PNO-III-86-091, on 860902,licensee Reported Loss of Tiny Plastic Tube Containing 10 Ir-192 Seeds After Removal from Patient on 860830.Seeds Assumed Discarded in Trash
| ML20209F080 | |
| Person / Time | |
|---|---|
| Site: | 03001389 |
| Issue date: | 09/05/1986 |
| From: | Simmons T, Sreniawski D NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION III) |
| To: | |
| References | |
| PNO-III-86-091, PNO-III-86-91, NUDOCS 8609120044 | |
| Download: ML20209F080 (1) | |
. PRELIMINARY NOTIFICATION OF EVENT OR UNUSUAL OCCURRENCE--PNO-III-86-91 Data Stptember 5, 1986 D0h This preliminary notification constitutes EARLY notice of events of POSSIBLE safety cr public interest significance. The information is as initially received without v;rification or evaluation, and is basically all that is known by the Region III staff on this date.
Facility: St. Francis Hospital Licensee Emergency Classification:
Evanston, IL Notification of an Unusual Event Alert License No. 12-00963-02 Site Area Emergency
"*M General Emergency X Not Applicable
Subject:
LOST IRIDIUM-192 SEEDS The licensee reported the loss of a tiny plastic tube containing 10 iridium-192 seeds.
Th2 lost tube was among 17 implanted into a patient on August 27, 1986, during a brachytherapy treatment. The seeds were removed August 30, 1986, but because of the Labor Day holiday, an inventory was not conducted until September 2,1986, when the one tube was discovered missing.
The licensee conducted a search of the area, including trash disposal areas. It is now assumed the seeds were discarded in the trash.
A Region III (Chicago) inspector was onsite September 4, and surveyed various areas with a micro /R meter without success.
The radiation level at one meter from the seeds would be about 2 millirem per hour; at contact, 20 Rem per hour.
Region III is continuing its inspection.
Tha State of Illinois has been notified.
R:gicn III was notified of the loss of the seeds on September 3, 1986. This information is currant as of 4:00 p.m. (CDT), September 5,1986.
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