ENS 53313

v t e ENS Event
04:00 Mar 6, 2018
Title	Agreement State Report - Dose Delivered to Wrong Treatment Site
Event Description	A patient was prescribed treatment by High Dose Rate (HDR) brachytherapy to a breast keloid in two fractions on 3/6/18 and 3/7/18 of 600 cGy per fraction. The patient contacted the oncologist when a skin/tissue reaction was discovered on 4/2/18. The reaction was not an anticipated response to the treatment plan. The fractions were likely directed to the wrong treatment site due to an improper length HDR catheter. The patient will be evaluated by the oncologist this week. 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 53313 +/-
Where
Medical University Of Sc Charleston, South Carolina (NRC Region 1)
License number:	SC 081
Organization:	Sc Div Of Health & Env Control
Reporting

Agreement State
Time - Person (Reporting Time:+703.17 h29.299 days <br />4.186 weeks <br />0.963 months <br />)
Opened:	Jim Peterson 10:10 Apr 4, 2018
NRC Officer:	Bethany Cecere
Last Updated:	Apr 4, 2018
53313 - NRC Website
v • d • e

v t e Emergency Notification System
Medical University Of Sc with Agreement State
WEEKMONTHYEAR2018-03-06T04:00:00 [Table view]
[ENS list for Medical University Of Sc]

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