ENS 42965

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v t e ENS Event
22:00 Nov 5, 2006
Title	Texas Agreement State Report - Missing Source
Event Description	Two Radiation Oncologist Residents removed an LDR applicator from a cervical cancer patient. The applicator was supposed to have contained four Cesium-137 sources, 15 millicuries each, but only 3 of the sources were found. The patient's bed sheets had been changed and taken out of the room. Search for missing source is in progress. * * UPDATE FROM R. JISHA TO P. SNYDER AT 0843 ON 11/6/06 * * * The lost source material was found in the laundry. The state continues to investigate. Further information will be provided later. Notified R4DO (J. Clark) and NMSS EO (M. Burgess). A "Medical Event" may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient. THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks.

ENS 42965 +/-
Where
Ben Taub General Hospital Houston, Texas (NRC Region 4)
License number:	L01303
Organization:	Texas Department Of Health
Reporting

Agreement State
Time - Person (Reporting Time:+-3.88 h-0.162 days <br />-0.0231 weeks <br />-0.00531 months <br />)
Opened:	Ray Jisha 18:07 Nov 5, 2006
NRC Officer:	John Mackinnon
Last Updated:	Nov 6, 2006
42965 - NRC Website
v • d • e

v t e Emergency Notification System
Ben Taub General Hospital with Agreement State
WEEKMONTHYEAR2006-06-18T09:40:00 [Table view]
[ENS list for Ben Taub General Hospital]

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ENS Notification