ENS 46319

v t e ENS Event
04:00 Oct 6, 2010
Title	Delivered Dose Potentially Different than the Prescribed Dose
Event Description	During a brachytherapy treatment, the patient breast received an incorrect entry of the catheter position from a treatment planning system. Because of this, the prescribed dose was 340 centi-Gray at 1 centimeter from the tumor cavity while the actual dose received was 680 centi-Gray at 1 centimeter from the tumor cavity. The physician notified the patient of the potential dose difference. Based on physician review, it was determined that there was no affect on the patient. The reason for the potential dose difference was due to a missed change of a program default in the software program of the radiation treatment planning system. A new check step has been added to the Community Hospital procedure in order to correct the issue. * * UPDATE AT 1550 EDT ON 10/26/10 FROM ANDREA BROWNE TO S. SANDIN * * * The licensee is updating this report to confirm that upon further evaluation this is a medical event. Notified R3DO (Skokowski) and FSME (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.

ENS 46319 +/-
Where
Community Hospital Indianapolis, Indiana (NRC Region 3)
License number:	130600901
Organization:	Community Hospital
Reporting

10 CFR 35.3045(a)(1)
Time - Person (Reporting Time:+53.95 h2.248 days <br />0.321 weeks <br />0.0739 months <br />)
Opened:	Andrea Browne 09:57 Oct 8, 2010
NRC Officer:	Vince Klco
Last Updated:	Oct 26, 2010
46319 - NRC Website
v • d • e

v t e Emergency Notification System
Community Hospital with 10 CFR 35.3045(a)(1)
WEEKMONTHYEAR2010-10-06T04:00:00 [Table view]
[ENS list for Community Hospital]

Navigation menu