ENS 54184

v t e ENS Event
04:00 Jul 25, 2019
Title	Agreement State Report - Source Failed to Retract
Event Description	The following was received via e-mail: On Thursday, July 25, 2019, the licensee called to report an equipment failure event where, during a cardiovascular brachytherapy treatment, the source failed to retract at the end of the treatment time due to a kink in the catheter line. The unit being used was a Best Vascular, Inc., A1000 Series using the Novoste Beta-Cath 3.5 Delivery System and a Sr-90 source with a source strength of 79.3 mCi. A service engineer for Best Vascular was present during the time of treatment and was able to unkink the catheter line allowing the source to fully retract into the unit. There was no harm to the patient and no overexposure occurred. Event Report No.: PA190017 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 54184 +/-
Where
West Penn Allegheny Health Systems Inc Pittsburgh, Pennsylvania (NRC Region 1)
License number:	PA-0031
Organization:	Pa Bureau Of Radiation Protection
Reporting

Agreement State
Time - Person (Reporting Time:+34.57 h1.44 days <br />0.206 weeks <br />0.0474 months <br />)
Opened:	Joshua Myers 14:34 Jul 26, 2019
NRC Officer:	Jeffrey Whited
Last Updated:	Jul 26, 2019
54184 - NRC Website
v • d • e

v t e Emergency Notification System
West Penn Allegheny Health Systems Inc with Agreement State
WEEKMONTHYEAR2019-07-25T04:00:00 [Table view]
[ENS list for West Penn Allegheny Health Systems Inc]

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