Application Number: 21-795894(10/09/2021)

APPLICATION TO ATOMIC ENERGY REGULATORY BOARD (AERB) FOR LICENCE FOR

OPERATION OF EXISTING MEDICAL DIAGNOSTIC X-RAY EQUIPMENT
This application would be considered by the Competent Authority for issuance of relevant consents under the Atomic
Energy (Radiation Protection) Rules, 2004
Application Number : 21-795894
Date of Application : 10/09/2021

Part A
Institute Details:
Name : Command Hospital
Permanent Address : Central Command, ,
Landmark :
City : LUCKNOW
State : UTTAR PRADESH
Postal Code : 226002
Telephone Number : 05222480556
Fax Number :
Email Id : rtdeptchcc2006@gmail.com
Head of the Institute Details:
Name : MAJ GEN SANDEEP THAREJA
Designation : COMMANDANT
Telephone Number(Office) : 05222480556
Mobile Number : 8527483331
Email Id : rtdeptchcc2006@gmail.com
Licensee Details:
Name : MAJ GEN SANDEEP THAREJA
Designation : COMMANDANT
Telephone Number(Office) : 05222480556
Mobile Number : 8527483331
Email id : rtdeptchcc2006@gmail.com

Part B
Employee Details (Radiation Professionals) :
SRL Name Date of Birth Designation Qualification Experience PMS No.
No
1 ABHISHEK MAHATO 22/08/1987 Gd Spl Nuclear D.N.B 2.42 02320C0377
Medicine (Nuclear 02320W0377
Medicine)
2 ANURAG JAIN 20/04/1977 D.N.B 7.42 APPLIED FOR
(Nuclear
Medicine)

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 Application Number: 21-795894(10/09/2021)

3 ARINDAM DAS 23/02/1987 X-ray 6.17 02320C0333

Technologist
Course
4 AWADHESH TIWARI 01/03/1979 A.N.M.T(Accr 16 APPLIED FOR
edited Nuclear
Medicine
Technologist)
5 DURGESH KUMAR 17/07/1982 Nuclear A.N.M.T(Accr 6.17 02320C0347
CHATURVEDI Medicine edited Nuclear 02320w0347
Technologist Medicine
Technologist)
6 DURGESH SHRIWAS 19/08/1981 Radiotherapy RS-RTT- 4.75 02320C0390
Technologist 04/2013/15
COURSE
7 GAURAV TRIVEDI 19/02/1986 Graded Spl DNB 2.33 02320C0343
Radiotherapy (Radiotherapy)
8 HEMANT KUMAR 07/05/1991 X-ray 4.75 02320C0354
Technologist
Course
9 KISHOR EAKANATH 25/11/1985 Nuclear A.N.M.T(Accr 4.83 02320C0371
GUND Medicine edited Nuclear 02320W0371
Technologist Medicine
Technologist)
10 LAVETI ANILKUMAR 09/02/1989 X-ray 6.83 02320C0335
Technologist
Course
11 MADDULA 18/05/1989 X-ray 4.67 APPLIED
NAGARJUNA REDDY Technologist
Course
12 MANOJ KUMAR 06/02/1989 X-ray 5.75 APPLIED
SINGH Technologist
Course
13 MILIND BHIMRAO 15/06/1976 RADIOLOGIS MD 6.08 02320C0331
SAWANT T
14 MUTHUPANDI V 15/03/1990 RADIOTHER BACHELOR 2.67 02320C0375
APY OF
TECHNOLOG PARAMEDIC
IST AL
TECHNOLOG
Y
15 NIHARIKA BISHT 07/04/1984 Graded DNB 3.5 02320C0388
Specialist (Radiotherapy)
Radiation
Oncology
16 PANKAJ MEDHI 10/02/1980 Radiotherapy Diploma in 7.42 02320C0278
Technologist Radiotherapy

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 Application Number: 21-795894(10/09/2021)

Technology or
Equivalent
17 RAMESH KUMAR 01/01/1989 B. Sc 5.67 APPLIED
JAYASWAL
18 RAUSHAN KUMAR 05/05/1989 X-ray 6 02320C0339
Technologist
Course
19 REKHA SOMNATH 04/05/1975 Lt Col (Graded DNB 0.92 02320C0387
VASHISTH Specialist Rad (Radiotherapy)
Onco)
20 RUKMATHULLA M 01/06/1982 Nuclear A.N.M.T(Accr 8.08 02320C0318
Medicine edited Nuclear 02320w0318
Technologist Medicine
Technologist)
21 SANKALP SINGH 11/12/1981 Graded DNB 16.67 02320C0329
Specialist (Radiotherapy)
22 SHASHI BHUSHAN 01/07/1984 X-ray 11.42 APPLIED
Technologist
Course
23 SREEJITH T V 16/05/1994 X-ray 5.67 APPLIED
Technologist
Course
24 UDAY SINGH 05/10/1982 Post M. Sc. 8.92 02320C0216
Diploma in
Radiological
Physics
25 VARUN GUPTA 24/09/1986 MD 8.25 02320C0348
26 VENKATARAMANA 25/06/1987 X-ray 3.08 02320C0334
BAMMIDI Technologist
Course
27 VIKASH KUMAR 11/01/1982 X-ray 6.25 02320C0338
Technologist
Course

RSO Details :
SRL Name Designation PMS No. Valid Till Email Id (Off)
NO
1 Dr. MILIND BHIMRAO RADIOLOGIS 02320C0331 11/01/2024 majmbsawant
SAWANT T @gmail.com

Employee Details (Radiation Workers) :

SRL Name of Radiation Worker Role Eduactional PMS No.
NO Qualifications

Safety Tool Details:

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 Application Number: 21-795894(10/09/2021)

SRL Instrument ID Instrument Make Model Type Of Sr. No. Availability Last
No Type Detector Calibration
Date
1 SE-0078840 Thermomet JENSON 07665 NA 07665 Available
er
2 SE-0078839 Barometer SUNOH SAL7030 NA 028005 Available

3 SE-0075699 Gamma PRIMEAL 05-433 GM 107772 Available 31/12/2019

zone ERT 10 AND 05- Counter AND
monitor AND 434 107757
PRIMEAL
ARM

4 SE-0050772 Protective NA NA NA NA Available

Rubber
Flaps
5 SE-0050771 Protective NA NA NA NA Available
Apron
6 SE-0050768 Ceiling NA NA NA NA Available
Suspended
Protective
Glass
7 SE-0038403 Mobile NA NA NA NA Available
Protective
Barrier with
Viewing
Window
8 SE-0038226 Mobile NA NA NA NA Available
Protective
Barrier with
Viewing
Window
9 SE-0038020 Survey GUN GM-125 Ion 128 Available 18/11/2015
meter MONITO Chamber
R PLA

10 SE-0036919 Survey RADMON RM 701 GM 08/04/040 Available 31/12/2019

meter Counter

11 SE-0029383 Isodose NA NA NA NA Available

charts
12 SE-0029382 Transport NA NA NA NA Available
container
for the
sources
13 SE-0029381 Emergency NA NA NA NA Available

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 Application Number: 21-795894(10/09/2021)

source
storage
14 SE-0029380 T-Rod NA NA NA NA Available

15 SE-0029379 Breast NA NA NA NA Available

Board
16 SE-0029378 Head rest NA NA NA NA Available

17 SE-0029377 Wedges NA NA NA NA Available

18 SE-0029376 Focal Spot GAMMEX RMI NA NA Available

Test Tool FOCAL
SPOT
TEST
TOOL

19 SE-0029375 High GAMMEX RMI-141 NA NA Available

Contrast
Resolution
Test Tool
20 SE-0029374 Beam MED TEC MT-IAD-1 NA NA Available
Alignment ISO
Test Tool ALIGN

21 SE-0029373 Phantom for MEDTEC MT 150 NA NA Available

absolute
dosimetry
22 SE-0029176 Contaminati RAM MARK II GM 12813-017 Available 18/01/2021
on Monitor GENE-1 BAK-1880 Counter

23 SE-0029173 Contaminati RAM MARK II GM 12812-010 Available 18/01/2021

on Monitor GENE-1 Counter

24 SE-0029165 Thyroid NA NA NA NA Available

Shield
25 SE-0029164 Lead NA NA NA NA Available
pots/Source
Changer
26 SE-0029156 Decontamin NA NA NA NA Available
ation Kit
27 SE-0029155 Protective NA NA NA NA Available
Apron
28 SE-0029154 Foot NA NA NA NA Available
operated
Lead bins

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 Application Number: 21-795894(10/09/2021)

29 SE-0029153 Syringe NA NA NA NA Available

Carrier
30 SE-0029152 Lead bricks NA NA NA NA Available

31 SE-0029151 L-bench NA NA NA NA Available

with
viewing
system
32 SE-0029150 Transport NA NA NA NA Available
container
for the
sources
33 SE-0029149 CCTV NA NA NA NA Available

34 SE-0029146 Gamma PRIMALE 05-433 GM 15002 Available 31/12/2019

zone RT 10 Counter
monitor
35 SE-0029145 Thimble EXRADIN EXRADIN Ion XA07082 Available 19/02/2018
Chamber A12 A12 Chamber 4

36 SE-0029144 Large HDR HDR Ion A100844 Available 20/02/2018

volume/wel 1000PLUS 1000PLUS Chamber
l type ion
chamber/Do
se
Calibrator
37 SE-0028453 Electromete MAX 4000 MAX 4000 NA E070961 Available 19/02/2018
r
38 SE-0028440 Electromete CDX CDX NA J043028 Available 20/02/2018
r 2000B 2000B

39 SE-0028186 Pocket MYDOSE PDM 122 Solid State 09415 Available 18/01/2021
dosimeter MINI RH

40 SE-0028184 Pocket MYDOSE PDM 122 Solid State 09431 Available 18/01/2021
dosimeter MINI RH

41 SE-0028182 Pocket MYDOSE PDM 122 Solid State 09413 Available 18/01/2021
dosimeter MINI RH

42 SE-0028181 Pocket MYDOSE PDM 122 Solid State P1307 Available 18/01/2021
dosimeter MINI RH

43 SE-0028136 Survey SE INSPECTO GM 35686 Available 18/01/2021

meter INTERNA R Counter
TIONAL

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 Application Number: 21-795894(10/09/2021)

44 SE-0028135 Survey SE INSPECTO GM 35666 Available 03/11/2020

meter INTERNA R Counter
TIONAL

45 SE-0028130 Large CAPINTE CRC-25 Ion 270805 Available 19/04/2021

volume/wel C PET Chamber
l type ion
chamber/Do
se
Calibrator
46 SE-0028127 Large CAPINTE CRC-25 Ion 270804 Available 19/04/2021
volume/wel C PET Chamber
l type ion
chamber/Do
se
Calibrator

Part C
General Details:
Application for Renewal of Licence for operation
Equipment Type C-Arm
Equipment Id G-XR-55933
Manufacturer ALLENGERS MEDICAL SYSTEMS LTD.
Model Allengers HF -59
Serial number of equipment 2K16010021-BC
Service Agency responsible for QA

QA Test Report:

Date of QA test 27/04/2021

Accuracy of Operating Potential
Applied potential Measured potential
50 49.63
70 71.26
Reproducibility of radiation output (CoV) 0.02

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 Application Number: 21-795894(10/09/2021)

Total Total Filtration (mm of Al)

Applied Voltage (kVp) Measured Total Filtration (mm of Al)
<=100 3.61
Exposure rate at tabletop (cGy/min)
Select mode Table top dose rate
Manual Mode 3.25
Maximum radiation leakage level from x-ray tube 0.011
housing (mGy in one hour at 1m)
Image Quality (as per equipment and phantom Acceptable
specifications)

Part D
Attachments:
Copy of QA Test Report : NA
Copy of Layout : NA
Copy of RSO Certificate : NA

Part E
UNDERTAKING:
I hereby certify that,

1) all the information submitted in this application is correct to the best of my knowledge and belief.

2) applicable provisions of the Atomic Energy (Radiation Protection) Rules, 2004 will be strictly complied with.

3) applicable provisions of AERB Safety Code on Medical Diagnostic X-ray Equipment and Installations, AERB/SC/
MED- 2 or the revised version, currently in force, will be complied with.

4) the equipment will be put into operation only after obtaining “Licence” from the Competent Authority.

5) full facilities will be accorded by me to any authorised representatives of the competent authority to inspect this
installations at any time.

6) all necessary facilities will be provided to the RSO to discharge his duties and functions effectively.

7) on receipt of “Licence”, I will abide by the terms and conditions of “Licence” (Refer AERB website).

8) will ensure that I/ nominated RSO will observe “Duties and Responsibilities of RSO” (Refer AERB website).

9) keep AERB informed about any changes in the information furnished.

In case, it is found, at any stage, that the information provided by me/us is false and/ or not authentic, then I hereby
accept that appropriate regulatory actions may be initiated against me and my institution, in accordance with the
applicable Rules.

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 Application Number: 21-795894(10/09/2021)

----------------------------------------------End of Application---------------------------------------------

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