+--------------------------------------------------------+-------------+
| **GODDARD SPACE FLIGHT CENTER**                        |             |
|                                                        |             |
| **REQUEST FOR RADIATION SAFETY COMMITTEE ACTION**      |             |
|                                                        |             |
| **IONIZING RADIATION PRODUCING DEVICE QUESTIONNAIRE**  |             |
+--------------------------------------------------------+-------------+
| 1\. \_\_\_\_Krizmanic, John F \_\_\_\_\_\_\_           | Docket \#   |
| \_\_\_\_661 \_ \_\_\_6-6817 \_\_\_ 01/09/2007\_        |             |
|                                                        |             |
| #                                                      |             |
|  Originator\'s Name: (Last, First, MI) Code Phone Date |             |
+--------------------------------------------------------+-------------+
| 2\. Device Data and Description:                       |             |
|                                                        |             |
| a\. Device type: \_\_\_Electron Impact X-ray           |             |
| Source\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                   |             |
|                                                        |             |
| b\. Manufacturer and Address:                          |             |
|                                                        |             |
| X-Ray Technology, Inc                                  |             |
|                                                        |             |
| 360 El Pueblo Road, Suite 104                          |             |
|                                                        |             |
| Scotts Valley, CA 95066                                |             |
|                                                        |             |
| Tel: (831) 439-9729 Fax: (831) 438-5629                |             |
|                                                        |             |
| e-mail: <sales@oxfordxtg.com>                          |             |
|                                                        |             |
| Web Page: www.oxfordxtg.com                            |             |
|                                                        |             |
| c\. Model Number: \_\_XTG5011 Apogee\_\_               |             |
|                                                        |             |
| d\. Operating Parameters                               |             |
|                                                        |             |
| Maximum- \_\_\_\_\_50\_\_\_\_kVp; \_\_\_\_\_\_1.0 \_mA |             |
|                                                        |             |
| Normal- \_\_\_\_\_\_50_kVp; \_\_\_\_\_\_\_0.8\_\_mA    |             |
|                                                        |             |
| Average Weekly "on" time- \_\_\_ \<= 1000 minutes      |             |
|                                                        |             |
| e\. Target Materials: \_Molybdenum\_\_\_               |             |
|                                                        |             |
| f\. Description of Use: \_\_\_Calibration of and       |             |
| testing of X-ray Optics                                |             |
+--------------------------------------------------------+-------------+
| 3\. Detailed Description: (attach installation plans,  |             |
| diagrams, applicable manufacturer info, etc)           |             |
|                                                        |             |
| Number of pages attached: \_\_\_4\_ (Include State     |             |
| Certifications if applicable)                          |             |
+--------------------------------------------------------+-------------+
| ##  HEALTH PHYSICS USE ONLY                            |             |
+--------------------------------------------------------+-------------+
| 4\. Date Received: \_\_\_\_\_\_\_\_\_\_\_\_\_ 5. GSFC  |             |
| #\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 6. Source Type:  |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                         |             |
|                                                        |             |
| 7\. Serial Number: \_\_\_\_\_\_\_\_\_\_\_\_\_          |             |
|                                                        |             |
| 8\. Survey Frequency: \_\_\_\_\_Annual                 |             |
| \_\_\_\_\_\_Biennial \_\_\_\_\_\_Triennial             |             |
|                                                        |             |
| 9\. Notes:                                             |             |
|                                                        |             |
| 10\. Health Physics Certification:                     |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_                             |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |             |
| \_\_\_\_\_\_\_                                         |             |
|                                                        |             |
| Printed Name Date                                      |             |
|                                                        |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_                             |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |             |
|                                                        |             |
| Signature                                              |             |
|                                                        |             |
| FINAL DISPOSITION:                                     |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_             |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |             |
|                                                        |             |
| \_\_\_\_\_\_                                           |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |             |
| \_\_\_\_\_                                             |             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |             |
|                                                        |             |
| Person Authorizing Disposition                         |             |
+--------------------------------------------------------+-------------+

**GSFC Form 23-28I \[DEVICE\] (01/00) Return to Code 205.9**

Instructions for filling out GSFC Form 23-28I \[DEVICE\], Request for
Radiation Safety Committee Action - Ionizing Radiation Producing Device
Questionnaire. For additional guidance refer to GPG 1860.1 \"Ionizing
Radiation Protection,\" particularly paragraph 2.1.4.4.

### ALL ITEMS MUST BE LEGIBLE

1\. If you do not have a GSFC Code designation you must include a valid
mailing address on an attached paper.

2\. Source Data:

a\. Device type;

b\. Manufacturer and address of manufacturer (include telephone number
if known);

c\. Model number;

d\. List the operating parameters;

Maximum kVp and mA that the device is capable of

Normal kVp and mA that the device will be routinely operated

Average weekly use in minutes

e\. Types of target materials built into the system or which will be
targeted by the device.

f\. Give a brief description of the proposed use.

3\. Provide a detailed description of the installation, include a
diagram and specific dimensions. Provide any manufacturer information
that will be useful in reviewing the device and its installation.
Include a copy of State safety certifications if applicable.

**RETURN COMPLETED FORM TO CODE 205.9** (Health Physics).

If you have any questions concerning this form, please contact

the Safety and Environmental Branch, Health Physics Department at
301-286-8482.

*HEALTH PHYSICS USE ONLY*

4\. Indicates the date source was originally surveyed by Health Physics.

5\. Indicates the GSFC identification number assigned by Health Physics.

6\. Indicates the source Type classification determined by Health
Physics (GPG 1860.1, paragraph 2.1.4.3.a).

7\. Indicates the manufacturers serial number (if any).

8\. Survey requirements determined by Health Physics.

9\. Special Health Physics notes.

10\. Certifying Health Physics personnel.

Final disposition will be certified by persons authorized by the
Radiation Safety Committee only.

**Detailed Usage of X-ray Technology XTG5011 Apogee X-ray source at Area
200 X-ray Interferometry Testbed.**

**The MANSON MODEL 2 MINI FOCUS X-RAY SOURCE:**

![](media/image1.pct){width="7.809027777777778in"
height="5.924305555555556in"}

Figure 1: X-Ray Technology XTG5011 Apogee X-ray Tube

The source mounts on a tapped rotatable 2-3/4\" UHV flange on the
customer\'s vacuum system. We use the high voltage/beam current power
supply and cables made by the same manufacturer. The manufacturer has
provided a radiation map for this device detailed in an Application Note
and it is attached to this document.

**Location of this X-Ray Technology Model XTG5011 Apogee X-ray Tube:**

The source is located in a locked shed at the end of a 600 meter long
vacuum pipe- part of the GSFC X-ray Interferometry Testbed located at
Area 200. The beamline location is indicated in figure 2. The shed that
maintains the source is shown in figure 3. Area 200 is a controlled
access location that has very few visitors. A properly coded keycard is
required for access to the location.

The source is separated from the rest of the vacuum system by a gate
valve- unless when in use. Once a vacuum level of 50 mTorr is reached in
the beamline, the source is put on manually per the manufacturer's
instructions:

1)  The accelerating high voltage is slowly (over 10's of seconds)
    raised to 20 keV, and the electron emission current is adjusted to
    400 milliamps.

2)  The accelerating high voltage is slowly (over 10's of seconds)
    raised to 30 keV, and the electron emission current is adjusted to
    800 milliamps.

3)  The accelerating high voltage is slowly (over 10's of seconds)
    raised to 40 keV

4)  The accelerating high voltage is slowly (over 10's of seconds)
    raised to 50 keV

The chamber and the beamline is made of stainless steel and there are no
ports where x-rays could exit the vacuum system. The attenuation length
of stainless steel at the Mo Kα line (17.3 keV) is approximately 35
microns.

The X-rays will travel 147 meters in the vacuum system to an optics
chamber where we place test optics. The typical x-ray flux at this point
is expected to be less than 1000 photons/s/cm\^2 .

X-rays that pass through the optics will travel another 450 meters to an
x-ray CCD detector. At this position we expect a typical X-ray flux of
\< 100 photons/sec striking the CCD.

Operations will run for typically 1 week at a time with nearly
continuous x-ray usage. We expect to have \~1 week "runs" about once a
month or so.

![](media/image2.pct){width="7.810416666666667in" height="4.175in"}

![](media/image3.pct){width="6.861111111111111in"
height="4.986111111111111in"}

![](media/image4.pct){width="7.563888888888889in"
height="9.80486111111111in"}