H965--Medical Physicist Service Birmingham VAMC

Sources Sought Notice Sources Sought Notice Page 12 of 12 Sources Sought Notice *= Required Field Sources Sought Notice Page 1 of 12 THIS IS A SMALL BUSINESS SOURCES SOUGHT NOTICE REPRESENTING A MARKET SURVEY AND IS NOT A REQUEST FOR PROPOSALS, PROPOSAL ABSTRACTS, QUOTATIONS OR INVITATION FOR BIDS Â The Department of Veterans Affairs is conducting a sources sought to obtain information regarding: (1) the availability and capability of qualified small business sources; (2) whether they are Service-Disabled Veteran-Owned, Veteran-Owned, Small Business, HUB Zone 8(a), Women-Owned, or small disadvantaged business concerns; and (3) their size classification relative to the North American Industry Classification System (NAICS) code for the proposed acquisition. Your responses to the information requested will assist the Government in determining the appropriate acquisition method, including whether a set-aside is possible. An organization that is not considered a small business under the

applicable NAICS code should not submit a response to this notice. Small businesses concerns shall be capable of providing the necessary equipment and personnel to furnish service in the volume required for all the items under this contract. Contractor shall meet all requirements of Federal, State or City codes regarding operations of this type of service. The NAICS code is 541690 (Size Standard: $19M) The intent of this notice is to determine the availability of qualified commercial sources technically capable of providing the items below: The Contractor shall furnish all labor, material, supplies, equipment, and qualified personnel to provide on-site diagnostic medical physics support or services for the Veterans Health Administration (VHA), under the terms and conditions stated herein and must adhere to VHA Handbook 1105.04, Fluoroscopy Safety, dated June 21, 2018, https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=7454. 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). The X-ray units and radiation protection apparel in this contract are located at three locations: 1) 700 South 19th Street; Birmingham AL 35233 (Location of most of the equipment) 2) Birmingham VA Clinic; 2415 7th Avenue, Birmingham AL 35233 3) Huntsville VA Outpatient Clinic 500 Markaview Road NW; Huntsville, AL 35805 General Requirements Performance All work shall be performed by a qualified Diagnostic Medical Physicist (DMP). A DMP is a person who is certified by the American Board of Radiology, American Board of Medical Physics, American Board of Health Physics, American Board of Science in Nuclear Medicine, or the Canadian College of Physicists in Medicine. For mammography, a qualified medical physicist should be licensed by the State of Alabama and be ACR certified in Mammography. For mammography the physicist must have ample experience and been through at least 3 years of MQSA inspections and positive results. For diagnostic computed tomography (CT), a qualified medical physicist can meet the following requirements in lieu of board certification: A master s degree or higher in physical science, medical physics or engineering discipline from a college or university accredited by an organization recognized by the U.S. Department of Education. 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 Documented 3 years of clinical experience in CT. 2. Mandatory Services to be Performed a. The DMP shall perform x-ray equipment inspections to ensure compliance with the current American College of Radiology (ACR), Food and Drug Administration (FDA), VA National Health Physics Program (NHPP), Joint Commission (JC), federal regulations 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 DMP 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 10 business days after completion of the inspection. All x-ray equipment shall be inspected at least annually, not to exceed 14 months. b. The DMP shall perform acceptance testing of all new or relocated imaging equipment prior to first clinical use. The acceptance testing shall comply with ACR, FDA, VA NHPP and/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 DMP 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 10 business days after completion of the inspection. c. The DMP 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 DMP 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 RSO within 10 business days after performing of the inspection. d. The DMP will be available for consultation by phone and email for issues such as patient and staff radiation exposures, radiation safety issues, machine QA etc. e. The DMP shall review all used CT protocols at least annually and provide a report detailing his findings. Attachment# 1 f. The DMP 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 DMP shall review at least annually the QA program. A written report of the results shall be provided to the RSO within 10 business days after performing of the inspection. g. The DMP shall perform a follow-up inspection to verify compliance of any necessary corrective action performed to correct deficiencies found. h. Call back on equipment questions, radiation exposure of patients and staff, and other radiation physicist needs will be done within 2 hours of the call. On occasion same day services may be needed. i. All work will be compliant with most current regulations including updates and changes made by the VA National Health physics program, FDA, JC, and the State of Alabama Radiological Control board in reference to x-ray equipment. All checks and the documents associated with them will follow current regulatory trends and at a minimum VHA Handbook 1105.04, Updated Guidance for Reducing Radiation Dose from Computed tomography issued by Assistant Deputy Under Secretary for Health for Clinical Operation, new federal and applicable state regulations and items determined by the BVAMC Radiation Safety Committee j. The DMP will serve on the BVAMC Radiation Safety Committee as an active member, attend all meetings and participate in the meeting. He will also service on the Subcommittees of the Radiation Safety Committee as the medical physicist expert. Meetings are scheduled at least quarterly for the Radiation Safety Committee and as needed for the Subcommittees. 3. 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, Joint Commission standards and ACR recommendations, and shall include, but not be limited to, monitoring the following basic performance characteristics. 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 not to exceed 14 months. 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 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. Computed Radiography (CR) and Digital Radiography (DR) 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 Photostimulable Storage Phosphor Imaging Systems. The performance of CR and DR must be evaluated at least annually not to exceed 14 months. 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. CT Scanners 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. The contractor will assist in the review of CT protocols for optimization on at least annually not to exceed 14 months. The contractor physicist will review the QA program for each CT unit on an annual basis not to exceed 14 months. The contractor will perform dose measurements on all used CT protocols for each unit used for diagnostic CT. 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. (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. (13) Ensure Joint Commission Imaging Standard requirements are met Dental 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 not to exceed 14 months. This evaluation should include, but not be limited to, the following tests (as applicable). (1) Collimation. (2) Beam quality (half value layer). (3) Timer Accuracy and Reproducibility. (4) kVp Accuracy and Reproducibility. (5) mA or mAs Linearity. (6) Exposure Reproducibility. (7) Entrance Skin Exposure Evaluation, with comparison to published diagnostic reference levels and achievable doses (e.g., NCRP Report No. 172). (8) Technique Chart Evaluation. (9) Image uniformity (artifact evaluation). Dental CBCT Acceptance and Performance Testing 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 perform 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. 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. 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. Acceptance and Annual physics testing for Dental CBCT 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. 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. kVp Accuracy Measure the kVp at all clinically used settings. The measured kVp should be +/-5% of the selected kVp. kVp Repeatability Make five kVp measurements each for two clinically used kVp settings. All measured values should be +/-5% of the mean kVp. kVp Reproducibility Measure the kVp at all available kVp settings. The measured values should be +/ 5% of the baseline. 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. 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. 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. Accuracy of Linear Measurements Using images of an appropriate phantom, assess the accuracy of distance measurements. Accuracy of Patient Dose Metric Indication Assess the accuracy of the indicated dose metric (typically DAP). 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) 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. Display Monitors Perform a visual analysis of the SMPTE test pattern. 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. 2. Examine the pattern to confirm that the gray level display in the imaging console is subjectively correct. a. Review the line pair patterns in the center and at each of the corners. b. Review the black-white transition. c. Look for any evidence of scalloping (loss of bit depth) or geometric distortion. 3. Use a photometer to measure the maximum and minimum monitor brightness (0% and 100% steps) 4. Measure additional steps within the pattern to establish a response curve. 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). 14. Viewing Conditions Assess the viewing conditions for the area in which the monitor used to evaluation the CBCT studies is located at least annually not to exceed 14 months. E. Mammography 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 and performed annually. Inspection items may include: (1) Mammographic Unit Assembly Evaluation. (2) Collimation assessment. (3) Artifact evaluation. (4) kVp accuracy and reproducibility. (5) Beam quality assessment HVL measurements. (6) Evaluation of system resolution. (7) Automatic Exposure Control (AEC) function performance. (8) Breast entrance exposure, AEC reproducibility, and average glandular dose. (9) Radiation output rate. (10) Phantom image quality evaluation. (11) Signal to noise ratio and contrast to noise ratio measurements. (12) View box luminance and room illuminance. (13) Review Workstation (RWS) tests. J. Display Monitors The annual performance evaluation conducted by the diagnostic medical physicist (not to exceed 14 months) includes testing of image acquisition display monitors for maximum and minimum luminance, luminance uniformity, resolution, and spatial accuracy. The image acquisition display monitors for CT scanners shall be tested and shall conform to the AAPM On-line Report No. 03, Assessment of Display Perform for Medical Imaging Systems. The performance of each display monitor shall be evaluated initially, acceptance testing, and at least annually thereafter. This evaluation should include, but not be limited to the following tests (as applicable). Acceptance testing (Table 7 from AAPM On-line Report No. 03) (a) Geometric distortions {b) Reflection (c) Luminance response (d) Luminance dependencies (e) Resolution (f) Noise {g) Veiling glare {h) Chromaticity Annual testing (Table 8c from AAPM On-line Report No. 03) {a) Geometric distortions {b) Reflection {c) Luminance response (d) Luminance dependencies (e) Resolution (f) Noise (g) Veiling glare (h) Chromaticity K. Radiation Protection Apparel This contract also includes the visual and fluoroscopic check of radiation protection apparel in the form of thyroid shields, gloves, sleeves, gonadal shielding, skirts, vests, frontal aprons, etc. The physicist will be given a log of the apparel and assistance with finding the apparel. The check will be performed annually not to exceed 14 months. A written report will be given to the RSO within 10 business days of the completion of the apparel checks. Any apparel found to be faulty at the fluoroscopic x-ray check will immediately be given to the RSO to take out of use until a repair or other action can be taken.