards Act (MQSA), then the physicist must complete the service.

1.5 Type of Contract: The government will award a Firm Fixed Price contract.

Invoicing: Invoices shall be submitted through Invoice Processing Platform (IPP).

The IPP website address is: https://www.ipp.gov

In compliance with the Office of Management and Budget (OMB) M-15-19 memorandum

“Improving Government Efficiency and Saving Taxpayer Dollars Through Electronic Invoicing” directing Federal agencies to adopt electronic invoicing as the primary means to disburse payment to vendors. Invoices submitted under any award will be required to utilize the Invoice

Processing Platform (IPP) in accordance with HHSAR 352.232-71, Electronic Submission and

Processing of Payment Requests” IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the Treasury’s Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis (FRSTL).

Contractors are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register-however, we encourage you make sure your organization and designated IPP user accounts are valid and up to date. It will be the responsibility of the contractor to keep active and maintain their SAM.gov account, in order to keep their IPP account active. Payment is sent via E.F.T., through the account registered in SAM.gov.

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at

(866) 973-3131 (M-F 8AM to 6PM ET), or IPPCustomerSupport@fiscal.treasury.gov or ihse-invoicingteam@ihs.gov

Should the contractor feel that use of the IPP would be unduly burdensome, their response to the https://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov mailto:ihse-invoicingteam@ihs.gov mailto:ihse-invoicingteam@ihs.gov

Page | 2 solicitation should include an explanation of this position, for a determination by the contracting officer to allow non-IPP invoicing.

The contractor shall submit a signed and approved invoice to request payment through IPP, at least bi-weekly. If services are billed at an hourly rate, invoices will include timesheets, signed off by the department supervisor.

The Contractor shall include the following information on each invoice in accordance with the

Prompt Payment Act (5 CFR Part 1315.9(b):

1. Contractor's name;

2. Invoice number and date;

3. Entire award number/Contract number or other authorization number for delivery of goods or services;

4. Description (including dates of service), price, and quantity of goods and services rendered;

5. Shipping and payment terms;

6. UEI number and Taxpayer Identifying Number (TIN); and

7. Contact name (where practicable), title and telephone number.

Only actual hours worked must be invoiced for, at the Fixed Rate referenced in the award document(s). The government reserves the right to not use all hours enacted under each task order and will de-obligated excess hours at close-out of the task order.

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Section 2: Definitions & Acronyms

2.1 Definitions:

Contractor. A supplier or vendor awarded a contract to provide specific supplies or service to the government.

Work Day. The number of hours per day the Contractor provides services in accordance with the contract is an 8 hour day.

2.2 Acronyms:

AAPM

ACR

CBCT

CFR

COR-NA

CT

FOV

HVL

IEC

MQSA

MRI

NCRP

PET

QA

RSO

SMPTE

SOW

SPECT

TJC

American Association of Physicist in Medicine

American College of Radiology

Cone Beam Computed Tomography

Code of Federal Regulations

Contracting Officer Representative-Non Applicable

Computed Tomography

Field of View

Half Value Layer

International Electrotechnical Commission

Mammography Quality Standards Act

Magnetic Resonance Imaging

National Council for Radiation Protection

Positron Emission Tomography

Quality Assurance

Radiation Safety Officer

Society of Motion Picture and Television Engineers

Statement of Work

Single-Photon Emission Computed Tomography

The Joint Commission

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Section 3: Government Furnished Property, Equipment, and Services

None

Section 4: Contractor Furnished Items and Services

The Contractor shall provide all equipment, supplies, management, supervision, personnel, and transportation necessary to assure that all services are in accordance with the contract and all applicable laws and regulations. The contractor shall ensure all work meets performance standards specified in this

Statement of Work (SOW).

Section 5: Specific Tasks

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 Radiation Safety Officer (RSO).

5.1 General Requirements

A. All work shall be performed under the direction of a Qualified Medical Physicist (QMP) or the

QMP must be onsite providing direct quality control supervision during measurements made by a medical physicist assistant/technician. A Qualified 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. The contractors must submit evidence of board certification with their quote.

5.2 Required Services

A. All imaging equipment shall be inspected at least annually.

not to exceed 14 months. Other inspections as defined below (new equipment, repairs, shielding

(lead aprons), etc.) shall be completed as needed. A complete electronic report in

“pdf” format shall be provided to Biomedical Engineering, Radiology Department Supervisor and the Radiation Safety Officer (RSO) within 30 days after completion of the inspection. A complete electronic report in PDF format shall be provided within 30 working days after completion of the inspection.

Missed or errors in performance for required elements will be corrected at the expense of the contractor. If errors are found in reports, corrections in “pdf” form will be submitted expeditiously. If additional work for adjustments/repair beyond this sow are needed, a quote for the additional work will be submitted and a modification, at the approval of the contracting officer, will need to be incorporated. Any additional issues will be handled on a case by case basis and should be brought to the attention of the COR immediately.

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B. The qualified diagnostic Medical Physicist shall perform imaging equipment (x-ray equipment, CT, ultrasound units) inspections to ensure

Compliance with the current Regulatory agency requirements. Any deficiencies or non-conformances discovered during the inspection shall be verbally communicated to Biomedical

Engineering and the 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 must be reported to the RSO immediately upon discovery.

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 and MQSA requirements. Any deficiencies or non-conformances discovered during the inspection shall be verbally communicated to Biomedical Engineering and 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 Biomedical Engineering and the RSO immediately upon discovery. If the need for additional acceptance testing of new equipment, or relocation of existing equipment arises, a quote will be submitted and a modification, at the approval of the contracting officer, will need to be incorporated. Any additional issues will be handled on a case-by-case basis and should be brought to the attention of the COR immediately

D. 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 where required.

In cases where the unit may not be used clinically until inspected by a physicist, the inspection must be completed within 72 hours after the facility contacts the contractor, any deficiencies or non-conformances discovered during the inspection shall be verbally communicated to Biomedical

Engineering and the 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 Biomedical Engineering and the

RSO immediately upon discovery. Where acceptable, the physicist will review and accept the repairs report from Engineering. In the event of repairs/testing after repairs, a quote will be requested, and a modification to the contract will be done.

E. The qualified diagnostic medical physicist shall provide consultation for additional services as needed, such as safety training, reading dosimetry badge reports, i.e.

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

G. The qualified diagnostic medical physicist will assume Radiation Safety Officer duties and responsibilities. If any other site visits are needed after the initial visit, a quote for additional service will be submitted and a modification will be completed.

The qualified diagnostic medical physicist shall provide shielding design calculations for each new, replaced, or relocated x-ray imaging system. The calculations for each shall comply with the National

Council for Radiation Protection and Measurements (NCRP) Report No. 147, and shall be documented in a written report which includes a diagram showing adjacent areas. The qualified diagnostic medical physicist

Page | 6 shall perform a shielding survey to verify the structural shielding was installed per the shielding design report and complies with the design goals. If the need for a new shielding plan arises, a quote will be submitted and a modification, at the approval of the contracting

H. officer, will need to be incorporated. Any additional issues will be handled on a case-by-case basis and should be brought to the attention of the COR immediately.

I. 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.

J. The qualified diagnostic medical physicist shall review the report from Engineering to verify compliance of any necessary corrective action performed to correct deficiencies found. The contractor will perform a follow-up inspection if necessary, according to ACR, MQSA, or other relevant standards.

SERVICES

Radiation dosimeter services to be provided for Eagle Butte, SD IHS-Cheyenne River Health Center radiology department.

A. Communicate with dosimeter provider and utilize website for tracking and data entry

B. Maintain account with under 10 dosimeters

1. Coordinate dosimeter exchange with radiology manager

2. Changes

a. Departments – add and update accounts as needed

b. Participants – process paperwork and utilize provider website to add, change, and discontinue participants

c. Badges – process paperwork and utilize provider website to add, change, and discontinue body and ring dosimeters

d. Fetal badges – process paperwork for declaration of pregnancy, process paperwork and utilize provider website to coordinate monthly fetal monitoring

e. Recalculations – communicate and process paperwork for:

1) improper wear or handling of dosimeter

2) lost or damaged dosimeter

3) unworn dosimeter

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4) participant’s prior exposure for accurate cumulative lifetime exposure

C. Reporting

1. Send Form 5 annual report to all badged participants

2. Review exposure reports for wear period

3. Notify RSO of exposures exceeding ALARA limits

4. Notify participants when ALARA limits are exceeded

5. Provide exposure history for terminated participants

6. Provide exposure history to other employers for past participants, when requested

7. Request and collect prior exposure history for newly badged participants

5.1 Equipment Inspections

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.

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. 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).

1) Integrity of unit assembly.

2) Collimation and radiation beam alignment.

3) Fluoroscopic system spatial 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 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

Page | 8 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, the displays of cumulative air kerma and, if available, DAP.

18) 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. Digital Radiography (DR)

Physics inspections of 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. The performance of DR must be evaluated at least annually.

This evaluation should 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 Throughput.

12) Positioning and Collimation Errors.

C. CT Scanners

The physics inspection shall conform to the 2012 ACR Computed Tomography Quality Control

Manual or latest revision. 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).

1) Review of Clinical Protocols.

2) Scout Prescription and Alignment Light Accuracy.

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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. Ultrasound

The physics inspection shall conform to the ACR performance tests for ultrasound. Testing should be done for all transducers clinically used with any unit employing more than one transducer. Ultrasound equipment shall be inspected semi-annually (every 6 months).

1) System Sensitivity/Penetration

This test should be done with the following settings:

• maximum transmit power

• proper receiver gain and TGC that allows echo texture to be visible in the deep region

• transmit focus at the deepest depth

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

2) Image Uniformity

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

• vertical or radially oriented streaks?

• dropouts?

• reduction of brightness near edges of the scan?

• brightness transitions between focal zones?

3) Electrical and Mechanical Safety and Cleanliness

• Are all cords and cables intact (no frays)?

• Are all transducers intact without cracks or delamination?

• Are the transducers cleaned after each use?

• Are the image monitors clean?

• Are the air filters clean?

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• Are the wheel locks in working condition?

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

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

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

a) For Scanners with a Discrete Bar Pattern

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.

b) For Scanners with a Continuous Gray Bar Pattern

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.

c) For Laser Imager (Hard Copy Device)

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.

5) Hard Copy Output Quality Test (Digital) (if applicable)

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

Required Test Equipment

• Densitometer

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

The same test image should be used each time.

E. Display Monitors

1) The annual performance evaluation conducted by the diagnostic medical physicist includes testing of

Page | 11 image acquisition display monitors for maximum and minimum luminance, luminance uniformity, resolution, and spatial accuracy. The image acquisition display monitors for nuclear medicine, CT, and MRI units shall be tested.

5.1 Equipment List

Description X-ray Units Planned replacement or addition

CT: Cannon Aquillion 64 1

Fixed X-ray: Siemens 1

Portable X-ray: Shimadzu

DR: Konica Minolta 2

GE Ultrasound 1

F. Authority

1.1. No person other than the Contracting Officer has authority to bind the Government with respect to this contract.

1.2. No action or omission of any government employee or representative other than the Contracting Officer shall increase or decrease the scope of this contract or shall otherwise modify the terms and conditions of this contract.

1.3. In no event shall any of the following be effective or binding on the Government or imputed to the Contracting Officer with respect to this contract:

1.3.1. An understanding or agreement between the Contractor and anyone other than the Contracting Officer;

1.3.2. A purported modification or change order issued by anyone other than the Contracting Officer;

1.3.3. A promise by anyone other than the Contracting Officer to provide additional funding or make payments;

or

1.3.4. An order, direction, consent, or permission from anyone other than the Contracting Officer to:

1.3.4.1. Incur costs in excess of a specified estimated cost, allotment of funds, or other ceiling; or

1.3.4.2. Expend hours in excess of a specified level of effort.