ENS 51709
ENS Event | |
|---|---|
08:00 Feb 4, 2016 | |
| Title | Agreement State - Lost Shipment of Cs-131 Brachytherapy Seeds |
| Event Description | The following report was received from the Washington Department of Health, Office of Radiation Protection via email:
[On] 2/4/16, [a common carrier] has lost track of a RAM [radioactive material] Cs-131 brachytherapy seed shipment sent for a patient near Atlanta, GA. The seeds did not reach their destination in time for the implant in a patient at a clinic approximately 1 to 1.5 hrs from Atlanta, so the customer alerted IsoRay. According to IsoRay's Radiation Safety Officer, [the common carrier] is looking for the package. [The common carrier] thinks there is a possibility that the shipment may have been mistakenly transferred from the [common carriers] plane to the US Postal Service at the air field in Atlanta. IsoRay's Radiation Safety Officer called Washington State at [approximately] 9:40 AM [EST] to report the loss. Additional information is forthcoming. Washington Incident Number: WA-16-004
The following was received from Washington via email: Quantity of seeds in order: 48 Air kerma strength in micrograys per sq. meter/hr (U) - 2.02 - 2.08 = total 98 U Total apparent activity= 154 mCi (range from 3.17 - 3.26 mCi/seed) T1/2 = 9.69 days [half-life] Notified R4DO (O'Keefe), NMSS_EVENTS_NOTIFICATION (email), and CNSC Canada (email).
The following was received from Washington via email: According to the Radiation Safety Officer at the seed manufacturer/distributor, IsoRay, the US Postal Service delivered the lost package to the intended user at the end of last week. The source had decayed to the point of being useless. The customer is going to send shipment back IsoRay.' Notified R4DO (Vasquez), NMSS_EVENTS_NOTIFICATION (email), and CNSC Canada (email). 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 |
| Where | |
|---|---|
| Isoray Richland, Washington (NRC Region 4) | |
| License number: | WN-L0213-1 |
| Organization: | Wa Office Of Radiation Protection |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+8.78 h0.366 days <br />0.0523 weeks <br />0.012 months <br />) | |
| Opened: | Anine Grumbles 16:47 Feb 4, 2016 |
| NRC Officer: | Jeff Herrera |
| Last Updated: | Feb 17, 2016 |
| 51709 - NRC Website | |
Isoray with Agreement State | |
WEEKMONTHYEARENS 520092016-06-14T07:00:00014 June 2016 07:00:00
[Table view]Agreement State Agreement State Report - Lost and Found Brachytherapy Seeds ENS 517092016-02-04T08:00:0004 February 2016 08:00:00 Agreement State Agreement State - Lost Shipment of Cs-131 Brachytherapy Seeds ENS 448892009-02-19T08:00:00019 February 2009 08:00:00 Agreement State Improperly Packaged Radioactive Material ENS 439552008-02-01T08:00:0001 February 2008 08:00:00 Agreement State Agreement State Report - Depleted Cesium-131 Seeds Lost from Damaged Package During Shipment ENS 428762006-10-04T13:30:0004 October 2006 13:30:00 Agreement State Washington Agreement State Report - Two Damaged Shipping Packages Containing Cesium-131 Cancer Therapy Seeds. 2016-06-14T07:00:00 | |