clara maass medical center, amendment request for license ...binghamton university cumlaude...
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SAINT BARNABAS HEALTH CARE SYSTEM Clara Maass Medical Center
R O N A L D J. DEL M A U R O President and Chef Executive Officer Saint Barnahas Health Care System
9/22/05
United States Nuclear Regulatory Commission Region I 475 Allendale Road King of Prussia, PA 1 9406- 14 15
RE: License # 29-03163 - Notification of Change
I _. . '1
To Whom It May Concern:
Please be advised that Clara Maass Medical Center would like to add Karen E. Borofsky, MD to our radioactive materials license as an authorized user for materials listed in 35.400; and Iridium 192 for uses in a High Dose Rate Remote Afterloading Brachytherapy Device.
Dr. Borofsky's credentials are attached for your review
If you require additional information, please contact us at your earliest convenience.
Sincerely,
Vincent M. Immerso, MS, DABR Radiation Safety Officer
Thomas A. Biga
vvcp
N~JSS/RG?J ?u!ATERIALS-OX ...... ONE C L A R A M A A S S DRIVE 8 BELLEVILI.E, NEW jERSEY u71OY (973) 450-2000 ......
Saint Barnahas 1 Icalth Carr S!.htrm - New jrrsey's hcalth care 1cadc.r.
Karen Loeb Borofsky, M.D. Clara Maass Medical Center
Department of Radiation Oncology 1 Clara Maass Drive
EDUCATION
July 2001 -June 2005
July 2000-June 200 1
July 1996-May 2000
August 1993-May 1996
August 1992- May 1993
WORK EXPERIENCE
August 2005- present
PAPERS
Resident Physician in Radiation Oncology Department of Radiation Oncology Mount Sinai School of Medicine, New York, New York
Chief Resident (January 2004-present)
Internship in Internal Medicine Department of Medicine Columbia University New York Presbyterian Hospital
Doctor of Medicine, M.D. State University of New York at Stony Brook
Chapter President of the American Medical Association
Bachelor of Science, Biology Binghamton University
CumLaude
Washington University in Saint Louis
Clara Maass Medical Center Department of Radiation Oncology
J.A. Cesaretti, M.D., R.G. Stock, M.D., S. Lehrer, M.D.,D.A. Atencio, PH.D., J. L. Bemstein, PILD., N. N. Stone, M.D., S. Wallenstein, PH.D., S. Green, M.D., K. Loeb, M.D.,M. Kollmeier, M.D., M. Smith, M.D., B. S. Rosenstein, PH.D. “ATM Sequence Variants are predictive of Adverse Radiotherapy Response Among Patients treated for Prostate Cancer.” Int. J . Radiation Oncology Biol. Phys., Vol. 61, No. 1, pp. 196-202, 2005
I
Consortium on Graduate Medical Education - Elected to review all aspects of graduate medical education for all members of the consortium including content of curriculums, size of residency programs and all internal reviews. The commipe@dizes a number of subcommittees to carry out its duties. *
House Staff Affairs - Elected to serve on this committee serves as the adjudication body for appeals on adverse actions involving the House Staff.
MEDICALSoclETIES
Amen& Society for Therapeutic Radiation and Oncology American Society of Clinical Oncology American Cancer Society New York Roentgen Society American Medical Association American Brachytherapy Society
LICENSE
New York State 22 1693 New Jersey 25h4A07850700
119
Program Number / Program Name 4303521 1 19/Mount Sinai CityBtate ]New YotkMY
Supplement C 200j!-200~RADIATION ONCOLOGY RESIDENT EXPERIENCE LOG
The completed form should be given to the Program Director by July 1,2002, To be completed by the Program Director:
J
Resident Name Karen Locb-Borofsky lsignaturel fl/&fi b S
- Time Period to be Covered by h g From: 7/1/01 ITo: 6/30/02 c
List institutions used for outside rotations: Dates: From - To 1. 2. 3.
1.
Elmhurst 4/1102-6/30/02
~~ ~~
Adult External Beam Simulated: Primary Site (Non-Metastatic Disease): t&!EEi
33
7
0 0 6 2 0 33 1 0 0
Breast: Intact Breast: Post-Mastectomy BondSoft Tissue Sarcoma Central Nervous System Head/Neck: Intact Hearneck: Post- operative Gastrointestinal: Esophagus Gastrointestinal: Stomach Gastrointestinal: Pancreas Gastrointestinal: Hepato biliary Gastrointestinal: Colon Gastrointestinal: Rectum Gastrointestinal: Anus Gastrointestinal : Other Genitourinary: Prostate Genitourinary: Bladder Genitourinary: Testes Genitourinary: Other
9 3
10 2 1
Gynecologic: Cervix Intact Gynecologic: Cervix Post-Hysterectomy Gynecologic: Uterus
Gynecologic: 0 t h ~ Hodgkin’s Lymphoma Non-Hodgkin’s Lymphoma
7 Leukemia / Myeloma
Other Hematologic Malignancies
Skin
Thorax: Small Cell Lung Cancer
6 1 1 0 3 0
a) - 147- Total Primary Site Adult External
Thorn: Non-small Cell Lung Cancer Thorax: Other Benign: Hetcrotopic Bone Benign: Eye Benign: Other (does notj;! in other cutegoria) All Others (Give Examples)
Beam Simulated (total of both columns above) b) -45- Total Secondary (Metastatic) Adult External Beam Simulated p o t Covered Above Under Primary Sire) C) -192- TotaJ Adult External Beam Simulated Cases (Primary Plus Secondary [c equals toial cases e plus b])
2. Pediatric External Beam Simulated: 120
~ ~
Medulloblastoma CNS Won-Medulloblastoma)
on Outside lastitution(s) # Simulnttd
/Leukemia I I
€wing’s Sarcoma / Bone Tumor Neuroblastoma . Retino blastoma ’
.
I
r Hodgkins’s Lymphoma Non-Hodakins’s LvmDhoma
1 I
Wilms’ Tumor I I
Y I
Rhabdomyosarcoma / STS I I I
Surface Applications (moulds, plaque, Sr-90) Unscaled Sourccs (e.g. 1-131 oral, P-32 colloid, Sr- 89,
Other: Describe case(s) for Primary or other institution
4. Specific Rsdlotbenpy Techniques: Cases As Primary Resident in Treatment Planning
# Simulated Mantle 1
Craniospinal Total Body Irradiation 3 Total Skin Irradiation Stcreotactic Radiosurgery: Brain 1 Stcreotactic Radiosurgery: Other
121
Supplement C 122 2002-2003 RADiXTION ONCOLOGY RESIDENT EXPERIENCE LOG
1
The completed form should bk given to the Program Director by July 1,2003. To be completed by the Program Director:
Program Number / Program Name 4303521 1 19/h.lount Sinai City/State New York/NY
Resident Name ' Karen Locb-Borofsky Signature[ fl# -&e--- ,
Time Period to be Covered by Log From: 71 1 /02 To: 6130103 r a
List institutions used for outside rotations: Dates: From - To I . 2. 3.
1. Adult External Beam Simulated: Primary Site (Non-Metartatic Disease): # cases 35 9
2 3 1
8
3
3
4
2 0 43 1 0 0
Breast: Intact Breast: Post-Mastectomy BondSoft Tissue Sarcoma Central Nervous System Hearneck: Intact HeadMeck: Post- operative Gastrointestinal: Esophagus Gastrointestinal : Stomach Gastrointestinal: Pancreas Gastrointestinal: Hepatobiliary Gastrointestinal: Colon Gastrointestinal: Rectum Gastrointestinal: Anus Gastrointestinal: Other Genitourinary: Prostate Genitourinary: Bladder Genitourinary: Testes Genitourinary: Other
0 2
13 2 0
6
OD
0
0
0 3 I
-
Gynecologic; Cervix Intact Gynccologic: Ccrvix Post-Hysterectomy Gynecologic: Uterus
Gynecologic: Other Hodgkin's Lymphoma Non-Hodgkin's Lymphoma
Leukemia 1 Myeloma
Other Hcmatologic Malignancies
Skin
Thorax: Small Cell Lung Cancer
Thorax: Non-small Ce!l Lung Cancer Thorax: Other Benign: Heterotopic Bone Benign: Eye Benign: Other (does noffif in ofher curegotfes) All Others (Give Examples)
4 - 149 Total Primary Site Adult External Beam Simulated (total of both columns above) b) -29- Total Secondary (Metastatic) Adult External Beam SirnuJated (Poi Covered Above Under Primary Site) c) - 178- Total Adult Extcrnal Beam Simulated Cases (Primary Plus Secondary [c equals total cases a plus b))
123 2. Pediatric External Beam Simulated:
Neuroblastoma Retinoblastoma Wilms' Tumor
..
1
Orher: Describe case@) for Primary or other institution
Surface Applications {moulds, plaque, Sr-90) Unsealed Sources :e.g 1-1 3 1 oral, P-32 colloid, Sr- 89, Srn- 153, other) fEndovascular Insertions
I !
,
I
4. Specific Radiotherapy Techniques: Cnses As Primary Resident in Treatment Planning
Mantle Craniospinal Total Body Irradiation Total Skin Irradiation Stereotactic Radiosurgery: Stereotactic Radiosurgery:
# Simulated I
Brain 1 Other
/
'1 24
Supplement C 125
200~-20~RADlATION ONCOLOGY RESIDENT EXPERIENCE LOG I
The completed form should be given to ihe Program Director by July 1,2004. To be completed by tbe Program Director:
Program Number I Program Name 430352 1 1 19/Mount Sinai CityIState N
List institutions used for outside rotations: Dates: From - To
Resident Name Karen Loeb-Borofsky Signature@- 4/4C& / , Time Pcriod to be Covered by Log From:7/1/03 To: 6/30/04
1. 2. 3.
1.
Memorial Sloan Kettering Cancer Center ll3104-313 1 /04
- --
Adult External Beam Simulated: Primary Site (Non-Metastatic Disease): # Cases
13 . 0
2 0 3 0 0 49 0 2 0
Breast: Intact . Breast: Post-Mastectomy BoneISoft Tissue Sarcoma Central Nervous System HeadMeck: Intact HeadMeck: Post- Operative Gastrointestinal: Esophagus Gastrointestinal : Stomach Gastrointestinal : Pancreas Gastrointestinal: Hcpatobiliary Gastrointestinal: Colon Gastrointestinal: Rectum Gastrointestinal: Anus Gastrointestinal: Other Genitourinary: Prostate Genitourinary: Bladder Genitourinary: Testes Genitourinary: Other
3 Gynecologic: Cervix Intact GynecoIogic: Cervix Post-Hysterectomy Gynecologic: Uterus
Gynecologic: Other Hodgkin's Lymphoma Non-Hodgkin's Lymphoma
Leukemia / Myeloma
Other Hematologic Malignancies 0
0
3 3 0
_I__
0 0 1
Skin
Thorax: Small Cell Lung Cancer
Thorax: Non-small Cell Lung Cancer Thorax: Othcr Benign: Heterotopic Bone Benign: Eye Benign: Other (does norfir in other caregories) All Others (Give Examples)
- a) - 1 08- Total Primary Site Adult External Beam Simulated (total of both columns above) b) -1 8- Total Secondary (Metastatic) Adult External Beam Simulated @of Covered Above Under Primary Site) c ) 126- Total Adult External Beam Simulated Cases (Primary Plus Secondary [ c c q u r l ~ l o t l l c ~ ~ P i m w-
2. Pediatric External Beam Simulated:
3ther: Describe case(s) for Primary or other institution
. I- I3 1 oral, P-32 aolloid, Sr- 89,
126
4. Specific Radiotherapy Techniques: Cases As Primary Rcaident in Treatment PGnnlng
## Simulated I Mantle I
Craniospinal 1 Total Body Irradiation 5
Stereotactic Radiosurgery: Brain 2 Total Skin Irradiation
Stereotactic Radiosurgery: Other
127
Resident Experience Report
Program ID: 4303521 119 Program Name: Mount Sinai School of Medicine Program at All Institutes liaren e. loeb
For All %pes in All Areas and All Groups Donc Between 7/1/2004 And 6/21/2005
For Procedures in All Ycars For All Resident Roles
NOTE: Thc Progrm Director i n rcsponsiblc Tor validating thc acouracy of the don in this record. Records signed by both thc resident and Program Di rum must be kept on filc in thc Program OtTm Records scnt to the Residency Rcvicw Committee Oftice MUST bc signed by the Program Dircctor.
GI2 ?‘200! 4
.
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Resident and Fellow Privileges Granted - Consortium for Graduate Medical Education - ... Page 1 of 2
Back to Searches 1 Bark to list of Residents
Name Hospital Specialty
Privileges Granted:
RT-04-
Application of Radiopaque Clips
RT-OSA-
Catheterlzation and Injection of Inbavesical Co nbast for Simulation
RT-12-
Clinical Determination of Treatment Fltlds
RT-10-
Defining Target Volume and Outlining Blocks on Simulation Films
UT- 14-
Determine the Appropriateness and Carry Out the Planning of A Bnchythempy Procedure
RT-11-
Evaluation of Physics Treatment Plan
RT-09-
Evaluation of Simulation and Portal Films
RT-06-
Injection of Intravenous Contmstfor Simulaaion
RT-03-
Insertion of Vaginal Tube/Rectal Tubes
RT-06A-
Instillation of Intraluminal Contrast for Simulation
RT-21-
Loading and Unloading Ra dioacbive Material
RT-07-
Outiining Tumor Volume and Critical Organs on Ct\Mri
RT-23-
petform ing Survey for Radioactive M aterial
RT-16-
Placement and Removal of Intracavitary Applicators
RT-22-
http://fusion.mssm.edu/privileges/nghtsquery_drilldown.cfm?ResID=5064 5/2 1 I2004
Resident and Fellow Privileges Granted - Consortium for Graduate Medical Education - ... Page 2 of 2
Treatment with A Remote Afterbad-
RT-05-
Venipuncture J
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http://fusion.mssm.edu/privileges/rightsquery - drilldown.cfm?ResID=5064 512 1/2004
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Sincerely, Licensing Assistance Team Leader