ENS 46116
ENS Event | |
|---|---|
04:00 Jun 3, 2010 | |
| Title | Agreement State Report - Potentially Lost Radioactive Material |
| Event Description | The following was received via fax from the State of Massachusetts:
On June 3, 2010, two packages containing I-125 seeds were received by the Medical Physicist [MP], who brought them to the radiation oncology hot lab. The MP removed the paperwork and left the packages in the lab while he went back to his office to update the inventory system. He returned to the hot lab to place the cartridges containing the seeds in the vault. He put one cartridge in the vault next to a cartridge that was left over from a canceled treatment. The MP thought that the other cartridge already in the vault was from one of the packages just received, and proceeded to remove the labels from the packages and survey the packages before discarding them. Since the seeds are shielded by a stainless steel cartridge, the survey measurement was indistinguishable from background. The event was discovered by him on Tuesday, June 8, when he was preparing for a treatment and noticed the serial numbers on the cartridges did not match the ones in the inventory system. He reported his findings to the Radiation Safety Officer. The event was reported to Massachusetts Radiation Control Program on Thursday, June 10. Approximately 43 milliCuries of I-125 seeds were disposed in the clean trash system. Attempts to locate the material in the trash were unsuccessful and they concluded on Tuesday, June 8, that the package had left the premises via the trash. 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. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf This source is not amongst those sources or devices identified by the IAEA Code of Conduct for the Safety & Security of Radioactive Sources to be of concern from a radiological standpoint. Therefore is it being categorized as a less than Category 3 source |
| Where | |
|---|---|
| Brigham And Women'S Hospital Boston, Massachusetts (NRC Region 1) | |
| License number: | 44-0004 |
| Organization: | Ma Radiation Control Program |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+1181.4 h49.225 days <br />7.032 weeks <br />1.618 months <br />) | |
| Opened: | Kenath O. Traegde 09:24 Jul 22, 2010 |
| NRC Officer: | Dong Park |
| Last Updated: | Jul 22, 2010 |
| 46116 - NRC Website | |
Brigham And Women'S Hospital with Agreement State | |
WEEKMONTHYEARENS 470382011-05-01T04:00:0001 May 2011 04:00:00
[Table view]Agreement State Agreement State Report- Underexposure ENS 461162010-06-03T04:00:0003 June 2010 04:00:00 Agreement State Agreement State Report - Potentially Lost Radioactive Material ENS 451762009-06-30T15:30:00030 June 2009 15:30:00 Agreement State Agreement State Report - Potential Worker Overexposure 2011-05-01T04:00:00 | |