ENS 50644: Difference between revisions
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| facility = University Of Cincinnati Medical Center | | facility = University Of Cincinnati Medical Center | ||
| Organization = Ohio Bureau Of Radiation Protection | | Organization = Ohio Bureau Of Radiation Protection | ||
| license number = | | license number = OH 2110-31-00 | ||
| region = 3 | | region = 3 | ||
| state = Ohio | | state = Ohio | ||
| Line 16: | Line 16: | ||
| event date = 11/26/2014 11:29 EST | | event date = 11/26/2014 11:29 EST | ||
| last update date = 11/28/2014 | | last update date = 11/28/2014 | ||
| title = Agreement State Report - Y-90 Therasphere Underdose | | title = Agreement State Report - Y-90 Therasphere Underdose to Liver | ||
| event text = The following email was received from the State of Ohio: | | event text = The following email was received from the State of Ohio: | ||
On Wednesday, November 26, 2014 at 1129 [EST], the Interventional Radiologist Authorized User [AU] physician began to administer the prescribed activity of 1.38 GBq Y-90 micro-spheres (Theraspherer) for an estimated dose of 125 Gy to segment 7 of the right liver lobe. After a couple of 20 cc syringes of saline had been pushed through the administration kit, the Nuclear Medicine technologist made an ion chamber measurement of the dose vial and tubing set and observed a very high reading of 2.5 Roentgens/hour using a Keithley 451B/RYR, serial number 2935, ion chamber with the beta window open. This was a very high measurement, so the AU physician continued to push an additional 6 syringes of saline for a total of 8 syringes through the administration set with very little reduction in the ion chamber reading. At that point the AU physician decided to call an end to the therapy. | On Wednesday, November 26, 2014 at 1129 [EST], the Interventional Radiologist Authorized User [AU] physician began to administer the prescribed activity of 1.38 GBq Y-90 micro-spheres (Theraspherer) for an estimated dose of 125 Gy to segment 7 of the right liver lobe. After a couple of 20 cc syringes of saline had been pushed through the administration kit, the Nuclear Medicine technologist made an ion chamber measurement of the dose vial and tubing set and observed a very high reading of 2.5 Roentgens/hour using a Keithley 451B/RYR, serial number 2935, ion chamber with the beta window open. This was a very high measurement, so the AU physician continued to push an additional 6 syringes of saline for a total of 8 syringes through the administration set with very little reduction in the ion chamber reading. At that point the AU physician decided to call an end to the therapy. | ||
Latest revision as of 19:07, 24 November 2018
| Where | |
|---|---|
| University Of Cincinnati Medical Center Cincinnati, Ohio (NRC Region 3) | |
| License number: | OH 2110-31-00 |
| Organization: | Ohio Bureau Of Radiation Protection |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+42.47 h1.77 days <br />0.253 weeks <br />0.0582 months <br />) | |
| Opened: | Mark Light 10:57 Nov 28, 2014 |
| NRC Officer: | Dong Park |
| Last Updated: | Nov 28, 2014 |
| 50644 - NRC Website | |