ENS 50823

v t e ENS Event
06:00 Feb 13, 2015
Title	Agreement State Report - Gamma Knife Unit Failed to Function as Designed
Event Description	The following information was received from the State of Wisconsin via email: On Friday, February 13, 2015, the Wisconsin Radiation Protection Section received notice from the Radiation Safety Officer (RSO) of Marshfield Clinic that their Leksell Gamma Knife Perfexion gamma stereotactic radiosurgery unit failed to function as designed. The Gamma Knife unit became stuck open and staff had to manually retract the patient bed and close the shielding doors on the unit. It is not believed that the patient received a dose higher than was planned but it is unknown if it is a medical event at this time. The Wisconsin Radiation Protection Section will conduct an investigation on Monday, February 16, 2015 and provide updates through NMED. WI Event ID: WI150001

ENS 50823 +/-
Where
Marshfield Clinic Marshfield, Wisconsin (NRC Region 3)
License number:	141-1162-01
Organization:	Wisconsin Radiation Protection
Reporting

Agreement State
Time - Person (Reporting Time:+11.57 h0.482 days <br />0.0689 weeks <br />0.0158 months <br />)
Opened:	Lauren James 17:34 Feb 13, 2015
NRC Officer:	Steve Sandin
Last Updated:	Feb 13, 2015
50823 - NRC Website
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v t e Emergency Notification System
Marshfield Clinic with Agreement State
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