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| Entered date | Event description | |
|---|---|---|
| ENS 44224 | 20 May 2008 09:44:00 | The prescribing physician ordered that a regular treadmill stress test be given to a patient. Instead of the correct test the hospital actually gave the patient a treadmill myocardial perfusion imaging test (MPIT) which uses a dose of Tc-99m. At 9:44 AM on 5/19/08 the patient was given a dose of 16.3 milliCuries of Tc-99m for the resting portion of the MPIT. Then at 10:24 AM on 5/19/08 the patient was given a dose of 35.3 milliCuries of Tc-99m for the stress portion of the MPIT. This resulted in a total dose of 51.6 milliCuries of Tc-99m given to the patient which is typical for a MPIT procedure. The hospital is currently conducting an investigation into this occurrence. The hospital will inform the patient of the error.
Upon investigation the licensee has determined that the event does not meet the reporting requirements of 10 CFR 35.3045(a)(1). Notified the R3DO (Riemer) and FSME EO (Burgess). |
| ENS 44021 | 29 February 2008 14:50:00 | Sixty-two I-125 seeds were to be implanted in a patient's prostate. After 37 seeds were implanted, surgery was halted and the location verified as being 1-2 cm below the prostate. The hospital is evaluating the medical implications of this event. The physicians and patient were notified. Seeds: 0.315 milliCuries each
The NRC's medical events review committee has determined that is report is a medical event. 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. |