On July 23, 2007, a Notice of Violation and Confirmatory Order (Effective Immediately) were issued to the licensee, for a Severity Level III violation. As a result of an Alternative Dispute Resolution (ADR) mediation session conducted at the licensee's request, the NRC agreed to final disposition of this matter by citing a single violation of the requirements in 10 CFR 35.24(b). Specifically, the licensee through the Radiation Safety Officer (a) failed to ensure that the physical presence requirements of 10 CFR 35.615(f)(3) from May 13, 2004, to March 10, 2005; and (b) failed to ensure that written directives were consistently signed by all three members of a Gamma Knife team prior to administration of gamma stereotactic radiosurgery treatments in accordance with 10 CFR 35.32 between 1998 and 2000. The NRC concluded that certain aspects of the 10 CFR 35.24(b) violation were willful. The licensee disputed this conclusion. The NRC and the licensee have agreed to disagree regarding any willful aspects of this violation. In light of the actions that the licensee has taken, or has committed to take, as described in the Confirmatory Order, as well as the fact that the violation did not result in any known safety consequences to patients, workers, or the public, the NRC agreed to issue a Notice of Violation without a civil penalty.