ENS 56319

v t e ENS Event
05:00 Jan 11, 2023
Title	Patient Underdose
Event Description	The following information was provided by the Pennsylvania Department of Environmental Protection, Bureau of Radiation Protection (the Department) via email: On January 20, 2023 the licensee informed the Department of an under-dose incident involving yttrium-90 (Y-90) TheraSpheres. It is reportable per 10 CFR 35.3045(a)(1). On January 11, 2023 an Authorized User (AU) in Interventional Radiology was attempting to treat a patient with 45.4 mCi of yttrium-90 TheraSphere. The AU could not get the spheres to infuse. After consultation with the manufacturer (Boston Scientific), they decided on aborting the procedure. It was determined the patient received zero activity and all the radioactivity from the spheres remained inside the treatment vial. The patient and referring physician have been informed. The Department is currently in contact with the licensee and will update this event as soon as more information is provided. Event Report ID No: PA230005 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 56319 +/-
Where
Geisinger Health System Danville, Pennsylvania (NRC Region 1)
License number:	PA-0006
Organization:	Pa Bureau Of Radiation Protection
Reporting

Agreement State
Time - Person (Reporting Time:+226.77 h9.449 days <br />1.35 weeks <br />0.311 months <br />)
Opened:	John Chippo 15:46 Jan 20, 2023
NRC Officer:	Ian Howard
Last Updated:	Jan 20, 2023
56319 - NRC Website
v • d • e

v t e Emergency Notification System
Geisinger Health System with Agreement State
WEEKMONTHYEAR2023-01-11T05:00:00 [Table view]
[ENS list for Geisinger Health System]

Navigation menu