ENS 56945

v t e ENS Event
22:00 Feb 1, 2024
Title	Medical Event - Overdose
Event Description	The following is a summary of information provided by the licensee via phone: A patient received a Y-90 Therasphere injection to the liver. The procedure was successfully completed with no abnormalities noted. After the procedure, an imaging study was conducted on the patient's liver, and it was determined that the Theraspheres had concentrated in a single segment of the liver (segment 4) when they had been expected to distribute throughout the entire liver. The calculated dose to the single segment would have exceeded the prescribed dose (633 Gy vice 91 Gy) due to the higher concentration of Y-90. The physician and patient were notified. No adverse effect is expected to the patient or the target organ. * * RETRACTION ON 2/8/24 AT 1547 EDT FROM VRINDA NARAYANA TO BILL GOTT * * * After further review, the correct target was irradiated, the correct activity was injected and all procedures were followed. The average dose to the target matched the written directive. Thus, the event was not reportable, and the licensee is retracting the event. Notified R3DO (Ziolkowski), NMSS Events (email). 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 56945 +/- *RETRACTED*
Where
Ascension Providence Hospital Southfield, Michigan (NRC Region 3)
License number:	21-02-802-03
Organization:	Ascension Providence Hospital
Reporting

10 CFR 35.3045(a)(1)
Time - Person (Reporting Time:+14 h0.583 days <br />0.0833 weeks <br />0.0192 months <br />)
Opened:	Vrinda Narayana 12:00 Feb 2, 2024
NRC Officer:	Adam Koziol
Last Updated:	Feb 8, 2024
56945 - NRC Website
v • d • e

v t e Emergency Notification System
Ascension Providence Hospital with 10 CFR 35.3045(a)(1)
WEEKMONTHYEAR2024-02-01T22:00:00 [Table view]
[ENS list for Ascension Providence Hospital]

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