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The following information was received fro … The following information was received from the state of Nevada via email:</br>The patient was undergoing radiation treatment using Ir-192 and the high dose rate remote afterloader (Varian VS 2000) in three fractions. There were no problems with fractions one and two. During the third fraction, the vaginal cylinder device was inserted into the patient by the doctor. Unknown to the doctor, the device penetrated through the body wall weakened by previous surgery (according to the doctor, (this is) not unknown following robotic hysterectomies). This penetration allowed the source to move about 4 cm past the treatment area. As a result, the treatment area only received 25 percent volume coverage instead of the planned 95 percent volume coverage.</br>The device was a Varian Remote Afterloader, Model VS 2000, which contained 407 GBq of Ir-192.</br>NMED Report No: NV200007</br>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.necessarily result in harm to the patient. +
07:00:00, 29 April 2020 +
54,685 +
18:51:00, 30 April 2020 +
07:00:00, 29 April 2020 +
The following information was received fro … The following information was received from the state of Nevada via email:</br>The patient was undergoing radiation treatment using Ir-192 and the high dose rate remote afterloader (Varian VS 2000) in three fractions. There were no problems with fractions one and two. During the third fraction, the vaginal cylinder device was inserted into the patient by the doctor. Unknown to the doctor, the device penetrated through the body wall weakened by previous surgery (according to the doctor, (this is) not unknown following robotic hysterectomies). This penetration allowed the source to move about 4 cm past the treatment area. As a result, the treatment area only received 25 percent volume coverage instead of the planned 95 percent volume coverage.</br>The device was a Varian Remote Afterloader, Model VS 2000, which contained 407 GBq of Ir-192.</br>NMED Report No: NV200007</br>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.necessarily result in harm to the patient. +
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00:00:00, 30 April 2020 +
16-12-0016-01 +
Modification date"Modification date" is a predefined property that corresponds to the date of the last modification of a subject and is provided by <a rel="nofollow" class="external text" href="https://www.semantic-mediawiki.org/wiki/Help:Special_properties">Semantic MediaWiki</a>.
16:39:20, 15 January 2021 +
18:51:00, 30 April 2020 +
1.494 d (35.85 hours, 0.213 weeks, 0.0491 months) +
07:00:00, 29 April 2020 +
Brachytherapy + and Underdose +
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