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| {{#Wiki_filter:UNITED STATESNUCLEAR REGULATORY COMMISSIONOFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDSWASHINGTON, D.C. 20555December 13, 1996NRC INFORMATION NOTICE 96-66: RECENT MISADMINISTRATIONS CAUSED BYINCORRECT CALIBRATIONS OF STRONTIUM-90EYE APPLICATORS | | {{#Wiki_filter:UNITED STATES NUCLEAR REGULATORY |
| | |
| | COMMISSION |
| | |
| | ===OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS=== |
| | WASHINGTON, D.C. 20555 December 13, 1996 NRC INFORMATION |
| | |
| | NOTICE 96-66: RECENT MISADMINISTRATIONS |
| | |
| | CAUSED BY INCORRECT |
| | |
| | CALIBRATIONS |
| | |
| | OF STRONTIUM-90 |
| | |
| | ===EYE APPLICATORS=== |
|
| |
|
| ==Addressees== | | ==Addressees== |
| All U.S. Nuclear Regulatory Commission Medical Use Licensees authorized to usestrontium-90 (Sr-90) eye applicators. | | All U.S. Nuclear Regulatory |
| | |
| | Commission |
| | |
| | Medical Use Licensees |
| | |
| | authorized |
| | |
| | to use strontium-90 (Sr-90) eye applicators. |
|
| |
|
| ==Purpose== | | ==Purpose== |
| The U.S. Nuclear Regulatory Commission (NRC) is issuing this informationnotice to alert addressees to recent misadministrations caused by incorrectsource strength determinations of Sr-90 eye applicators. It is expected thatrecipients will review the information for applicability to their facilitiesand consider actions, as appropriate, to avoid similar problems. However,suggestions contained in this information notice are not NRC requirements;therefore, no specific action nor written response is required.DescriDtion of CircumstancesThe primary causes of two recent events have been problems with calibrationand calculation of the dose rates from Sr-90 applicators. As a result, theadministered doses were not within 20 percent of the prescribed dose.Case 1. In October 1995, during an inspection of a licensee authorized to usea Sr-90 eye applicator in Mayag~ez, Puerto Rico, it was determined that thecalibration record for the licensee's Sr-90 eye applicator was missing. Aprevious owner of the source lost the original calibration certificate, andhis medical physics consultant performed a check of the source strength. Thischeck was performed with an inappropriate measurement instrument and resultedin an incorrect determination of the source strength as 0.24 Gray (Gy)/sec 0(24 rad/sec). The licensee obtained the source in 1994 and relied on theerroneous source strength determination during treatments. Also, the sourcehad not been decay-corrected by either owner since 1990. NRC urged thelicensee to have the eye applicator recalibrated and to be instructed in the D Fc2proper method to calculate the decay of the source.The licensee subsequently had the eye applicator recalibrated by the NationalInstitute of Standards and Technology. The resultant recalibration revealed adose rate of 0.53 Gray (53 rad)/sec rather than the 0.24 Gy (24 rad)/sec usedby the licensee. The licensee had prescribed a total dose of between 10 to25 Gy (1000 to 2500 rad) for approximately9-0709036 f arr&0 C. Dr Ilt, 2a | | The U.S. Nuclear Regulatory |
| | |
| | Commission (NRC) is issuing this information |
| | |
| | notice to alert addressees |
| | |
| | to recent misadministrations |
| | |
| | caused by incorrect source strength determinations |
| | |
| | of Sr-90 eye applicators. |
| | |
| | It is expected that recipients |
| | |
| | will review the information |
| | |
| | for applicability |
| | |
| | to their facilities |
| | |
| | and consider actions, as appropriate, to avoid similar problems. |
| | |
| | However, suggestions |
| | |
| | contained |
| | |
| | in this information |
| | |
| | notice are not NRC requirements; |
| | therefore, no specific action nor written response is required.DescriDtion |
| | |
| | of Circumstances |
| | |
| | The primary causes of two recent events have been problems with calibration |
| | |
| | and calculation |
| | |
| | of the dose rates from Sr-90 applicators. |
| | |
| | As a result, the administered |
| | |
| | doses were not within 20 percent of the prescribed |
| | |
| | dose.Case 1. In October 1995, during an inspection |
| | |
| | of a licensee authorized |
| | |
| | to use a Sr-90 eye applicator |
| | |
| | in Mayag~ez, Puerto Rico, it was determined |
| | |
| | that the calibration |
| | |
| | record for the licensee's |
| | |
| | Sr-90 eye applicator |
| | |
| | was missing. A previous owner of the source lost the original calibration |
| | |
| | certificate, and his medical physics consultant |
| | |
| | performed |
| | |
| | a check of the source strength. |
| | |
| | This check was performed |
| | |
| | with an inappropriate |
| | |
| | measurement |
| | |
| | instrument |
| | |
| | and resulted in an incorrect |
| | |
| | determination |
| | |
| | of the source strength as 0.24 Gray (Gy)/sec 0 (24 rad/sec). |
| | |
| | The licensee obtained the source in 1994 and relied on the erroneous |
| | |
| | source strength determination |
| | |
| | during treatments. |
| | |
| | Also, the source had not been decay-corrected |
| | |
| | by either owner since 1990. NRC urged the licensee to have the eye applicator |
| | |
| | recalibrated |
| | |
| | and to be instructed |
| | |
| | in the D Fc2 proper method to calculate |
| | |
| | the decay of the source.The licensee subsequently |
| | |
| | had the eye applicator |
| | |
| | recalibrated |
| | |
| | by the National Institute |
| | |
| | of Standards |
| | |
| | and Technology. |
| | |
| | The resultant |
| | |
| | recalibration |
| | |
| | revealed a dose rate of 0.53 Gray (53 rad)/sec rather than the 0.24 Gy (24 rad)/sec used by the licensee. |
| | |
| | The licensee had prescribed |
| | |
| | a total dose of between 10 to 25 Gy (1000 to 2500 rad) for approximately |
| | |
| | 9-0709036 f arr&0 C. Dr Ilt, 2a |
| | |
| | IN 96-66 December 13, 1996 70 patients, but actually administered |
| | |
| | about twice this amount. An NRC medical consultant |
| | |
| | has reviewed the cases and has recommended |
| | |
| | that the patients be evaluated |
| | |
| | for any adverse effects.Case 2. In November 1995, while reviewing |
| | |
| | treatment |
| | |
| | records during a routine NRC inspection |
| | |
| | of a licensee authorized |
| | |
| | to use a Sr-90 eye applicator |
| | |
| | in Honolulu, Hawaii, an NRC inspector |
| | |
| | determined |
| | |
| | that the licensee had incorrectly |
| | |
| | calculated |
| | |
| | the decay of the strength of a Sr-90 eye applicator |
| | |
| | and subsequently |
| | |
| | delivered |
| | |
| | doses 20 percent over the prescribed |
| | |
| | doses to 16 patients. |
| | |
| | The root cause of this event was the licensee improperly |
| | |
| | calculating |
| | |
| | the decay of the Sr-90 source. Specifically, the licensee linearly decayed the strength of the source instead of logarithmically |
| | |
| | decaying the source strength of the eye applicator. |
| | |
| | Before May 1995, a technologist |
| | |
| | had correctly |
| | |
| | calculated |
| | |
| | the decay of the source; however, when this technologist |
| | |
| | left, the physician |
| | |
| | incorrectly |
| | |
| | calculated |
| | |
| | the source decay based on a linear decay from the previous calculations. |
| | |
| | In addition, the incorrect |
| | |
| | half-life |
| | |
| | of Sr-90 was used in the calculation. |
| | |
| | Following |
| | |
| | a correct determination |
| | |
| | of the source strength, the licensee determined |
| | |
| | that 17 misadministrations |
| | |
| | involving |
| | |
| | 16 patients occurred, from May 6, 1995 to November 16, 1995, including |
| | |
| | one patient who was treated on both eyes. The delivered |
| | |
| | doses range from 21.1 to 22.7 percent greater than the prescribed |
| | |
| | dose of 40 Gy (4000 rad).Discussion |
| | |
| | 10 CFR 35.32, *Quality Management |
| | |
| | Program," requires licensees |
| | |
| | to develop written procedures |
| | |
| | to meet five objectives |
| | |
| | associated |
| | |
| | with any brachytherapy |
| | |
| | dose, including |
| | |
| | assurance |
| | |
| | that the prescribed |
| | |
| | dose is the administered |
| | |
| | dose.A necessary |
| | |
| | part of this is to ensure that the dose rate emitted from an applicator |
| | |
| | is correct. If the manufacturer's |
| | |
| | certificate |
| | |
| | of calibration |
| | |
| | or original activity/dose |
| | |
| | rate name plate is missing, the licensee should arrange with a qualified |
| | |
| | expert to determine |
| | |
| | the dose rate from the Sr-90 source.(For additional |
| | |
| | details, see NRC IN 94-17, NSr-90 Eye Applicators: |
| | Submission |
| | |
| | of Quality Management |
| | |
| | Plan, Calibration |
| | |
| | and Use," dated March 11, 1994.)Failure to implement |
| | |
| | the Quality Management |
| | |
| | Rule and make required reports may subject a licensee to orders, civil penalties, and notices of violation. |
| | |
| | In view of the nature of the cited events, it appears worthwhile |
| | |
| | to review some of the properties |
| | |
| | of Sr-90 eye applicators |
| | |
| | and the related processes |
| | |
| | for decay correction |
| | |
| | over time. New Sr-90 eye applicators |
| | |
| | typically |
| | |
| | contain a 2 gigabecquerel (GBq) [54 millicurie(mCi)] |
| | source, exhibiting |
| | |
| | a surface dose rate of about 0.50 Gy (50 rad)/sec. |
| | |
| | The half-life |
| | |
| | of the parent Sr-90 is 28.5 yrs [maximum beta energy equal to 0.54 mega-electron |
| | |
| | volts (MeY)], and the yttrium-90 (Y-90) daughter half-life |
| | |
| | is 64.2 hrs (beta-max, 2.27 MeV);therefore, both isotopes are in equilibrium |
| | |
| | on the eye applicator. |
| | |
| | Since Sr-90 and Y-90 are in equilibrium, emissions |
| | |
| | from both isotopes must be accounted |
| | |
| | for in dosimetry |
| | |
| | calculations. |
| | |
| | IN 96-66 December 13, 1996 The dose rate (D,) at a time (t) can be calculated |
| | |
| | from the initial dose rate (De) at the time of the most recent calibration |
| | |
| | with the following |
| | |
| | formula: D = D -(e-^t) (FI)where e, the base of the natural logarithm |
| | |
| | (2.718), is raised to the power -Xt and is referred to as the 'decay factor' (df), where -X --0.693/Tx, T. is the half-life |
| | |
| | of the isotope, and t is the elapsed time. For Sr-90, TX-28.5 years; therefore, X -(0.693)/(28.5 yrs) = 0.0243 yr'. The values for df can be used to determine |
| | |
| | the fraction of original activity remaining |
| | |
| | after t years. These values can then be used to calculate |
| | |
| | dose rates by using the following |
| | |
| | formula: D,= Dao df (F2)The fraction of activity remaining |
| | |
| | after a given number of years from the original measurement |
| | |
| | date is given in Table 1 (Attachment |
| | |
| | 1).For example An eye applicator |
| | |
| | calibrated |
| | |
| | by the manufacturer |
| | |
| | on January 1, 1978, delivered an initial dose rate ( Do) of 0.75 Gy/sec (75 rad/sec) on contact. If, on January 1, 1996, the eye applicator |
| | |
| | needs to be used, the elapsed time (in years) since calibration |
| | |
| | is 18, and from Table 1, df = 0.646 for Sr-90.Using formula F2: D, = bo. df D18yaM -(0.75 Gy/sec)(0.646) |
| | bigyea -0.485 Gy/sec (48.5 rad/sec) |
| | IN 96-66 December 13, 1996 Table I may be extended using formula F1 and the value X -0.0243 yr' for Sr-90. Other values of df that need to be evaluated |
| | |
| | by licensees |
| | |
| | will need to be re-calculated |
| | |
| | by using the appropriate |
| | |
| | half-life |
| | |
| | for that isotope.Alternatively, a semi-logarithmic |
| | |
| | plot of the above data will yield a straight line, which may be extended beyond 25 years.This information |
| | |
| | notice requires no specific action nor written response. |
| | |
| | If you have any questions |
| | |
| | about the information |
| | |
| | in this notice, please contact one of the technical |
| | |
| | contacts listed below or the appropriate |
| | |
| | regional office.Donald A. Cool, D rector Division of Industrial |
| | |
| | and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards |
| | |
| | Technical |
| | |
| | contacts: |
| | Jose M. Diaz-Velez, RII (404) 331-7438 E-mail: jxd2@nrc.gov |
| | |
| | Emilio M. Garcia, RIV (510) 975-0239 E-mail: emg@nrc.gov |
| | |
| | James A. Smith, NMSS (301) 415-7904 E-mail: jas4@nrc.gov |
| | |
| | Attachments: |
| | 1. List of Recently Issued NMSS Information |
| | |
| | Notices 2. List of Recently Issued NRC Information |
| | |
| | Notices 42 T7SS I (/4e |
| | |
| | Attachment |
| | |
| | I IN 96-66 December 13, 1996 Page 1 of I TABLE 1 FRACTION (EXPRESSED |
| | |
| | AS DECIMAL) OF ORIGINAL SR-90 ACTIVITY REMAINING |
| | |
| | AFTER (t) YEARS Years (t) df Years (t) df Years (t) df Years (t) df.25 0.994 6.5 0.854 12.75 0.734 19 0.63.5 0.988 6.75 0.849 13 0.729 19.25 0.626.75 0.982 7 0.844 13.25 0.725 19.5 0.623 1 0.976 7.25 0.838 13.5 0.72 19.75 0.619 1.25 0.97 7.5 0.833 13.75 0.716 20 0.615 1.5 0.964 7.75 0.828 14 0.712 20.25 0.611 1.75 0.958 8 0.823 14.25 0.707 20.5 0.608 2 0.953 8.25 0.818 14.5 0.703 20.75 0.604 2.25 0.947 8.5 0.813 14.75 0.699 21 0.6 2.5 0.941 8.75 0.808 15 0.695 21.25 0.597 2.75 0.935 9 0.804 15.25 0.69 21.5 0.593 3 0.93 9.25 0.799 15.5 0.686 21.75 0.589 3.25 0.924 9.5 0.794 15.75 0.682 22 0.586 3.5 0.918 9.75 0.789 16 0.678 22.25 0.582 3.75 0.913 10 0.784 16.25 0.674 22.5 0.579 4 0.907 10.25 0.78 16.5 0.67 22.75 0.575 4.25 0.902 10.5 0.775 16.75 0.666 23 0.572 4.5 0.896 10.75 0.77 17 0.662 23.25 0.568 4.75 0.891 11 0.765 17.25 0.658 23.5 0.565 5 0.886 11.25 0.761 17.5 0.654 23.75 0.562 5.25 0.88 11.5 0.756 17.75 0.65 24 0.558 5.5 0.875 11.75 0.752 18 0.646 24.25 0.555 5.75 0.87 12 0.747 18.25 0.642 24.5 0.551 6 0.864 12.25 0.743 18.5 0.638 24.75 0.548 6.25 0.859 12.5 0.738 18.75 0.634 25 0.545 Attachment |
| | |
| | 2 IN 96-66 December 13, 1996 Page 1 of I UST OF RECENTLY ISSUED NMSS INFORMATION |
| | |
| | NOTICES Information |
| | |
| | Date of Notice No. Subject Issuance Issued to 96-63 96-57 96-54 96-53 96-52 96-51 Potential |
| | |
| | Safety Issue Regarding |
| | |
| | the Shipment of Fissile Material Incident-Reporting |
| | |
| | Require-ments Involving |
| | |
| | Intakes, During a 24-Hour Period that May Cause a Total Effective |
| | |
| | ===Dose Equivalent=== |
| | in Excess of 0.05 Sv (5 rem)Vulnerability |
| | |
| | of Stainless Steel to Corrosion |
| | |
| | ===When Sensitized=== |
| | Retrofit to Amersham 660 Posilock Radiography |
| | |
| | Camera to Correct Incon-sistency in 10 CFR Part 34 Compatibility |
| | |
| | Cracked Insertion |
| | |
| | Rods on Troxler Model 3400 Series Portable Moisture Density Gauges Residual Contamination |
| | |
| | Remaining |
| | |
| | in Krypton-85 Handling System After Venting 12/05196 10/30196 10/17/96 10115/96 09/26/96 09/11196 All U.S. Nuclear Regulatory |
| | |
| | Commission |
| | |
| | licensees authorized |
| | |
| | to possess special nuclear material in unsealed quantities |
| | |
| | greater than a critical mass All U.S. Nuclear Regulatory |
| | |
| | Commission |
| | |
| | licensees All material licensees All industrial |
| | |
| | radiography |
| | |
| | licensees All U.S. Nuclear Regulatory |
| | |
| | Commission |
| | |
| | portable gauge licensees |
| | |
| | and vendors All material licensees |
| | |
| | ' >Attachment |
| | |
| | 3 IN 96-66 December 13, 1996 Page 1 of I UST OF RECENTLY ISSUED NRC INFORMATION |
| | |
| | NOTICES Information |
| | |
| | Date of Notice No. Subject Issuance Issued to 96-65 96-64 96-63 96-62 96-61 96-60 Undetected |
| | |
| | ===Accumulation=== |
| | of Gas in Reactor Coolant System and Inaccurate |
| | |
| | Reactor Water Level Indication |
| | |
| | During Shutdown Modifications |
| | |
| | to Con-tainment Blowout Panels Without Appropriate |
| | |
| | Design Controls Potential |
| | |
| | Safety Issue Regarding |
| | |
| | the Shipment of Fissile Material Potential |
| | |
| | Failure of the Instantaneous |
| | |
| | Trip Function of General Electric RMS-9 Programmers |
| | |
| | Failure of a Main Steam Safety Valve to Reseat Caused by an Improperly |
| | |
| | Installed |
| | |
| | Release Nut Potential |
| | |
| | Common-Mode |
| | |
| | Post-Accident Failure of Residual Heat Removal Heat Exchangers |
| | |
| | 1211 1/96 12/10196 12/05196 11120196 11/20/96 11/14/96 All holders of OLs or CPs for nuclear power reactors All holders of OLs or CPs for nuclear reactors All U.S. Nuclear Regulatory |
| | |
| | Commission |
| | |
| | licensees |
| | |
| | authorized |
| | |
| | to possess special nuclear material in unsealed quantities |
| | |
| | greater than a critical mass All holders of OLs and CPs for nuclear power plants All holders of OLs or CPs for nuclear power.reactors All holders of OLs or CPs for nuclear power reactors OL = Operating |
| | |
| | License CP = Construction |
| | |
| | Permit |
| | |
| | IN 96-66.December 13, 1996 Table 1 may be extended using formula FH and the value x -0.0243 yr 1 for Sr-90. Other values of df that need to be evaluated |
| | |
| | by licensees |
| | |
| | will need to be re-calculated |
| | |
| | by using the appropriate |
| | |
| | half-life |
| | |
| | for that isotope.Alternatively, a semi-logarithmic |
| | |
| | plot of the above data will yield a straight line, which may be extended beyond 25 years.This information |
| | |
| | notice requires no specific action nor written response. |
| | |
| | If you have any questions |
| | |
| | about the information |
| | |
| | in this notice, please contact one of the technical |
| | |
| | contacts listed below or the appropriate |
| | |
| | regional office.Donald A. Cool, Director Division of Industrial |
| | |
| | and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards |
| | |
| | Technical |
| | |
| | contacts: Jose M. Diaz-Velez, RII (404) 331-7438 E-mail: jxd2@nrc.gov |
| | |
| | Emilio M. Garcia, RIV (510) 975-0239 E-mail: emg@nrc.gov |
| | |
| | James A. Smith, NMSS (301) 415-7904 E-mail: jas4enrc.gov |
| | |
| | Attachments: |
| | 1. List of Recently 2. List of Recently Issued NMSS Information |
| | |
| | Notices Issued NRC Information |
| | |
| | Notices Official Record Copy S:\Jsmith\imns5350.JAS |
| | |
| | OFC IMAB I E IMAB lIMAB I IMOB I Tech Ed I KANE JASmith SLMerchant |
| | |
| | LWCamper o JMPiccone |
| | |
| | o EKraus o DATE 1 11/26/96 11/26/96 1 10/28/96 10/29/96 8/01/96 OFC J JE I OGC I DD/IMNS I D/IMNS I NAME JLiebermano |
| | |
| | SATreby o FCCombso DACool DATE 08/07/96 1 1/07/96 11/12/96 I 11/29/96-COWVER E = COVER & Attachment |
| | |
| | N -NO COPY o- See Previous Concurrence |
| | |
| | eIN 96-##'J November .1996 Table 1 may be extended using formula F1 and the value A = 0.0243 yr" for Sr-90. Other values of df that need to be evaluated |
| | |
| | by licensees |
| | |
| | will need to be re-calculated |
| | |
| | by using the appropriate |
| | |
| | half-life |
| | |
| | for that isotope.Alternatively, a semi-logarithmic |
| | |
| | plot of the above data will yield a straight line, which may extended beyond 25 years.This information |
| | |
| | notice requires no specific action nor written response. |
| | |
| | If you have any questions |
| | |
| | about the information |
| | |
| | in this notice, please contact one of the technical |
| | |
| | contacts listed below or the appropriate |
| | |
| | regional office.Donald A. Cool, Director Division of Industrial |
| | |
| | and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards |
| | |
| | Contacts: Jose M. Diaz-Velez, RII (404) 331-7438 Internet: |
| | JXD2@NRC.GOV |
| | |
| | Emilio M. Garcia, RIV (510) 975-0239 Internet: |
| | EMG@NRC.GOV |
| | |
| | James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC.GOV |
| | |
| | Attachments: |
| | 1. Table of decay factors 2. List of Recently Issue(3. List of Recently Issue(fffirial Rernrd COnY Svisr d NMSS Information |
| | |
| | Notices d NRC Information |
| | |
| | Notices nith\imns5350JAS |
| | |
| | OFC IMAB lE IMAB lIMAB lIMOB j Tech Ed NAME JASmi SLM@f@I~nt |
| | |
| | LWCamper o JMPiccone |
| | |
| | o EKraus @DATE it /96 i 10/8/ 9 6 10/29/96 8/01/96 OFC OE I OGC DD/IMNS DlIMNS NAME JLieberman@ |
| | SATreby @ FCCombs@ _____ __ _ _l DATE 08/07/96 11/07/96 11/12/96 ///t11/96= COVER E = COVER & Attachment |
| | |
| | N = NO COPY ?--See Previous Concurrence |
| | |
| | N 96-Il-N ovember 91996 This information |
| | |
| | notice requires no specific action nor written respons .If you have any questions |
| | |
| | about the information |
| | |
| | in this notice, please c tact one of the technical |
| | |
| | contacts listed below or the appropriate |
| | |
| | reglo 1 office.Donald A. Cool, Director, Division of Industrial |
| | |
| | and Medical Nuclear Sa ty Office of Nuclear terial Safety and Safeguards |
| | |
| | Contacts: |
| | Jose M. Diaz-Velez, RI (404) 331-7438 Internet: |
| | JXD2@NRC.GOV |
| | |
| | Emilio M. Garcia, RIV (510) 975-0239 Internet: |
| | EMG@NRC.GOV |
| | |
| | James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC.GOV |
| | |
| | Attachments: |
| | 1. Table of decay factors 2. List of Recently Issued NMS Information |
| | |
| | Notices 3. List of Recently Issued MR Information |
| | |
| | Notices Official Record Copy 5: \smitinins5350.JAS |
| | |
| | OFC IMAB I E IMAB//1S IMAB I IMOB I Tech E NAME JASmithm SL e rc nt LWCamper o JMPiccone |
| | |
| | a EKraus o DATE t/ /14/96 A/ 96 10/28/96 10/29/96 8/01/96 OFC OE l OGC DD/IMNS D/IMNS NAME JLiebermanq/ |
| | SATreby o FCCombso DACool DATE 08/07/9 11/07/96 11/12/96 / /96 C = COVER E M OVER h Attachment |
| | |
| | N a NO COPY o- See Previous Concurrence |
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| | ;. N 96-##a *-i ovember .1996 D 18year " (0.75 Gy/sec)(0.646) |
| | blyrs, 0G 0.485 Gy/sec Table 1 may be extended using formula F1 and the value A 0.0243 yr-.Alternatively, a semi-logarithmic |
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| | plot of the above dat will yield a straight line, which may extended beyond 20 years.This information |
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| | notice requires no specific actio nor written response. |
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| | If you have any questions |
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| | about the information |
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| | in t s notice, please contact one of the technical |
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| | contacts listed below or t appropriate |
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| | regional office.Donald .Cool. Director Divis on of Industrial |
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| | and M ical Nuclear Safety Ofice of Nuclear Material Safety and Safeguards |
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| | Contacts: |
| | Jose M. Diaz-Velez, (404) 331-7438 Internet:JMD2@NRC. |
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| | V Emilio M. Garci , RIV (510) 975-0239/Internet:EM |
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| | C.GOV James A. S ,th NMSS (301) 415- 904 Internet- AS4@NRC.GOV |
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| | Attachments: |
| | 1. List of Recent y Issued NMSS Information |
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| | Notices 2. List of Rece ly Issued NRC Information |
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| | Notices Official Recordo S:\jsmith\imns5350.JAS |
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| | OFC IMA E IMAB jI I I MOB I Tech Ed i NAME I ant LWCamper o JMPiccone |
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| | @ EKraus o DATE / /1196 le /6///96 10/28/96 10/29/96 8/01/96 OFC / OE I OGC DD/IMNS D/IMNS lAM JLiebermano |
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| | SATreby o FCCombso DACool D0/07/96 11/07/96 11/12/96 / /96 ,COVER E = COVER & Attachment |
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| | N = NO COPY @- See Previous Concurrence |
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| | N 96-ft<iovember |
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| | ,1996 D (0.75 Gy/sec)(0.646) |
| | .0.485 Gy/sec Table 1 may be etended using formula F1 and the value X -0.0243 yr 1.Alternatively, a mi-logarithmic |
| | |
| | plot of the above data will yield a straight line, which may ext nded beyond 20 years.This information |
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| | noti requires no specific action nor written response. |
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| | If you have any questions |
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| | bout the information |
| | |
| | in this notice, please contact (one of) the technical |
| | |
| | c tact(s) listed below or the appropriate |
| | |
| | regional office.Donald A. Cool, Director Division of Industrial |
| | |
| | and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards |
| | |
| | Contacts: |
| | Jose M. Diaz-Velez, RII (404) 331-7438 Internet:JMD2@NRC.GOY |
| | |
| | Emilio M. Garcia, RIV (510) 975-0239 Internet:EMG@NRC.GOV |
| | |
| | James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC.GOV |
| | |
| | Attachments: |
| | 1. List of Recently Issued NMSS Information |
| | |
| | Notices 2. List of Recently Issued NRC Information |
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| | Notices Official Record Copy S:\Jsmith\imns5350.JAS |
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| | \OFC qIMABiLW B IM4AB -IMOB l E\Tech Ed NAME JASm1 i SL chant LWCamper a JMPiccone |
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| | c EKraus o DATE I I 1/96 _ / j 10/28/96 10/29/96 8/01/96 OFC OE OGC DD/IMNS D/IMNS NAME JLiebermano |
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| | SATreby a F (Cm DACool DATE 08/07/96 11/07/96 / /96 C a COVER E a CUVLK & Attacnment |
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| | N = mU LUr1'u- aee rrevmuUs IA0ICUIIrCLM. |
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| | ,N 96-##' "-'-6ctober |
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| | ,1996 ble8.. -(0.75 Gy/sec)(0.646) |
| | l 0.4 y/sec Table 1 may be extended using fo ula F1 and the value X -0.0243 yre.Alternatively, a semi-logarithmic |
| | |
| | lot of the above data will yield a straight line, which may extended beyond 20 ars.This information |
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| | notice requires no sp ific action nor written response. |
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| | If you have any questions |
| | |
| | about the in frma ion in this notice, please contact (one of) the technical |
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| | contact(s) |
| | listed elow or the appropriate |
| | |
| | regional office.Donald A. -ool, Director Division o Industrial |
| | |
| | and Medical Ntclear Safety Office of N clear Material Safety and Safegu rds Contacts: |
| | Jose M. Diaz-Velez, RII (404) 331-7438 Internet:JMD2@NRC. |
| | |
| | GOY Emilio M. Garcia, RIV (510) 975-0239 Internet:EMG@NRC.GOV |
| | |
| | James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC .GOV Attachments: |
| | 1. List of Recently Issued NMSS Information |
| | |
| | Notices 2. List of Recently Issued NRC Information |
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| | Notices Official Record Copy S:\Jsmithi\mns5350.JAS |
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| | \OFC IMAB AB IMAB I l IMOB l \l,Tech EdlNAME JASai R SUM nt LWCamper a JMPiccone |
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| | o EKraus o DATE / -J/ 10/28/96 10/29/96 8/01/96 OFC OE DD/IMNS D/IMNS KANE JLiebermano |
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| | S ireb NIL FCCombs DACool DATE 08/07/96 l/ /1/96 / /96 / /96 aCOVER E a COVER & Attachment |
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| | K = ND COPY o- See Previous Concurrence |
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| | \ |
| | C, 6 I< ~N 96-#t 4 October ,1996 We have Dlew. -(0.75 Gy/sec)(0.646) |
| | Table I may be extended using formula FH and the value X -0.0243 yr 1.Alternatively, a semi-icgarithmic |
| | |
| | plot of the above data will yield a straight line, which may extended be~yond 20 years.This information |
| | |
| | notice requires no specific action nor written response. |
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| | If you have any questions |
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| | about the information |
| | |
| | in this notice, please contact (one of) the technical |
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| | contact(s) |
| | listed below or the appropriate |
| | |
| | regional office.Donald A. Cool, Director Division of Industrial |
| | |
| | and Medical Nuclear Safety Office cf Nuclear Material and Safrguards |
| | |
| | Safety Contacts: Jose M. Diaz-Velez, RII (404) 331-7438 Internet:JMD2@NRC.60V |
| | |
| | Emilio M. Garcia, RIV (510) 975-0239 Internet:EMG@NRC.GOY |
| | |
| | James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC.GOV |
| | |
| | Attachments: |
| | 1. List 2. List Official of Recently of Recently Record CODY Issued NMSS Information |
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| | Notices Issued NRC Information |
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| | Notices SA:smithkimtns535GJAS |
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| IN 96-66December 13, 1996 0 patients, but actually administered about twice this amount. An NRCmedical consultant has reviewed the cases and has recommended that thepatients be evaluated for any adverse effects.Case 2. In November 1995, while reviewing treatment records during a routineNRC inspection of a licensee authorized to use a Sr-90 eye applicator inHonolulu, Hawaii, an NRC inspector determined that the licensee hadincorrectly calculated the decay of the strength of a Sr-90 eye applicator andsubsequently delivered doses 20 percent over the prescribed doses to 16patients. The root cause of this event was the licensee improperlycalculating the decay of the Sr-90 source. Specifically, the licenseelinearly decayed the strength of the source instead of logarithmicallydecaying the source strength of the eye applicator. Before May 1995, atechnologist had correctly calculated the decay of the source; however, whenthis technologist left, the physician incorrectly calculated the source decaybased on a linear decay from the previous calculations. In addition, theincorrect half-life of Sr-90 was used in the calculation.Following a correct determination of the source strength, the licenseedetermined that 17 misadministrations involving 16 patients occurred, fromMay 6, 1995 to November 16, 1995, including one patient who was treated onboth eyes. The delivered doses range from 21.1 to 22.7 percent greater thanthe prescribed dose of 40 Gy (4000 rad).Discussion10 CFR 35.32, *Quality Management Program," requires licensees to developwritten procedures to meet five objectives associated with any brachytherapydose, including assurance that the prescribed dose is the administered dose.A necessary part of this is to ensure that the dose rate emitted from anapplicator is correct. If the manufacturer's certificate of calibration ororiginal activity/dose rate name plate is missing, the licensee should arrangewith a qualified expert to determine the dose rate from the Sr-90 source.(For additional details, see NRC IN 94-17, NSr-90 Eye Applicators: Submissionof Quality Management Plan, Calibration and Use," dated March 11, 1994.)Failure to implement the Quality Management Rule and make required reports maysubject a licensee to orders, civil penalties, and notices of violation.In view of the nature of the cited events, it appears worthwhile to reviewsome of the properties of Sr-90 eye applicators and the related processes fordecay correction over time. New Sr-90 eye applicators typically contain a2 gigabecquerel (GBq) [54 millicurie(mCi)] source, exhibiting a surface doserate of about 0.50 Gy (50 rad)/sec. The half-life of the parent Sr-90 is28.5 yrs [maximum beta energy equal to 0.54 mega-electron volts (MeY)], andthe yttrium-90 (Y-90) daughter half-life is 64.2 hrs (beta-max, 2.27 MeV);therefore, both isotopes are in equilibrium on the eye applicator. SinceSr-90 and Y-90 are in equilibrium, emissions from both isotopes must beaccounted for in dosimetry calculations.
| | OFC IMAB E IMAB Tech NAME JASmi S on rchant C rer EKraus o DATE It /1 /96 /96 96 /09 /96 8/01/96 OFC OE lOGC lDD/IMNS l D/IMNS l~KANE JLiebermano |
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| IN 96-66December 13, 1996 The dose rate (D,) at a time (t) can be calculated from the initial dose rate(De) at the time of the most recent calibration with the following formula:D = D -(e-^t) (FI)where e, the base of the natural logarithm (2.718), is raised to the power -Xtand is referred to as the 'decay factor' (df), where -X --0.693/Tx, T. isthe half-life of the isotope, and t is the elapsed time. For Sr-90, TX-28.5years; therefore, X -(0.693)/(28.5 yrs) = 0.0243 yr'. The values for df canbe used to determine the fraction of original activity remaining after tyears. These values can then be used to calculate dose rates by using thefollowing formula:D,= Dao df (F2)The fraction of activity remaining after a given number of years from theoriginal measurement date is given in Table 1 (Attachment 1).For exampleAn eye applicator calibrated by the manufacturer on January 1, 1978, deliveredan initial dose rate ( Do) of 0.75 Gy/sec (75 rad/sec) on contact. If, onJanuary 1, 1996, the eye applicator needs to be used, the elapsed time (inyears) since calibration is 18, and from Table 1, df = 0.646 for Sr-90.Using formula F2:D, = bo. dfD18yaM -(0.75 Gy/sec)(0.646)bigyea -0.485 Gy/sec(48.5 rad/sec)
| | SATreby FCCombs DACool DATE 08/07/96 / /96 I /96 / /96:* COVER E a COVER & Attachment |
| IN 96-66December 13, 1996 Table I may be extended using formula F1 and the value X -0.0243 yr' forSr-90. Other values of df that need to be evaluated by licensees will need tobe re-calculated by using the appropriate half-life for that isotope.Alternatively, a semi-logarithmic plot of the above data will yield a straightline, which may be extended beyond 25 years.This information notice requires no specific action nor written response. Ifyou have any questions about the information in this notice, please contactone of the technical contacts listed below or the appropriate regional office.Donald A. Cool, D rectorDivision of Industrial andMedical Nuclear SafetyOffice of Nuclear Material Safetyand SafeguardsTechnical contacts: Jose M. Diaz-Velez, RII(404) 331-7438E-mail: jxd2@nrc.govEmilio M. Garcia, RIV(510) 975-0239E-mail: emg@nrc.govJames A. Smith, NMSS(301) 415-7904E-mail: jas4@nrc.govAttachments:1. List of Recently Issued NMSS Information Notices2. List of Recently Issued NRC Information Notices42 T7SS I (/4e
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| Attachment IIN 96-66December 13, 1996Page 1 of ITABLE 1FRACTION (EXPRESSED AS DECIMAL) OF ORIGINALSR-90 ACTIVITY REMAINING AFTER (t) YEARSYears (t) df Years (t) df Years (t) df Years (t) df.25 0.994 6.5 0.854 12.75 0.734 19 0.63.5 0.988 6.75 0.849 13 0.729 19.25 0.626.75 0.982 7 0.844 13.25 0.725 19.5 0.6231 0.976 7.25 0.838 13.5 0.72 19.75 0.6191.25 0.97 7.5 0.833 13.75 0.716 20 0.6151.5 0.964 7.75 0.828 14 0.712 20.25 0.6111.75 0.958 8 0.823 14.25 0.707 20.5 0.6082 0.953 8.25 0.818 14.5 0.703 20.75 0.6042.25 0.947 8.5 0.813 14.75 0.699 21 0.62.5 0.941 8.75 0.808 15 0.695 21.25 0.5972.75 0.935 9 0.804 15.25 0.69 21.5 0.5933 0.93 9.25 0.799 15.5 0.686 21.75 0.5893.25 0.924 9.5 0.794 15.75 0.682 22 0.5863.5 0.918 9.75 0.789 16 0.678 22.25 0.5823.75 0.913 10 0.784 16.25 0.674 22.5 0.5794 0.907 10.25 0.78 16.5 0.67 22.75 0.5754.25 0.902 10.5 0.775 16.75 0.666 23 0.5724.5 0.896 10.75 0.77 17 0.662 23.25 0.5684.75 0.891 11 0.765 17.25 0.658 23.5 0.5655 0.886 11.25 0.761 17.5 0.654 23.75 0.5625.25 0.88 11.5 0.756 17.75 0.65 24 0.5585.5 0.875 11.75 0.752 18 0.646 24.25 0.5555.75 0.87 12 0.747 18.25 0.642 24.5 0.5516 0.864 12.25 0.743 18.5 0.638 24.75 0.5486.25 0.859 12.5 0.738 18.75 0.634 25 0.545 Attachment 2IN 96-66December 13, 1996Page 1 of IUST OF RECENTLY ISSUEDNMSS INFORMATION NOTICESInformation Date ofNotice No. Subject Issuance Issued to96-6396-5796-5496-5396-5296-51Potential Safety IssueRegarding the Shipmentof Fissile MaterialIncident-Reporting Require-ments Involving Intakes,During a 24-Hour Periodthat May Cause a TotalEffective Dose Equivalentin Excess of 0.05 Sv (5 rem)Vulnerability of StainlessSteel to Corrosion WhenSensitizedRetrofit to Amersham 660Posilock RadiographyCamera to Correct Incon-sistency in 10 CFR Part 34CompatibilityCracked Insertion Rodson Troxler Model 3400Series Portable MoistureDensity GaugesResidual ContaminationRemaining in Krypton-85Handling System AfterVenting12/0519610/3019610/17/9610115/9609/26/9609/11196All U.S. Nuclear RegulatoryCommission licenseesauthorized to possess specialnuclear material in unsealedquantities greater than acritical massAll U.S. Nuclear RegulatoryCommission licenseesAll material licenseesAll industrial radiographylicenseesAll U.S. Nuclear RegulatoryCommission portable gaugelicensees and vendorsAll material licensees
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| ' >Attachment 3IN 96-66December 13, 1996Page 1 of IUST OF RECENTLY ISSUEDNRC INFORMATION NOTICESInformation Date ofNotice No. Subject Issuance Issued to96-6596-6496-6396-6296-6196-60Undetected Accumulationof Gas in Reactor CoolantSystem and InaccurateReactor Water LevelIndication During ShutdownModifications to Con-tainment Blowout PanelsWithout AppropriateDesign ControlsPotential Safety IssueRegarding the Shipmentof Fissile MaterialPotential Failure of theInstantaneous Trip Functionof General Electric RMS-9ProgrammersFailure of a Main Steam SafetyValve to Reseat Caused by anImproperly Installed ReleaseNutPotential Common-Mode Post-Accident Failure of ResidualHeat Removal Heat Exchangers1211 1/9612/1019612/051961112019611/20/9611/14/96All holders of OLsor CPs for nuclearpower reactorsAll holders of OLsor CPs for nuclearreactorsAll U.S. NuclearRegulatory Commissionlicensees authorizedto possess specialnuclear material inunsealed quantitiesgreater than a criticalmassAll holders of OLsand CPs for nuclearpower plantsAll holders of OLs orCPs for nuclear power.reactorsAll holders of OLs orCPs for nuclear powerreactorsOL = Operating LicenseCP = Construction Permit | | A 'IN 96-##August ,1996 This informat n not1ce requires no specific action nor written response. |
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| IN 96-66.December 13, 996Table 1 may be extended using formula FH and the value x -0.0243 yr1 forSr-90. Other values of df that need to be evaluated by licensees will need tobe re-calculated by using the appropriate half-life for that isotope.Alternatively, a semi-logarithmic plot of the above data will yield a straightline, which may be extended beyond 25 years.This information notice requires no specific action nor written response. Ifyou have any questions about the information in this notice, please contactone of the technical contacts listed below or the appropriate regional office.Donald A. Cool, DirectorDivision of Industrial andMedical Nuclear SafetyOffice of Nuclear Material Safetyand SafeguardsTechnical contacts:Jose M. Diaz-Velez, RII(404) 331-7438E-mail: jxd2@nrc.govEmilio M. Garcia, RIV(510) 975-0239E-mail: emg@nrc.govJames A. Smith, NMSS(301) 415-7904E-mail: jas4enrc.govAttachments:1. List of Recently2. List of RecentlyIssued NMSS Information NoticesIssued NRC Information NoticesOfficial Record Copy S:\Jsmith\imns5350.JASOFC IMAB I E IMAB lIMAB I IMOB I Tech Ed IKANE JASmith SLMerchant LWCamper o JMPiccone o EKraus oDATE 1 11/26/96 11/26/96 1 10/28/96 10/29/96 8/01/96OFC J JE I OGC I DD/IMNS I D/IMNS INAME JLiebermano SATreby o FCCombso DACoolDATE 08/07/96 1 1/07/96 11/12/96 I 11/29/96-COWVER E = COVER & Attachment N -NO COPY o- See Previous Concurrence
| | If you have any qu tions about the information |
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| eIN 96-##'J November .1996 Table 1 may be extended using formula F1 and the value A = 0.0243 yr" forSr-90. Other values of df that need to be evaluated by licensees will need tobe re-calculated by using the appropriate half-life for that isotope.Alternatively, a semi-logarithmic plot of the above data will yield a straightline, which may extended beyond 25 years.This information notice requires no specific action nor written response. Ifyou have any questions about the information in this notice, please contactone of the technical contacts listed below or the appropriate regional office.Donald A. Cool, DirectorDivision of Industrial andMedical Nuclear SafetyOffice of Nuclear Material Safetyand SafeguardsContacts:Jose M. Diaz-Velez, RII(404) 331-7438Internet: JXD2@NRC.GOVEmilio M. Garcia, RIV(510) 975-0239Internet: EMG@NRC.GOVJames A. Smith, NMSS(301) 415-7904Internet:JAS4@NRC.GOVAttachments:1. Table of decay factors2. List of Recently Issue(3. List of Recently Issue(fffirial Rernrd COnY Svisrd NMSS Information Noticesd NRC Information Noticesnith\imns5350JASOFC IMAB lE IMAB lIMAB lIMOB j Tech EdNAME JASmi SLM@f@I~nt LWCamper o JMPiccone o EKraus @DATE it /96 i 10/8/ 9 6 10/29/96 8/01/96OFC OE I OGC DD/IMNS DlIMNSNAME JLieberman@ SATreby @ FCCombs@ _____ __ _ _lDATE 08/07/96 11/07/96 11/12/96 ///t11/96= COVER E = COVER & Attachment N = NO COPY ?--See Previous Concurrence
| | in this notice, please contact (one of) the techn cal contact(s) |
| | listed below or the appropriate |
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| N 96-Il-N ovember 91996 This information notice requires no specific action nor written respons .Ifyou have any questions about the information in this notice, please c tactone of the technical contacts listed below or the appropriate reglo 1 office.Donald A. Cool, Director,Division of Industrial andMedical Nuclear Sa tyOffice of Nuclear terial Safetyand SafeguardsContacts: Jose M. Diaz-Velez, RI(404) 331-7438Internet: JXD2@NRC.GOVEmilio M. Garcia, RIV(510) 975-0239Internet: EMG@NRC.GOVJames A. Smith, NMSS(301) 415-7904Internet:JAS4@NRC.GOVAttachments:1. Table of decay factors2. List of Recently Issued NMS Information Notices3. List of Recently Issued MR Information NoticesOfficial Record Copy 5: \smitinins5350.JASOFC IMAB I E IMAB//1S IMAB I IMOB I Tech ENAME JASmithm SL e rc nt LWCamper o JMPiccone a EKraus oDATE t/ /14/96 A/ 96 10/28/96 10/29/96 8/01/96OFC OE l OGC DD/IMNS D/IMNSNAME JLiebermanq/ SATreby o FCCombso DACoolDATE 08/07/9 11/07/96 11/12/96 / /96C = COVER E M OVER h Attachment N a NO COPY o- See Previous Concurrence
| | regional office.Donald A. Cool, Director Division of Industrial |
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| ;. N 96-##a *-i ovember .1996 D18year " (0.75 Gy/sec)(0.646)blyrs, 0G 0.485 Gy/secTable 1 may be extended using formula F1 and the value A 0.0243 yr-.Alternatively, a semi-logarithmic plot of the above dat will yield a straightline, which may extended beyond 20 years.This information notice requires no specific actio nor written response. Ifyou have any questions about the information in t s notice, please contactone of the technical contacts listed below or t appropriate regional office.Donald .Cool. DirectorDivis on of Industrial andM ical Nuclear SafetyOfice of Nuclear Material Safetyand SafeguardsContacts: Jose M. Diaz-Velez,(404) 331-7438Internet:JMD2@NRC. VEmilio M. Garci , RIV(510) 975-0239/Internet:EM C.GOVJames A. S ,th NMSS(301) 415- 904Internet- AS4@NRC.GOVAttachments:1. List of Recent y Issued NMSS Information Notices2. List of Rece ly Issued NRC Information NoticesOfficial Recordo S:\jsmith\imns5350.JASOFC IMA E IMAB jI I I MOB I Tech Ed iNAME I ant LWCamper o JMPiccone @ EKraus oDATE / /1196 le /6///96 10/28/96 10/29/96 8/01/96OFC / OE I OGC DD/IMNS D/IMNS lAM JLiebermano SATreby o FCCombso DACoolD0/07/96 11/07/96 11/12/96 / /96,COVER E = COVER & Attachment N = NO COPY @- See Previous Concurrence
| | and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards |
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| N 96-ft<iovember ,1996 D (0.75 Gy/sec)(0.646).0.485 Gy/secTable 1 may be etended using formula F1 and the value X -0.0243 yr1.Alternatively, a mi-logarithmic plot of the above data will yield a straightline, which may ext nded beyond 20 years.This information noti requires no specific action nor written response. Ifyou have any questions bout the information in this notice, please contact(one of) the technical c tact(s) listed below or the appropriate regionaloffice.Donald A. Cool, DirectorDivision of Industrial andMedical Nuclear SafetyOffice of Nuclear Material Safetyand SafeguardsContacts: Jose M. Diaz-Velez, RII(404) 331-7438Internet:JMD2@NRC.GOYEmilio M. Garcia, RIV(510) 975-0239Internet:EMG@NRC.GOVJames A. Smith, NMSS(301) 415-7904Internet:JAS4@NRC.GOVAttachments:1. List of Recently Issued NMSS Information Notices2. List of Recently Issued NRC Information NoticesOfficial Record Copy S:\Jsmith\imns5350.JAS \OFC qIMABiLW B IM4AB -IMOB l E\Tech EdNAME JASm1 i SL chant LWCamper a JMPiccone c EKraus oDATE I I 1/96 _ / j 10/28/96 10/29/96 8/01/96OFC OE OGC DD/IMNS D/IMNSNAME JLiebermano SATreby a F (Cm DACoolDATE 08/07/96 11/07/96 / /96C a COVER E a CUVLK & Attacnment N = mU LUr1'u- aee rrevmuUs IA0ICUIIrCLM.
| | Contacts: |
| | Jose M. Diaz-Velez, RII (404) 331-7438 Emilio M. Garcia, RIV (510) 975-0239 James A. Smith, NMSS (301) 415-7904 Attachments: |
| | 1. List of Recently Issued NMSS Information |
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| ,N 96-##' "-'-6ctober ,1996 ble8.. -(0.75 Gy/sec)(0.646)l 0.4 y/secTable 1 may be extended using fo ula F1 and the value X -0.0243 yre.Alternatively, a semi-logarithmic lot of the above data will yield a straightline, which may extended beyond 20 ars.This information notice requires no sp ific action nor written response. Ifyou have any questions about the in frma ion in this notice, please contact(one of) the technical contact(s) listed elow or the appropriate regionaloffice.Donald A. -ool, DirectorDivision o Industrial andMedical Ntclear SafetyOffice of N clear Material Safetyand Safegu rdsContacts: Jose M. Diaz-Velez, RII(404) 331-7438Internet:JMD2@NRC. GOYEmilio M. Garcia, RIV(510) 975-0239Internet:EMG@NRC.GOVJames A. Smith, NMSS(301) 415-7904Internet:JAS4@NRC .GOVAttachments:1. List of Recently Issued NMSS Information Notices2. List of Recently Issued NRC Information NoticesOfficial Record Copy S:\Jsmithi\mns5350.JAS \OFC IMAB AB IMAB I l IMOB l \l,Tech EdlNAME JASai R SUM nt LWCamper a JMPiccone o EKraus oDATE / -J/ 10/28/96 10/29/96 8/01/96OFC OE DD/IMNS D/IMNSKANE JLiebermano S ireb NIL FCCombs DACoolDATE 08/07/96 l/ /1/96 / /96 / /96aCOVER E a COVER & Attachment K = ND COPY o- See Previous Concurrence \
| | Notices 2. List of Recently Issued NRC Information |
| C, 6 I< ~N 96-#t4 October ,1996 We have Dlew. -(0.75 Gy/sec)(0.646)Table I may be extended using formula FH and the value X -0.0243 yr1.Alternatively, a semi-icgarithmic plot of the above data will yield a straightline, which may extended be~yond 20 years.This information notice requires no specific action nor written response. Ifyou have any questions about the information in this notice, please contact(one of) the technical contact(s) listed below or the appropriate regionaloffice.Donald A. Cool, DirectorDivision of Industrial andMedical Nuclear SafetyOffice cf Nuclear Materialand SafrguardsSafetyContacts:Jose M. Diaz-Velez, RII(404) 331-7438Internet:JMD2@NRC.60VEmilio M. Garcia, RIV(510) 975-0239Internet:EMG@NRC.GOYJames A. Smith, NMSS(301) 415-7904Internet:JAS4@NRC.GOVAttachments:1. List2. ListOfficialof Recentlyof RecentlyRecord CODYIssued NMSS Information NoticesIssued NRC Information NoticesSA:smithkimtns535GJASOFC IMAB E IMAB TechNAME JASmi S on rchant C rer EKraus oDATE It /1 /96 /96 96 /09 /96 8/01/96OFC OE lOGC lDD/IMNS l D/IMNS l~KANE JLiebermano SATreby FCCombs DACoolDATE 08/07/96 / /96 I /96 / /96:* COVER E a COVER & Attachment N = NO COPY e- See Previous Concurrence
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| A 'IN 96-##August ,1996 This informat n not1ce requires no specific action nor written response. Ifyou have any qu tions about the information in this notice, please contact(one of) the techn cal contact(s) listed below or the appropriate regionaloffice.Donald A. Cool, DirectorDivision of Industrial andMedical Nuclear SafetyOffice of Nuclear Material Safetyand SafeguardsContacts: Jose M. Diaz-Velez, RII(404) 331-7438Emilio M. Garcia, RIV(510) 975-0239James A. Smith, NMSS(301) 415-7904Attachments:1. List of Recently Issued NMSS Information Notices2. List of Recently Issued NRC Information NoticesOfficial Record Copy G:\imns5350.JAS , )OFC IMAB l E I OGC lTech EdNAME JASmi'W per SATreby EKraus aDATE *in /96 __ /________ \___96 / /96 8/01/96OFC \ lI I DD/IMNS l D/IMNS lNAME Q jeerman FCCombs DACoolDATE ___9_ / /96: w COVER 'E i. COVER & Attachment N = NO COPY o- See Previous Concurrence
| | Notices Official Record Copy G:\imns5350.JAS , )OFC IMAB l E I OGC lTech Ed NAME JASmi'W per SATreby EKraus a DATE *in /96 __ /________ |
| | \___96 / /96 8/01/96 OFC \ lI I DD/IMNS l D/IMNS lNAME Q jeerman FCCombs DACool DATE ___9_ / /96: w COVER 'E i. COVER & Attachment |
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| {{Information notice-Nav}} | | {{Information notice-Nav}} |
Recent Misadministrations Caused by Incorrect Calibrations of Strontium-90 Eye ApplicatorsML031050494 |
Person / Time |
---|
Site: |
Beaver Valley, Millstone, Hatch, Monticello, Calvert Cliffs, Dresden, Davis Besse, Peach Bottom, Browns Ferry, Salem, Oconee, Nine Mile Point, Palisades, Palo Verde, Perry, Indian Point, Fermi, Kewaunee, Catawba, Harris, Wolf Creek, Saint Lucie, Point Beach, Oyster Creek, Watts Bar, Hope Creek, Grand Gulf, Cooper, Sequoyah, Byron, Pilgrim, Arkansas Nuclear, Three Mile Island, Braidwood, Susquehanna, Summer, Prairie Island, Columbia, Seabrook, Brunswick, Surry, Limerick, North Anna, Turkey Point, River Bend, Vermont Yankee, Crystal River, Haddam Neck, Ginna, Diablo Canyon, Callaway, Vogtle, Waterford, Duane Arnold, Farley, Robinson, Clinton, South Texas, San Onofre, Cook, Comanche Peak, Yankee Rowe, Maine Yankee, Quad Cities, Humboldt Bay, La Crosse, Big Rock Point, Rancho Seco, Zion, Midland, Bellefonte, Fort Calhoun, FitzPatrick, McGuire, LaSalle, Fort Saint Vrain, Shoreham, Satsop, Trojan, Atlantic Nuclear Power Plant ![Entergy icon.png](/w/images/7/79/Entergy_icon.png) |
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Issue date: |
12/13/1996 |
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From: |
Cool D A NRC/NMSS/IMNS |
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To: |
|
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References |
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IN-96-066, NUDOCS 9612090360 |
Download: ML031050494 (15) |
|
Similar Documents at Beaver Valley, Millstone, Hatch, Monticello, Calvert Cliffs, Dresden, Davis Besse, Peach Bottom, Browns Ferry, Salem, Oconee, Nine Mile Point, Palisades, Palo Verde, Perry, Indian Point, Fermi, Kewaunee, Catawba, Harris, Wolf Creek, Saint Lucie, Point Beach, Oyster Creek, Watts Bar, Hope Creek, Grand Gulf, Cooper, Sequoyah, Byron, Pilgrim, Arkansas Nuclear, Three Mile Island, Braidwood, Susquehanna, Summer, Prairie Island, Columbia, Seabrook, Brunswick, Surry, Limerick, North Anna, Turkey Point, River Bend, Vermont Yankee, Crystal River, Haddam Neck, Ginna, Diablo Canyon, Callaway, Vogtle, Waterford, Duane Arnold, Farley, Robinson, Clinton, South Texas, San Onofre, Cook, Comanche Peak, Yankee Rowe, Maine Yankee, Quad Cities, Humboldt Bay, La Crosse, Big Rock Point, Rancho Seco, Zion, Midland, Bellefonte, Fort Calhoun, FitzPatrick, McGuire, LaSalle, Fort Saint Vrain, Shoreham, Satsop, Trojan, Atlantic Nuclear Power Plant |
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Category:NRC Information Notice
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Mclaughlin on NRC, Regarding NRC Information Notice 2006-13: Groundwater Contamination 2020-09-03 The following query condition could not be considered due to this wiki's restrictions on query size or depth: <code> [[:Beaver Valley]] OR [[:Millstone]] OR [[:Hatch]] OR [[:Monticello]] OR [[:Calvert Cliffs]] OR [[:Dresden]] OR [[:Davis Besse]] OR [[:Peach Bottom]] OR [[:Browns Ferry]] OR [[:Salem]] OR [[:Oconee]] OR [[:Nine Mile Point]] OR [[:Palisades]] OR [[:Palo Verde]] OR [[:Perry]] OR [[:Indian Point]] OR [[:Fermi]] OR [[:Kewaunee]] OR [[:Catawba]] OR [[:Harris]] OR [[:Wolf Creek]] OR [[:Saint Lucie]] OR [[:Point Beach]] OR [[:Oyster Creek]] OR [[:Watts Bar]] OR [[:Hope Creek]] OR [[:Grand Gulf]] OR [[:Cooper]] OR [[:Sequoyah]] OR [[:Byron]] OR [[:Pilgrim]] OR [[:Arkansas Nuclear]] OR [[:Three Mile Island]] OR [[:Braidwood]] OR [[:Susquehanna]] OR [[:Summer]] OR [[:Prairie Island]] OR [[:Columbia]] OR [[:Seabrook]] OR [[:Brunswick]] OR [[:Surry]] OR [[:Limerick]] OR [[:North Anna]] OR [[:Turkey Point]] OR [[:River Bend]] OR [[:Vermont Yankee]] OR [[:Crystal River]] OR [[:Haddam Neck]] OR [[:Ginna]] OR [[:Diablo Canyon]] OR [[:Callaway]] OR [[:Vogtle]] OR [[:Waterford]] OR [[:Duane Arnold]] OR [[:Farley]] OR [[:Robinson]] OR [[:Clinton]] OR [[:South Texas]] OR [[:San Onofre]] OR [[:Cook]] OR [[:Comanche Peak]] OR [[:Yankee Rowe]] OR [[:Maine Yankee]] OR [[:Quad Cities]] OR [[:Humboldt Bay]] OR [[:La Crosse]] OR [[:Big Rock Point]] OR [[:Rancho Seco]] OR [[:Zion]] OR [[:Midland]] OR [[:Bellefonte]] OR [[:Fort Calhoun]] OR [[:FitzPatrick]] OR [[:McGuire]] OR [[:LaSalle]] OR [[:Fort Saint Vrain]] OR [[:Shoreham]] OR [[:Satsop]] OR [[:Trojan]] OR [[:Atlantic Nuclear Power Plant]] </code>.
[Table view]The following query condition could not be considered due to this wiki's restrictions on query size or depth: <code> [[:Beaver Valley]] OR [[:Millstone]] OR [[:Hatch]] OR [[:Monticello]] OR [[:Calvert Cliffs]] OR [[:Dresden]] OR [[:Davis Besse]] OR [[:Peach Bottom]] OR [[:Browns Ferry]] OR [[:Salem]] OR [[:Oconee]] OR [[:Nine Mile Point]] OR [[:Palisades]] OR [[:Palo Verde]] OR [[:Perry]] OR [[:Indian Point]] OR [[:Fermi]] OR [[:Kewaunee]] OR [[:Catawba]] OR [[:Harris]] OR [[:Wolf Creek]] OR [[:Saint Lucie]] OR [[:Point Beach]] OR [[:Oyster Creek]] OR [[:Watts Bar]] OR [[:Hope Creek]] OR [[:Grand Gulf]] OR [[:Cooper]] OR [[:Sequoyah]] OR [[:Byron]] OR [[:Pilgrim]] OR [[:Arkansas Nuclear]] OR [[:Three Mile Island]] OR [[:Braidwood]] OR [[:Susquehanna]] OR [[:Summer]] OR [[:Prairie Island]] OR [[:Columbia]] OR [[:Seabrook]] OR [[:Brunswick]] OR [[:Surry]] OR [[:Limerick]] OR [[:North Anna]] OR [[:Turkey Point]] OR [[:River Bend]] OR [[:Vermont Yankee]] OR [[:Crystal River]] OR [[:Haddam Neck]] OR [[:Ginna]] OR [[:Diablo Canyon]] OR [[:Callaway]] OR [[:Vogtle]] OR [[:Waterford]] OR [[:Duane Arnold]] OR [[:Farley]] OR [[:Robinson]] OR [[:Clinton]] OR [[:South Texas]] OR [[:San Onofre]] OR [[:Cook]] OR [[:Comanche Peak]] OR [[:Yankee Rowe]] OR [[:Maine Yankee]] OR [[:Quad Cities]] OR [[:Humboldt Bay]] OR [[:La Crosse]] OR [[:Big Rock Point]] OR [[:Rancho Seco]] OR [[:Zion]] OR [[:Midland]] OR [[:Bellefonte]] OR [[:Fort Calhoun]] OR [[:FitzPatrick]] OR [[:McGuire]] OR [[:LaSalle]] OR [[:Fort Saint Vrain]] OR [[:Shoreham]] OR [[:Satsop]] OR [[:Trojan]] OR [[:Atlantic Nuclear Power Plant]] </code>. |
UNITED STATES NUCLEAR REGULATORY
COMMISSION
OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS
WASHINGTON, D.C. 20555 December 13, 1996 NRC INFORMATION
NOTICE 96-66: RECENT MISADMINISTRATIONS
CAUSED BY INCORRECT
CALIBRATIONS
OF STRONTIUM-90
EYE APPLICATORS
Addressees
All U.S. Nuclear Regulatory
Commission
Medical Use Licensees
authorized
to use strontium-90 (Sr-90) eye applicators.
Purpose
The U.S. Nuclear Regulatory
Commission (NRC) is issuing this information
notice to alert addressees
to recent misadministrations
caused by incorrect source strength determinations
of Sr-90 eye applicators.
It is expected that recipients
will review the information
for applicability
to their facilities
and consider actions, as appropriate, to avoid similar problems.
However, suggestions
contained
in this information
notice are not NRC requirements;
therefore, no specific action nor written response is required.DescriDtion
of Circumstances
The primary causes of two recent events have been problems with calibration
and calculation
of the dose rates from Sr-90 applicators.
As a result, the administered
doses were not within 20 percent of the prescribed
dose.Case 1. In October 1995, during an inspection
of a licensee authorized
to use a Sr-90 eye applicator
in Mayag~ez, Puerto Rico, it was determined
that the calibration
record for the licensee's
Sr-90 eye applicator
was missing. A previous owner of the source lost the original calibration
certificate, and his medical physics consultant
performed
a check of the source strength.
This check was performed
with an inappropriate
measurement
instrument
and resulted in an incorrect
determination
of the source strength as 0.24 Gray (Gy)/sec 0 (24 rad/sec).
The licensee obtained the source in 1994 and relied on the erroneous
source strength determination
during treatments.
Also, the source had not been decay-corrected
by either owner since 1990. NRC urged the licensee to have the eye applicator
recalibrated
and to be instructed
in the D Fc2 proper method to calculate
the decay of the source.The licensee subsequently
had the eye applicator
recalibrated
by the National Institute
of Standards
and Technology.
The resultant
recalibration
revealed a dose rate of 0.53 Gray (53 rad)/sec rather than the 0.24 Gy (24 rad)/sec used by the licensee.
The licensee had prescribed
a total dose of between 10 to 25 Gy (1000 to 2500 rad) for approximately
9-0709036 f arr&0 C. Dr Ilt, 2a
IN 96-66 December 13, 1996 70 patients, but actually administered
about twice this amount. An NRC medical consultant
has reviewed the cases and has recommended
that the patients be evaluated
for any adverse effects.Case 2. In November 1995, while reviewing
treatment
records during a routine NRC inspection
of a licensee authorized
to use a Sr-90 eye applicator
in Honolulu, Hawaii, an NRC inspector
determined
that the licensee had incorrectly
calculated
the decay of the strength of a Sr-90 eye applicator
and subsequently
delivered
doses 20 percent over the prescribed
doses to 16 patients.
The root cause of this event was the licensee improperly
calculating
the decay of the Sr-90 source. Specifically, the licensee linearly decayed the strength of the source instead of logarithmically
decaying the source strength of the eye applicator.
Before May 1995, a technologist
had correctly
calculated
the decay of the source; however, when this technologist
left, the physician
incorrectly
calculated
the source decay based on a linear decay from the previous calculations.
In addition, the incorrect
half-life
of Sr-90 was used in the calculation.
Following
a correct determination
of the source strength, the licensee determined
that 17 misadministrations
involving
16 patients occurred, from May 6, 1995 to November 16, 1995, including
one patient who was treated on both eyes. The delivered
doses range from 21.1 to 22.7 percent greater than the prescribed
dose of 40 Gy (4000 rad).Discussion
10 CFR 35.32, *Quality Management
Program," requires licensees
to develop written procedures
to meet five objectives
associated
with any brachytherapy
dose, including
assurance
that the prescribed
dose is the administered
dose.A necessary
part of this is to ensure that the dose rate emitted from an applicator
is correct. If the manufacturer's
certificate
of calibration
or original activity/dose
rate name plate is missing, the licensee should arrange with a qualified
expert to determine
the dose rate from the Sr-90 source.(For additional
details, see NRC IN 94-17, NSr-90 Eye Applicators:
Submission
of Quality Management
Plan, Calibration
and Use," dated March 11, 1994.)Failure to implement
the Quality Management
Rule and make required reports may subject a licensee to orders, civil penalties, and notices of violation.
In view of the nature of the cited events, it appears worthwhile
to review some of the properties
of Sr-90 eye applicators
and the related processes
for decay correction
over time. New Sr-90 eye applicators
typically
contain a 2 gigabecquerel (GBq) [54 millicurie(mCi)]
source, exhibiting
a surface dose rate of about 0.50 Gy (50 rad)/sec.
The half-life
of the parent Sr-90 is 28.5 yrs [maximum beta energy equal to 0.54 mega-electron
volts (MeY)], and the yttrium-90 (Y-90) daughter half-life
is 64.2 hrs (beta-max, 2.27 MeV);therefore, both isotopes are in equilibrium
on the eye applicator.
Since Sr-90 and Y-90 are in equilibrium, emissions
from both isotopes must be accounted
for in dosimetry
calculations.
IN 96-66 December 13, 1996 The dose rate (D,) at a time (t) can be calculated
from the initial dose rate (De) at the time of the most recent calibration
with the following
formula: D = D -(e-^t) (FI)where e, the base of the natural logarithm
(2.718), is raised to the power -Xt and is referred to as the 'decay factor' (df), where -X --0.693/Tx, T. is the half-life
of the isotope, and t is the elapsed time. For Sr-90, TX-28.5 years; therefore, X -(0.693)/(28.5 yrs) = 0.0243 yr'. The values for df can be used to determine
the fraction of original activity remaining
after t years. These values can then be used to calculate
dose rates by using the following
formula: D,= Dao df (F2)The fraction of activity remaining
after a given number of years from the original measurement
date is given in Table 1 (Attachment
1).For example An eye applicator
calibrated
by the manufacturer
on January 1, 1978, delivered an initial dose rate ( Do) of 0.75 Gy/sec (75 rad/sec) on contact. If, on January 1, 1996, the eye applicator
needs to be used, the elapsed time (in years) since calibration
is 18, and from Table 1, df = 0.646 for Sr-90.Using formula F2: D, = bo. df D18yaM -(0.75 Gy/sec)(0.646)
bigyea -0.485 Gy/sec (48.5 rad/sec)
IN 96-66 December 13, 1996 Table I may be extended using formula F1 and the value X -0.0243 yr' for Sr-90. Other values of df that need to be evaluated
by licensees
will need to be re-calculated
by using the appropriate
half-life
for that isotope.Alternatively, a semi-logarithmic
plot of the above data will yield a straight line, which may be extended beyond 25 years.This information
notice requires no specific action nor written response.
If you have any questions
about the information
in this notice, please contact one of the technical
contacts listed below or the appropriate
regional office.Donald A. Cool, D rector Division of Industrial
and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
Technical
contacts:
Jose M. Diaz-Velez, RII (404) 331-7438 E-mail: jxd2@nrc.gov
Emilio M. Garcia, RIV (510) 975-0239 E-mail: emg@nrc.gov
James A. Smith, NMSS (301) 415-7904 E-mail: jas4@nrc.gov
Attachments:
1. List of Recently Issued NMSS Information
Notices 2. List of Recently Issued NRC Information
Notices 42 T7SS I (/4e
Attachment
I IN 96-66 December 13, 1996 Page 1 of I TABLE 1 FRACTION (EXPRESSED
AS DECIMAL) OF ORIGINAL SR-90 ACTIVITY REMAINING
AFTER (t) YEARS Years (t) df Years (t) df Years (t) df Years (t) df.25 0.994 6.5 0.854 12.75 0.734 19 0.63.5 0.988 6.75 0.849 13 0.729 19.25 0.626.75 0.982 7 0.844 13.25 0.725 19.5 0.623 1 0.976 7.25 0.838 13.5 0.72 19.75 0.619 1.25 0.97 7.5 0.833 13.75 0.716 20 0.615 1.5 0.964 7.75 0.828 14 0.712 20.25 0.611 1.75 0.958 8 0.823 14.25 0.707 20.5 0.608 2 0.953 8.25 0.818 14.5 0.703 20.75 0.604 2.25 0.947 8.5 0.813 14.75 0.699 21 0.6 2.5 0.941 8.75 0.808 15 0.695 21.25 0.597 2.75 0.935 9 0.804 15.25 0.69 21.5 0.593 3 0.93 9.25 0.799 15.5 0.686 21.75 0.589 3.25 0.924 9.5 0.794 15.75 0.682 22 0.586 3.5 0.918 9.75 0.789 16 0.678 22.25 0.582 3.75 0.913 10 0.784 16.25 0.674 22.5 0.579 4 0.907 10.25 0.78 16.5 0.67 22.75 0.575 4.25 0.902 10.5 0.775 16.75 0.666 23 0.572 4.5 0.896 10.75 0.77 17 0.662 23.25 0.568 4.75 0.891 11 0.765 17.25 0.658 23.5 0.565 5 0.886 11.25 0.761 17.5 0.654 23.75 0.562 5.25 0.88 11.5 0.756 17.75 0.65 24 0.558 5.5 0.875 11.75 0.752 18 0.646 24.25 0.555 5.75 0.87 12 0.747 18.25 0.642 24.5 0.551 6 0.864 12.25 0.743 18.5 0.638 24.75 0.548 6.25 0.859 12.5 0.738 18.75 0.634 25 0.545 Attachment
2 IN 96-66 December 13, 1996 Page 1 of I UST OF RECENTLY ISSUED NMSS INFORMATION
NOTICES Information
Date of Notice No. Subject Issuance Issued to 96-63 96-57 96-54 96-53 96-52 96-51 Potential
Safety Issue Regarding
the Shipment of Fissile Material Incident-Reporting
Require-ments Involving
Intakes, During a 24-Hour Period that May Cause a Total Effective
Dose Equivalent
in Excess of 0.05 Sv (5 rem)Vulnerability
of Stainless Steel to Corrosion
When Sensitized
Retrofit to Amersham 660 Posilock Radiography
Camera to Correct Incon-sistency in 10 CFR Part 34 Compatibility
Cracked Insertion
Rods on Troxler Model 3400 Series Portable Moisture Density Gauges Residual Contamination
Remaining
in Krypton-85 Handling System After Venting 12/05196 10/30196 10/17/96 10115/96 09/26/96 09/11196 All U.S. Nuclear Regulatory
Commission
licensees authorized
to possess special nuclear material in unsealed quantities
greater than a critical mass All U.S. Nuclear Regulatory
Commission
licensees All material licensees All industrial
radiography
licensees All U.S. Nuclear Regulatory
Commission
portable gauge licensees
and vendors All material licensees
' >Attachment
3 IN 96-66 December 13, 1996 Page 1 of I UST OF RECENTLY ISSUED NRC INFORMATION
NOTICES Information
Date of Notice No. Subject Issuance Issued to 96-65 96-64 96-63 96-62 96-61 96-60 Undetected
Accumulation
of Gas in Reactor Coolant System and Inaccurate
Reactor Water Level Indication
During Shutdown Modifications
to Con-tainment Blowout Panels Without Appropriate
Design Controls Potential
Safety Issue Regarding
the Shipment of Fissile Material Potential
Failure of the Instantaneous
Trip Function of General Electric RMS-9 Programmers
Failure of a Main Steam Safety Valve to Reseat Caused by an Improperly
Installed
Release Nut Potential
Common-Mode
Post-Accident Failure of Residual Heat Removal Heat Exchangers
1211 1/96 12/10196 12/05196 11120196 11/20/96 11/14/96 All holders of OLs or CPs for nuclear power reactors All holders of OLs or CPs for nuclear reactors All U.S. Nuclear Regulatory
Commission
licensees
authorized
to possess special nuclear material in unsealed quantities
greater than a critical mass All holders of OLs and CPs for nuclear power plants All holders of OLs or CPs for nuclear power.reactors All holders of OLs or CPs for nuclear power reactors OL = Operating
License CP = Construction
Permit
IN 96-66.December 13, 1996 Table 1 may be extended using formula FH and the value x -0.0243 yr 1 for Sr-90. Other values of df that need to be evaluated
by licensees
will need to be re-calculated
by using the appropriate
half-life
for that isotope.Alternatively, a semi-logarithmic
plot of the above data will yield a straight line, which may be extended beyond 25 years.This information
notice requires no specific action nor written response.
If you have any questions
about the information
in this notice, please contact one of the technical
contacts listed below or the appropriate
regional office.Donald A. Cool, Director Division of Industrial
and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
Technical
contacts: Jose M. Diaz-Velez, RII (404) 331-7438 E-mail: jxd2@nrc.gov
Emilio M. Garcia, RIV (510) 975-0239 E-mail: emg@nrc.gov
James A. Smith, NMSS (301) 415-7904 E-mail: jas4enrc.gov
Attachments:
1. List of Recently 2. List of Recently Issued NMSS Information
Notices Issued NRC Information
Notices Official Record Copy S:\Jsmith\imns5350.JAS
OFC IMAB I E IMAB lIMAB I IMOB I Tech Ed I KANE JASmith SLMerchant
LWCamper o JMPiccone
o EKraus o DATE 1 11/26/96 11/26/96 1 10/28/96 10/29/96 8/01/96 OFC J JE I OGC I DD/IMNS I D/IMNS I NAME JLiebermano
SATreby o FCCombso DACool DATE 08/07/96 1 1/07/96 11/12/96 I 11/29/96-COWVER E = COVER & Attachment
N -NO COPY o- See Previous Concurrence
eIN 96-##'J November .1996 Table 1 may be extended using formula F1 and the value A = 0.0243 yr" for Sr-90. Other values of df that need to be evaluated
by licensees
will need to be re-calculated
by using the appropriate
half-life
for that isotope.Alternatively, a semi-logarithmic
plot of the above data will yield a straight line, which may extended beyond 25 years.This information
notice requires no specific action nor written response.
If you have any questions
about the information
in this notice, please contact one of the technical
contacts listed below or the appropriate
regional office.Donald A. Cool, Director Division of Industrial
and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
Contacts: Jose M. Diaz-Velez, RII (404) 331-7438 Internet:
JXD2@NRC.GOV
Emilio M. Garcia, RIV (510) 975-0239 Internet:
EMG@NRC.GOV
James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC.GOV
Attachments:
1. Table of decay factors 2. List of Recently Issue(3. List of Recently Issue(fffirial Rernrd COnY Svisr d NMSS Information
Notices d NRC Information
Notices nith\imns5350JAS
OFC IMAB lE IMAB lIMAB lIMOB j Tech Ed NAME JASmi SLM@f@I~nt
LWCamper o JMPiccone
o EKraus @DATE it /96 i 10/8/ 9 6 10/29/96 8/01/96 OFC OE I OGC DD/IMNS DlIMNS NAME JLieberman@
SATreby @ FCCombs@ _____ __ _ _l DATE 08/07/96 11/07/96 11/12/96 ///t11/96= COVER E = COVER & Attachment
N = NO COPY ?--See Previous Concurrence
N 96-Il-N ovember 91996 This information
notice requires no specific action nor written respons .If you have any questions
about the information
in this notice, please c tact one of the technical
contacts listed below or the appropriate
reglo 1 office.Donald A. Cool, Director, Division of Industrial
and Medical Nuclear Sa ty Office of Nuclear terial Safety and Safeguards
Contacts:
Jose M. Diaz-Velez, RI (404) 331-7438 Internet:
JXD2@NRC.GOV
Emilio M. Garcia, RIV (510) 975-0239 Internet:
EMG@NRC.GOV
James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC.GOV
Attachments:
1. Table of decay factors 2. List of Recently Issued NMS Information
Notices 3. List of Recently Issued MR Information
Notices Official Record Copy 5: \smitinins5350.JAS
OFC IMAB I E IMAB//1S IMAB I IMOB I Tech E NAME JASmithm SL e rc nt LWCamper o JMPiccone
a EKraus o DATE t/ /14/96 A/ 96 10/28/96 10/29/96 8/01/96 OFC OE l OGC DD/IMNS D/IMNS NAME JLiebermanq/
SATreby o FCCombso DACool DATE 08/07/9 11/07/96 11/12/96 / /96 C = COVER E M OVER h Attachment
N a NO COPY o- See Previous Concurrence
- . N 96-##a *-i ovember .1996 D 18year " (0.75 Gy/sec)(0.646)
blyrs, 0G 0.485 Gy/sec Table 1 may be extended using formula F1 and the value A 0.0243 yr-.Alternatively, a semi-logarithmic
plot of the above dat will yield a straight line, which may extended beyond 20 years.This information
notice requires no specific actio nor written response.
If you have any questions
about the information
in t s notice, please contact one of the technical
contacts listed below or t appropriate
regional office.Donald .Cool. Director Divis on of Industrial
and M ical Nuclear Safety Ofice of Nuclear Material Safety and Safeguards
Contacts:
Jose M. Diaz-Velez, (404) 331-7438 Internet:JMD2@NRC.
V Emilio M. Garci , RIV (510) 975-0239/Internet:EM
C.GOV James A. S ,th NMSS (301) 415- 904 Internet- AS4@NRC.GOV
Attachments:
1. List of Recent y Issued NMSS Information
Notices 2. List of Rece ly Issued NRC Information
Notices Official Recordo S:\jsmith\imns5350.JAS
OFC IMA E IMAB jI I I MOB I Tech Ed i NAME I ant LWCamper o JMPiccone
@ EKraus o DATE / /1196 le /6///96 10/28/96 10/29/96 8/01/96 OFC / OE I OGC DD/IMNS D/IMNS lAM JLiebermano
SATreby o FCCombso DACool D0/07/96 11/07/96 11/12/96 / /96 ,COVER E = COVER & Attachment
N = NO COPY @- See Previous Concurrence
N 96-ft<iovember
,1996 D (0.75 Gy/sec)(0.646)
.0.485 Gy/sec Table 1 may be etended using formula F1 and the value X -0.0243 yr 1.Alternatively, a mi-logarithmic
plot of the above data will yield a straight line, which may ext nded beyond 20 years.This information
noti requires no specific action nor written response.
If you have any questions
bout the information
in this notice, please contact (one of) the technical
c tact(s) listed below or the appropriate
regional office.Donald A. Cool, Director Division of Industrial
and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
Contacts:
Jose M. Diaz-Velez, RII (404) 331-7438 Internet:JMD2@NRC.GOY
Emilio M. Garcia, RIV (510) 975-0239 Internet:EMG@NRC.GOV
James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC.GOV
Attachments:
1. List of Recently Issued NMSS Information
Notices 2. List of Recently Issued NRC Information
Notices Official Record Copy S:\Jsmith\imns5350.JAS
\OFC qIMABiLW B IM4AB -IMOB l E\Tech Ed NAME JASm1 i SL chant LWCamper a JMPiccone
c EKraus o DATE I I 1/96 _ / j 10/28/96 10/29/96 8/01/96 OFC OE OGC DD/IMNS D/IMNS NAME JLiebermano
SATreby a F (Cm DACool DATE 08/07/96 11/07/96 / /96 C a COVER E a CUVLK & Attacnment
N = mU LUr1'u- aee rrevmuUs IA0ICUIIrCLM.
,N 96-##' "-'-6ctober
,1996 ble8.. -(0.75 Gy/sec)(0.646)
l 0.4 y/sec Table 1 may be extended using fo ula F1 and the value X -0.0243 yre.Alternatively, a semi-logarithmic
lot of the above data will yield a straight line, which may extended beyond 20 ars.This information
notice requires no sp ific action nor written response.
If you have any questions
about the in frma ion in this notice, please contact (one of) the technical
contact(s)
listed elow or the appropriate
regional office.Donald A. -ool, Director Division o Industrial
and Medical Ntclear Safety Office of N clear Material Safety and Safegu rds Contacts:
Jose M. Diaz-Velez, RII (404) 331-7438 Internet:JMD2@NRC.
GOY Emilio M. Garcia, RIV (510) 975-0239 Internet:EMG@NRC.GOV
James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC .GOV Attachments:
1. List of Recently Issued NMSS Information
Notices 2. List of Recently Issued NRC Information
Notices Official Record Copy S:\Jsmithi\mns5350.JAS
\OFC IMAB AB IMAB I l IMOB l \l,Tech EdlNAME JASai R SUM nt LWCamper a JMPiccone
o EKraus o DATE / -J/ 10/28/96 10/29/96 8/01/96 OFC OE DD/IMNS D/IMNS KANE JLiebermano
S ireb NIL FCCombs DACool DATE 08/07/96 l/ /1/96 / /96 / /96 aCOVER E a COVER & Attachment
K = ND COPY o- See Previous Concurrence
\
C, 6 I< ~N 96-#t 4 October ,1996 We have Dlew. -(0.75 Gy/sec)(0.646)
Table I may be extended using formula FH and the value X -0.0243 yr 1.Alternatively, a semi-icgarithmic
plot of the above data will yield a straight line, which may extended be~yond 20 years.This information
notice requires no specific action nor written response.
If you have any questions
about the information
in this notice, please contact (one of) the technical
contact(s)
listed below or the appropriate
regional office.Donald A. Cool, Director Division of Industrial
and Medical Nuclear Safety Office cf Nuclear Material and Safrguards
Safety Contacts: Jose M. Diaz-Velez, RII (404) 331-7438 Internet:JMD2@NRC.60V
Emilio M. Garcia, RIV (510) 975-0239 Internet:EMG@NRC.GOY
James A. Smith, NMSS (301) 415-7904 Internet:JAS4@NRC.GOV
Attachments:
1. List 2. List Official of Recently of Recently Record CODY Issued NMSS Information
Notices Issued NRC Information
Notices SA:smithkimtns535GJAS
OFC IMAB E IMAB Tech NAME JASmi S on rchant C rer EKraus o DATE It /1 /96 /96 96 /09 /96 8/01/96 OFC OE lOGC lDD/IMNS l D/IMNS l~KANE JLiebermano
SATreby FCCombs DACool DATE 08/07/96 / /96 I /96 / /96:* COVER E a COVER & Attachment
N = NO COPY e- See Previous Concurrence
A 'IN 96-##August ,1996 This informat n not1ce requires no specific action nor written response.
If you have any qu tions about the information
in this notice, please contact (one of) the techn cal contact(s)
listed below or the appropriate
regional office.Donald A. Cool, Director Division of Industrial
and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
Contacts:
Jose M. Diaz-Velez, RII (404) 331-7438 Emilio M. Garcia, RIV (510) 975-0239 James A. Smith, NMSS (301) 415-7904 Attachments:
1. List of Recently Issued NMSS Information
Notices 2. List of Recently Issued NRC Information
Notices Official Record Copy G:\imns5350.JAS , )OFC IMAB l E I OGC lTech Ed NAME JASmi'W per SATreby EKraus a DATE *in /96 __ /________
\___96 / /96 8/01/96 OFC \ lI I DD/IMNS l D/IMNS lNAME Q jeerman FCCombs DACool DATE ___9_ / /96: w COVER 'E i. COVER & Attachment
N = NO COPY o- See Previous Concurrence
|
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|
list | - Information Notice 1996-01, Potential For High Post-Accident Closed-Cycle Cooling Water Temperatures to Disable Equipment Important to Safety (3 January 1996)
- Information Notice 1996-01, Potential for High Post-Accident Closed-Cycle Cooling Water Temperatures to Disable Equipment Important to Safety (3 January 1996)
- Information Notice 1996-02, Inoperability of Power-Operated Relief Valves Masked by Downstream Indications During Testing (5 January 1996, Topic: Stroke time)
- Information Notice 1996-03, Main Steam Safety Valve Setpoint Variation as a Result of Thermal Effects (5 January 1996)
- Information Notice 1996-03, Main Steam Safety Valve Setpoint Variation As a Result of Thermal Effects (5 January 1996)
- Information Notice 1996-04, Incident Reporting Requirements for Radiography Licensees (10 January 1996, Topic: Brachytherapy)
- Information Notice 1996-05, Partial Bypass of Shutdown Cooling Flow from Reactor Vessel (18 January 1996, Topic: Reactor Vessel Water Level)
- Information Notice 1996-06, Design & Testing Deficiencies of Tornado Dampers at Nuclear Power Plants (25 January 1996)
- Information Notice 1996-07, Slow Five Percent Scram Insertion Times Caused by Viton Diaphragms in Scram Solenoid Pilot Valves (26 January 1996)
- Information Notice 1996-08, Thermally Induced Pressure Locking of a High Pressure Coolant Injection Gate Valve (5 February 1996, Topic: Anchor Darling, Cold shutdown justification)
- Information Notice 1996-09, Damage in Foreign Steam Generator Internals (12 February 1996, Topic: Earthquake)
- Information Notice 1996-10, Potential Blockage by Debris of Safety System Piping Which Is Not Used During Normal Operation or Tested During Surveillances (13 February 1996)
- Information Notice 1996-10, Potential Blockage by Debris of Safety System Piping Which is Not Used During Normal Operation or Tested During Surveillances (13 February 1996)
- Information Notice 1996-11, Ingress of Demineralizer Resins Increases Potential For Stress Corrosion Cracking of Control Rod Drive Mechanism Penetrations (14 February 1996)
- Information Notice 1996-11, Ingress of Demineralizer Resins Increases Potential for Stress Corrosion Cracking of Control Rod Drive Mechanism Penetrations (14 February 1996)
- Information Notice 1996-12, Control Rod Insertion Problems (15 February 1996)
- Information Notice 1996-13, Potential Containment Leak Paths Through Hydrogen Analysis (26 February 1996)
- Information Notice 1996-14, Degradation of Radwaste Facility Equipment at Millstone Nuclear Power Station, Unit 1 (1 March 1996)
- Information Notice 1996-15, Unexpected Plant Performance During Performance of New Surveillance (8 March 1996)
- Information Notice 1996-16, BWR Operation with Indicated Flow Less than Natural Circulation (14 March 1996)
- Information Notice 1996-17, Reactor Operation Inconsistent with the Updated Final Safety Analysis Report (18 March 1996)
- Information Notice 1996-18, Compliance with 10 CFR Part 20 for Airborne Thorium (25 March 1996, Topic: Brachytherapy)
- Information Notice 1996-19, Failure of Tone Alert Radios to Activate When Receiving a Shortened Activation Signal (2 April 1996)
- Information Notice 1996-20, Demonstration of Associated Equipment Compliance with 10 CFR 34.20 (4 April 1996, Topic: Brachytherapy)
- Information Notice 1996-21, Safety Concerns Related to the Design of the Door Interlock Circuit on Nucletron High-Dose Rate and Pulsed Dose Rate Remote Afterloading Brachytherapy Devices (10 April 1996, Topic: Brachytherapy)
- Information Notice 1996-22, Improper Equipment Settings Due to Use of Nontemperature-Compensated Test Equipment (11 April 1996, Topic: Brachytherapy)
- Information Notice 1996-23, Fires in Emergency Diesel Generator Exciters During Operation Following Undetected Fuse Blowing (22 April 1996, Topic: Brachytherapy)
- Information Notice 1996-24, Preconditioning of Molded-Case Circuit Breakers Before Surveillance Testing (25 April 1996, Topic: Brachytherapy)
- Information Notice 1996-25, Traversing In-Core Probe Overwithdrawn at Lasalle County Station, Unit 1 (30 April 1996, Topic: Brachytherapy)
- Information Notice 1996-26, Recent Problems with Overhead Cranes (30 April 1996, Topic: Brachytherapy)
- Information Notice 1996-26, Recent Problems With Overhead Cranes (30 April 1996)
- Information Notice 1996-27, Potential Clogging of High Pressure Safety Injection Throttle Valves During Recirculation (1 May 1996, Topic: Brachytherapy)
- Information Notice 1996-28, Suggested Guidance Relating to Development and Implementation of Corrective Action (1 May 1996, Topic: Brachytherapy)
- Information Notice 1996-29, Requirements in 10 CFR Part 21 for Reporting and Evaluating Software Errors (20 May 1996, Topic: Brachytherapy)
- Information Notice 1996-30, Inaccuracy of Diagnostic Equipment for Motor-Operated Butterfly Valves (21 May 1996)
- Information Notice 1996-31, Cross-Tied Safety Injection Accumulators (22 May 1996)
- Information Notice 1996-32, Implementation of 10 CFR 50.55a(g) (6) (II) (A), Augmented Examination of Reactor Vessel (5 June 1996, Topic: Non-Destructive Examination)
- Information Notice 1996-32, Implementation of 10 CFR 50.55a(g) (6) (ii) (A), Augmented Examination of Reactor Vessel (5 June 1996, Topic: Nondestructive Examination)
- Information Notice 1996-33, Erroneous Data From Defective Thermocouple Results in a Fire (24 May 1996, Topic: Reverse polarity)
- Information Notice 1996-33, Erroneous Data from Defective Thermocouple Results in a Fire (24 May 1996, Topic: Reverse polarity)
- Information Notice 1996-34, Hydrogen Gas Ignition During Closure Welding of a VSC-24 Multi-Assembly Sealed Basket (31 May 1996)
- Information Notice 1996-35, Failure of Safety Systems on Self-Shielded Irradiators Because of Inadequate Maintenance and Training (11 June 1996)
- Information Notice 1996-36, Degradation of Cooling Water Systems Due to Icing (12 June 1996, Topic: High winds, Ultimate heat sink, Frazil ice)
- Information Notice 1996-37, Inaccurate Reactor Water Level Indication and Inadvertent Draindown During Shutdown (18 June 1996, Topic: Reactor Vessel Water Level)
- Information Notice 1996-38, Results of Steam Generator Tube Examinations (21 June 1996)
- Information Notice 1996-39, Estimates of Decay Heat Using ANS 5.1 Decay Heat Standard May Vary Significantly (5 July 1996)
- Information Notice 1996-40, Defciencies in Material Dedication and Procurement Practices and in Audits of Vendors (7 October 1996, Topic: Coatings, Troxler Moisture Density Gauge)
- Information Notice 1996-41, Effects of a Decrease in Feedwater Temperature on Nuclear Instrumentation (26 July 1996)
- Information Notice 1996-42, Unexpected Opening of Multiple Safety Relief Valves (5 August 1996, Topic: Reactor Vessel Water Level)
- Information Notice 1996-43, Failures of General Electric Magne-Blast Circuit Breakers (2 August 1996)
... further results |
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