ENS 57830

v t e ENS Event
04:00 Jul 25, 2025
Title	Medical Event
Event Description	The following information was provided by the Florida Bureau of Radiation Control (BRC) via email: BRC was notified on 7/28/25 that on Friday, 7/25/25, a patient at Advent Health, Daytona was receiving Y-90 TheraSphere treatment for the liver. The patient received a dose which differed by more than 20 percent from the prescribed dose. Treatment was provided in 2 segments, denoted in 2 scripts. One segment received the full prescribed treatment, while the other segment received 51 percent of the intended treatment. Due to the treatment being provided as 2 scripts, treatment two differed by more than 20 percent. The [licensee's] radiation safety officer states that the dosimeter on the vial showed a dose of 0, but when all administration materials were removed, the residual within the equipment was much higher than expected. The primary care provider has been informed. It is unknown if the patient has been informed. 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 57830 +/-
Where
Adventist Health Systems Altamont Springs, Florida (NRC Region 1)
License number:	2897-1
Organization:	Florida Bureau Of Radiation Control
Reporting

Agreement State
Time - Person (Reporting Time:+85.38 h3.558 days <br />0.508 weeks <br />0.117 months <br />)
Opened:	Monroe A. Cooper 17:23 Jul 28, 2025
NRC Officer:	Ernest West
Last Updated:	Jul 28, 2025
57830 - NRC Website
v • d • e

v t e Emergency Notification System
Adventist Health Systems with Agreement State
WEEKMONTHYEAR2025-07-08T04:00:00 [Table view]
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