PWS Medical Physicist Service.pdf

Performance Work Statement Service Plan/Agreement For

Medical Physicist X-ray and Imaging QA Facilities Management Service

G.V. (Sonny) Montgomery VAMC, Jackson MS 1500 E Woodrow Wilson Ave

1. OBJECTIVE: The G.V. (Sonny) Montgomery Veterans Affairs Medical Center located in Jackson, MS requires the following services for the facility: Medical Physicist X-ray and Imaging QA

2. GENERAL: This is a non-personnel services requirement. The contractor shall provide all management, supervision, labor, transportation, tools, materials, parts, and other items necessary to perform work, execute services, and to successfully complete all deliverables as contained within this Performance Work Statement.

The Government shall not exercise any supervision and/or control over contractor personnel (which includes contractor service providers, contractor representatives, and subcontractors employed with and/or being utilized by the prime contractor) during all active performance periods of the contract. All contractor personnel shall be accountable solely to the Contractor, who in turn is responsible to the Government.

3. BACKGROUND: Several pieces of imaging equipment employed at the facility utilize x-rays to produce images. A medical physicist is needed to perform annual inspections and quality assurance exams to ensure safe and accurate administration of any radiation used to produce a medical diagnostic image.

4. SCOPE OF SERVICES: The services needed (to include required Deliverables) are described below.

1. The qualified diagnostic medical physicist(s) shall perform an evaluation of the operation of all G.V.

(Sonny) Montgomery VAMC x-ray or imaging devices including CT (Computed Tomography) units, gamma cameras, MRI (Magnetic Resonance Imaging) units, rad/fluoro rooms, c-arms, portable x-ray devices, fixed specialty units, shielding design, and CR (Computed Radiography) readers using appropriate radiation measuring devices and phantoms. The contractor shall present a written report on each x-ray device identifying the x-ray device by serial number as well as the functional parameters of the x-ray device. A written report of the results shall be provided to the RSO (Radiation Safety Officer) within 5 working days after completion of the inspection. All x-ray or imaging equipment shall be inspected at least annually. The work to be performed will also include the following:

a. The x-ray device inspection report must include an Entrance Exposure Chart plotting patient thickness against KVP (kilovoltage peak) for a range of KVP’s [50 KVP -120 KVP]. The Medical Physicist must verify that the software used for device checks can generate this document.

b. The Medical Physicist reviews the CT dose optimization on a calendar basis as part of the annual CT device checks

c. The Medical Physicist reviews the CT protocol documentation on a calendar basis as part of the annual CT device checks to ensure that protocols are optimized with regard to image quality and patient exposures

d. The Medical Physicist shall examine x-ray and CT devices prior to first clinical use following, repairs, installation or relocation of fixed units

e. If called upon to do so, the Medical Physicist shall examine x-ray and CT devices prior to first clinical use or no later than 30 days following tube changes, collimator repair, detector replacement, or generator repair, provided the facility Biomedical Service has established a written process to perform testing by a biomedical engineer or service engineer to validate dose output and image quality. In the absence of such a written process, the Medical Physicist shall examine the device prior to first clinical use.

f. Evaluation of x-ray devices shall be evaluated within the specified time frame.

g. Medical Physicist shall provide detail written reports.

h. Medical Physicist shall be available to evaluate repaired or new devices.

i. Medical Physicist shall review CT protocols for Optimization.

j. Medical Physicist shall perform QA (Quality Assurance) testing of the CR readers:

i. Including accuracy of the exposure index and make recommendations

ii. Periodically image grids used for mobile examinations and make recommendations.

k. Medical Physicist shall, for CT and Nuclear medicine imaging changes involving new equipment, equipment replacement, or room modifications, complete or review and approve, if called upon by the RSO to do so, a structural shielding design completed by the RSO, as specified in VHA Directive 1105.04 Item 5. Responsibilities i. (10).

2. Medical Physicist shall conduct a performance evaluation of MRI imaging equipment annually using phantoms to assess:

i. Image uniformity for RF coils

ii. Signal to noise ratio for coils

iii. Slice thickness and slice position accuracy

iv. Light alignment accuracy

v. High contrast resolution and low contrast resolution

vi. Geometric accuracy

vii. Artifact evaluation

3. The medical physicist shall conduct equipment inspections or quality control surveys of the imaging equipment listed attached. Equipment List

4. No later than ten (10) calendar days after notification of award, and prior to the start of services, the Contractor shall provide to the COR a listing of tis personnel that are certified by the American Board of Radiology in Diagnostic Medical Physics or Medical Nuclear Physics, and information regarding a contract person for this contract.

5. Only certified medical physicist(s) shall perform required services under this contract. Such inspector must bear the Contractor’s signed designation. On each work visit, the inspector(s) shall report to the Radiation Safety Officer (RSO) prior to performing any work

5. PLACE OF PERFORMANCE: Work will be performed, services will be executed, and deliverables will be completed at G.V. Sonny Montgomery VAMC at 1500 E Woodrow Wilson Ave. Contractor should report to Biomedical Engineering before completing any work.

https://vaww.aams.ecms.va.gov/AAMS_Production/DAV/g06vyyymyd41py0y/1105_04_D_2024-12-18.pdf https://vaww.aams.ecms.va.gov/AAMS_Production/DAV/g06vyyymyd41py0y/Radiation%20equipment.xlsx

6. PERIOD OF PERFORMANCE: The expected period of performance for services executed under the final contract for this acquisition is the following:

Base Year: 4/1/2026 thru 9/30/2026

Option Year One: 10/01/2026 thru 09/30/2027 Option Year Two: 10/01/2027 thru 09/30/2028 Option Year Three: 10/01/2028 thru 09/30/2029

Option Year Four: 10/01/2029 thru 09/30/2030

7. WORK HOURS AND SCHEDULE: All work, execution of services, and completion of deliverables must be accomplished during normal business hours, 8:00 a.m. through 4:30 p.m. Monday through Friday, Federal Holidays excluded. Prior to work being performed proper coordination shall be initiated between the contractor and the government to ensure that services/work can be executed when scheduled. Any work, services, and/or other tasks performed during other than normal business hours must be approved in advance by the Contracting Officer Representative (COR), Contracting Officer, and/or other authorized facility designee/representative before such work begins. The Federal Holidays that are currently being observed by the facility are listed in the table below.

New Year’s Day January 1 Martin Luther King ‘s Birthday Third Monday in January President’s Day Third Monday in February Memorial Day Last Monday in May Juneteenth Independence Day June 19th Independence Day July 4 Labor Day First Monday in September Columbus Day Second Monday in October Veterans Day November 11 Thanksgiving Day Fourth Thursday in November Christmas Day December 25

Other Federal Holidays (that could occur) Any other day specifically declared to be a national holiday (per Federal Statute, Executive Order, or by the President’s Proclamation).

An alternative schedule (different from the schedule described above) may be utilized if there is mutual agreement between the government and the contractor regarding this alternative schedule if implemented.

8. PERSONNEL PERFORMING WORK/SERVICES - REQUIRED “CORE COMPETENCIES”:

Personnel performing work, executing services, and completing deliverables during the active performance periods of the contract shall possess the knowledge, skills, and abilities required to successfully execute the services described herein. No unqualified individual shall be allowed to perform work, execute services, and to complete deliverables at any time under the contract while active.

9. KEY PERSONNEL

During the active performance periods of the contract a Key Personnel Person shall be designated by the contractor (to be contacted by the government when needed) regarding performance of work, execution of services, and completion of Deliverables as contained within this Performance Work Statement and covered by the final contract. This Key Personnel person must have sufficient knowledge to be able to respond to technical questions by the government.

10. DELIVERABLES:

DELIVERABLE #1:

ROUTINE REPORTING, DOCUMENTATION, AND SERVICE LOG

Documentation shall be provided following execution of services, performance of work, and completion of deliverables during the active performance periods of the contract. A service log describing the efforts completed under the final contract shall be prepared, maintained, and provided to the government if/when requested. All services should be communicated to the HTM department. Reports shall mee the criteria as specified in the Scope of Services to include but not limited to: Entrance Exposure Chart plotting patient thickness against KVP for a range of KVP’s [50 KVP – 120KVP], acceptance testing, shielding design calculations, full inspections after modifications or repairs, QA Program Reviews & Consultation, and survey reports. Deliverable must meet 100%.

DELIVERABLE #2:

CHECK IN AND CHECK OUT PROCEDURES

Before beginning any work at any time during the active performance periods of the contract personnel performing services must physically check in with the appropriate facility representative to obtain approval and confirmation of the expected work to be performed and services to be executed. Check out procedures will be the same once work has been completed, and services have been executed. Check in and check out procedures shall include the following: 1). Written documentation of the contractor’s arrival and departure while on site and 2). Written documentation showing the expected work to be performed, approval of such work before such work begins, and confirmation/completion status of the planned work that was scheduled to be performed.

Facility personnel and the contractor may modify such procedures if there is mutual agreement among both parties regarding changes to these procedures if implemented.

1. Check in and Identification

a. Regular Business Hours: (Monday – Friday 7A-5P) All contractors must report directly to the

HTM shop upon arrival during normal business hours to sign-in and obtain authorization before performing any work.

i. Contractors are required to sign the Contractor Log located in the HTM Shop providing

1. Full name

2. Company name

3. Purpose of visit

4. Arrival and departure time

ii. A temporary contractor badge will be issued upon check-in and must be visibly worn at all times while on hospital property.

iii. Medical equipment repair contractors are not permitted in patient care areas without prior authorization from HTM

b. Federal Holidays or After Business Hours. All contractors must report directly to Police Services dispatch.

i. Police service will verify contractor credentials and record the visit in the security log.

Contractors will be required to provide the following information:

1. Full name

2. Company name

3. Purpose of visit

4. Arrival and departure time

ii. Police service must notify the on-call HTM point of contact upon contractor arrival.

iii. Contractors must carry identification and display a temporary badge issued by Police

Services during their time on site.

DELIVERABLE #3:

PM equipment inspections by a certified Physicist on equipment listed.

100 % of necessary PM on the listed imaging equipment to be completed by a board-certified medial physicist.

DELIVERABLE #4:

Patient Exposure Chart A patient exposure chart for common projections & procedures shall be provided for each unit inspected.

Deliverable must meet 100%.

DELIVERABLE #5:

Dose Estimate Calculations Shall provide consultation and final reports for dose estimate calculations for patients, staff, and fetal exposures, and sentinel event investigations. Deliverable must meet 100%.

11. RECORDS MANAGEMENT

1. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

2. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be management and scheduled for disposition only as permitted by statute or regulation.

3. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be management in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

4. GVSM and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of GVSM VAMC or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to GVSM VAMC. The agency must report promptly to NARA in accordance with 36 CFR 1230.

5. The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment.

Disclosure of non-public information is limited to authorized personnel with need-to-know as described in the contract. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. Contractor personnel shall sign

VA Form 3248 “Employee Clearance from Indebtedness” before resigning or termination from Contractor working for GVSM VAMC Facility Records Officer must sign form. A copy of completed signed VA Form 3248 (with Contractor personnel and Facility Records Officer signatures) shall be placed in each competency folder. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to GVSM control, or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the contract. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

6. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take VHA provided records management training. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training. TMS (Talent Management System) course VA 4192704: “Records Management for Everyone”.

7. Flow-down of requirements to subcontractors

a. The Contractor shall incorporate the substance of this clause, its terms and requirements including this paragraph, in all subcontracts under this contract and require written subcontractor acknowledgment of same.

b. Violation by a subcontractor of any provision set forth in this clause will be attributed to the Contractor.

12. OTHER REQUIREMENTS:

12.1 Identification and Badges: Any individual performing work under this contract shall wear a badge or other identification while on site that is clearly displayed at all times. While on site, any person performing work directly or indirectly must be in a position to specify their authorized purpose for their presence at the facility in the event that such information is requested by VA facility personnel.

12.2 Parking: It is the responsibility of the contractor to park in the appropriate designated parking areas, to avoid ticketing or towing. Information on parking is available from the facility if requested by the contractor.

12.3 Contract Administration: The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue changes that will affect price, quantity, or quality of performance of this contract. In the event the Contractor makes any such change at the direction of any person other than the

Contracting Officer, this change shall be considered to have been made without authority and no adjustment will be made in the contract price to cover any increase in costs incurred as a result thereof. All changes to the contract will be issued via an amendment and/or modifications in writing from the Contracting Officer to the Contractor.

12.4 Invoicing and Payment: All invoices shall be submitted in arrears, properly prepared in accordance with FAR 52.212-4, contain sufficient details, and match the service tickets for the work rendered. Invoices shall be properly prepared and sent electronically to the VA Financial Services Center for payment processing via their electronic e-Invoice system. Invoices shall be sent in arrears at the beginning of the first month of each quarter following the quarter in which the services were rendered and billed for. At a minimum, all invoices shall include the following details:

A. Contract No.

B. Purchase Order No. Correct purchase order number which shall be issued by the Contracting Officer after the contract is awarded. Invoices without correct purchase order number shall be rejected and returned to the Contractor.

C. Item(s) covered (to include serial #‘s) D. Description of the services rendered

E. Billing period in which the services were rendered F. Invoice number and date G. Payments shall be made in accordance with the prompt payment act out of the Government H. annual appropriated funds obligated in a purchase order which shall be issued after the contract I. is awarded

12.5 Equipment and Tool Control. Any equipment, tools, or parts brought on-site must be declared at check-

in. These items are subject to HTM and/or Police Service inspection. HTM and/or Police Services reserve the right to reject any items deemed unsafe for use in the Medical Center.

12.6 Scanning of Contractor Media. All contractor USB devices or mobile media that will be utilized to service medical equipment or HTM controlled systems must be scanned prior to its use at the facility

12.7 Conduct and Compliance. Contractors must comply with all hospital infection control, safety, privacy, and confidentiality policies (including HIPAA). Contractors working in procedural or restricted areas (e.g., OR, Cath Lab) must coordinate entry with VA staff and adhere to all established protocols and procedures.

Attachment A: Equipment needing medical physicist coverage

Asset AEMS_MERS RefID Mfg Name Model Serial # Location 1085771 586 EE46869 GE Healthcare USA LIGHTSPEED 16 SLICE 4993 M22-01 2827295 586 MX2827295 Canon Medical Systems Aquilion One Genesis 320 6LD2282098 F21-01 2883667 586 MX2883667 Canon Medical Systems Aquilion One Genesis 6LD22X2104 F21-01 1719902 586 MX1719902 Philips Healthcare North AmeriINGENUITY CT 320476 F24-01

2493207 586 MX2493207 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011608 DENTAL

2493081 586 MX2493081 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011557 DENTAL

2493193 586 MX2493193 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011582 DENTAL

2493204 586 MX2493204 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011550 DENTAL

2493196 586 MX2493196 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011535 DENTAL

2493201 586 MX2493201 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011548 DENTAL

2493220 586 MX2493220 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011544 DENTAL

2493222 586 MX2493222 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011556 DENTAL

2493186 586 MX2493186 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011571 DENTAL

2493198 586 MX2493198 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011555 DENTAL

2493200 586 MX2493200 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011610 DENTAL

2493218 586 MX2493218 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011591 DENTAL

2493188 586 MX2493188 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011538 DENTAL

2493185 586 MX2493185 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011471 DENTAL

2493221 586 MX2493221 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011576 DENTAL

2493182 586 MX2493182 KAVO DENTAL TECHNOLOGIES, NOMAD PRO 2 1011595 DENTAL

3809910 586 MX3809910 Carestream Dental LLC CS 8100 NGIA072 DENTAL 3809913 586 MX3809913 Carestream Dental LLC CS 8100 NGIA426 DENTAL

2525364 586 MX2525364 AB MARTIN SERVICES, INC. PROMAX 3D KPP17020109 DENTAL

1082769 586 EE66319 GE Healthcare USA DISCOVERY NM 630 630V22638 HB15-07 1146526 586 EE67260 GE Healthcare USA DISCOVERY NM 630 630V22709 C32-01 1237990 586 EE66307 GE Healthcare USA DISCOVERY NM 630 630V22670 C29-01 1079812 586 EE33902 Philips Healthcare North AmeriINTERA 1.5T 9001 FB08E-01 1242128 586 EE41936 Philips Healthcare North AmeriACHIEVA 1.5T NOVA 16 CH 21665 F43-01 2455312 586 MX2455312 OrthoScan Inc TAU 2020 5R0133 L33-01

3621269 586 MX3621269 SIEMENS HEALTHCARE DIAGNOS CIOS SPIN 53470 K403-01

1172962 586 EE59194 GE Healthcare USA OPTIMA XR240AMX 1031249WK4 FB08-01 1862250 586 MX1862250 Canon Medical Systems ULTIMAX-I U4C1872011 B12-01 1242906 586 EE46724 Philips Healthcare North AmeriALLURA XPER FD20 1648 E7-01 2059426 586 MX2059426 Philips Medical Systems Inc CombiDiagnost R90 10000056 B12-01

Canon Medical Systems Alphenix Core + SVA24Y2004 CATH LAB 1077265 586 EE59916 GE Healthcare USA OEC 9900 ELITE E23768 L25-01 1111082 586 EE56847 GE Healthcare USA OEC 9900 ELITE E23207 L39-01 2150387 586 MX2150387 GE Healthcare USA OEC ELITE CFD FBXXTE00350 L33-01 2099473 586 MX2099473 GE Healthcare USA OEC ELITE CFD FBHXTX00090 M19-01 1998491 586 MX1998491 GE Healthcare USA OEC ELITE CFD FBXXXE00812 L33-01 1998486 586 MX1998486 GE Healthcare USA OEC ELITE CFD FBXXXE00811 L5-01 1244487 586 EE64937 Philips Healthcare North AmeriDIGITAL DIAGNOST 15000227 E143-01 1220269 586 EE65380 Philips Healthcare North AmeriDIGITAL DIAGNOST 15000208 E143-01 1192645 586 EE60238 Philips Healthcare North AmeriDIGITAL DIAGNOST 343048008 E138B-01 1161012 586 EE60237 Philips Healthcare North AmeriDIGITAL DIAGNOST 1339C8 E138B-01 2165674 586 MX2165674 Canon Medical Systems MOBILE 40KW FLEX PLUS G84490 E138B-01 2194281 586 MX2194281 Canon Medical Systems MOBILE 40KW FLEX PLUS G84640 FB08-01 2646670 586 MX2646670 Philips Healthcare MOBILE DIAGNOST WDR 21410379 L452-01 2646677 586 MX2646677 Philips Healthcare MOBILE DIAGNOST WDR 21410378 C2B2-01 2646680 586 MX2646680 Philips Healthcare MOBILE DIAGNOST WDR 21410384 B12-01 2010105 586 MX2010105 GE Healthcare USA Optima XR240amx DF2401900226WK E138B-01 1764778 586 MX1764778 Philips Healthcare North AmeriDIGITAL DIAGNOST 18000162 F13A-01 1777534 586 MX1777534 Philips Healthcare North AmeriDIGITAL DIAGNOST 18000202 BB06-01 1128991 586 EE52448 Varian Medical Systems Inc TRILOGY TX H295103 132-01

Performance Work Statement