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| {{#Wiki_filter:UNITED STATES NUCLEAR REGULATORY | | {{#Wiki_filter:UNITED STATES |
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| COMMISSION | | NUCLEAR REGULATORY COMMISSION |
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| ===OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS===
| | OFFICE OF NUCLEAR MATERIAL SAFETY AND SAFEGUARDS |
| WASHINGTON, D.C. 20555-0001 July 6, 1999 NRC INFORMATION
| |
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| |
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| NOTICE 99-23: SAFETY CONCERNS RELATED TO REPEATED CONTROL UNIT FAILURES OF THE NUCLETRON CLASSIC MODEL HIGH-DOSE-RATE | | WASHINGTON, D.C. 20555-0001 July 6, 1999 NRC INFORMATION NOTICE 99-23: SAFETY CONCERNS RELATED TO REPEATED |
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| |
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| REMOTE AFTERLOADING
| | CONTROL UNIT FAILURES OF THE NUCLETRON |
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| |
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| BRACHYTHERAPY
| | CLASSIC MODEL HIGH-DOSE-RATE REMOTE |
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| |
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| DEVICES | | AFTERLOADING BRACHYTHERAPY DEVICES |
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| |
|
| ==Addressees== | | ==Addressees== |
| : | | : |
| All U.S. Nuclear Regulatory
| | authorized to use |
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| |
|
| Commission (NRC) medical licensees | | All U.S. Nuclear Regulatory Commission (NRC) medical licensees |
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| |
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| authorized
| | remote afterloaders. |
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| |
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| to use brachytherapy
| | brachytherapy sources in Nucletron Classic Model high-dose-rate (HDR) |
| | |
| sources in Nucletron | |
| | |
| Classic Model high-dose-rate (HDR) remote afterloaders. | |
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| |
|
| ==Purpose== | | ==Purpose== |
| : NRC is issuing this information | | : |
| | unit failures with Nucletron |
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| |
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| notice to alert you to ongoing control unit failures with Nucletron Classic Model HDR devices. You should review this information | | NRC is issuing this information notice to alert you to ongoing control to your facilities |
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| |
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| for applicability | | for applicability |
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| |
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| to your facilities
| | Classic Model HDR devices. You should review this information patient |
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| |
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| and consider actions, as appropriate, to minimize the impact of such failures on patient treatments
| | failures on |
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| |
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| and personnel | | and consider actions, as appropriate, to minimize the impact of such |
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| exposures.
| | suggestions contained in this information notice |
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| |
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| However, suggestions | | treatments and personnel exposures. However, response is required. |
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| |
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| contained
| | are not NRC requirements; therefore, no specific action nor written |
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| |
|
| in this information
| | ==Description of Circumstances== |
| | : |
| | Classic Model HDR |
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| |
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| notice are not NRC requirements;
| | By January 1996, NRC was aware of three incidents where the Nucletron |
| therefore, no specific action nor written response is required.Description
| |
|
| |
|
| of Circumstances:
| | unit failures exposed a |
| By January 1996, NRC was aware of three incidents
| |
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| |
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| where the Nucletron
| | control units failed (locked up) for unexplained reasons. These control |
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| |
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| Classic Model HDR control units failed (locked up) for unexplained | | Classic Model HDR. |
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| |
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| reasons. These control unit failures exposed a deficiency
| | deficiency in the design of the door interlock circuitry for the Nucletron |
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| |
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| in the design of the door interlock
| | and providing |
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| |
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| circuitry
| | Nucletron issued a Safety Alert on March 4, 1996, describing this problem |
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| |
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| for the Nucletron
| | This safety alert was also issued |
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| |
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| Classic Model HDR.Nucletron
| | information on the proper operator response to such failures. discussed |
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| |
|
| issued a Safety Alert on March 4, 1996, describing
| | 10, 1996, that |
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| |
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| this problem and providing information
| | as an attachment to NRC Information Notice 96-21, issued on April |
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| |
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| on the proper operator response to such failures.
| | these three reported |
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| |
|
| This safety alert was also issued as an attachment
| | both the door interlock problem and the control unit failures. Following |
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| |
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| to NRC Information | | field modifications to these devices to |
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| |
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| Notice 96-21, issued on April 10, 1996, that discussed both the door interlock
| | failures of the control unit, Nucletron Corporation made |
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| |
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| problem and the control unit failures.
| | unexplained control unit |
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| |
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| Following
| | correct the door interlock failure mechanism and to eliminate the |
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| |
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| these three reported failures of the control unit, Nucletron
| | failures. |
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| |
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| Corporation
| | four in 1998, and three |
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| |
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| made field modifications
| | Following these modifications, two similar failures were reported in 1997, since the 1996 corrective |
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| |
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| to these devices to correct the door interlock | | to date in 1999. These additional nine control unit failures, reported |
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| failure mechanism
| | However, no further |
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| |
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| and to eliminate
| | action, indicate a ongoing problem with unexplained control unit failures. has continued |
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| the unexplained
| | interlocks. Nucletron |
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| |
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| control unit failures.Following
| | problems have been reported with the operation of the door cause of |
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| |
|
| these modifications, two similar failures were reported in 1997, four in 1998, and three to date in 1999. These additional
| | the root |
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| |
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| nine control unit failures, reported since the 1996 corrective
| | to investigate the ongoing control unit failures and now believes it has found |
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| |
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| action, indicate a ongoing problem with unexplained
| | We understand that |
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| |
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| control unit failures.
| | the failures and subsequently developed appropriate corrective measures. |
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| |
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| However, no further problems have been reported with the operation
| | before |
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| |
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| of the door interlocks.
| | the newly developed corrective measures are presently undergoing testing |
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| |
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| Nucletron
| | implementation. |
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| |
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| has continued to investigate
| | c |
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| |
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| the ongoing control unit failures and now believes it has found the root cause of the failures and subsequently
| | 0t rn4-] dwotaqq-O2s q4o1o |
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| developed
| | eas |
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| |
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| appropriate
| | -o4 cW |
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| corrective
| | '-I |
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| |
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| measures.
| | IN 99-23 July 6, 1999 Discussion: |
| | were reported. In |
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| We understand
| | In all 12 reported control unit failures no patient or personnel overexposures |
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| |
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| that the newly developed
| | when communications with the |
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| |
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| corrective
| | each case the treatment unit continued to operate, as designed, unit continues the |
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| |
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| measures are presently
| | control unit was lost. In this event, the microprocessor in the treatment |
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| |
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| undergoing
| | the failure occurs, halting upon |
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| |
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| testing before implementation.
| | preprogrammed treatment to the catheter being treated when |
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| |
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| 0t rn4-] dwotaqq-O2s
| | or during the last catheter in |
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| |
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| q4o1o -o4 cW c eas
| | completion. If the failure occurs during a single catheter treatment Otherwise, it will |
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| |
|
| '-I IN 99-23 July 6, 1999 Discussion:
| | a multi-catheter operation, then the treatment will proceed to completion. catheters |
| In all 12 reported control unit failures no patient or personnel
| |
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| |
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| overexposures
| | any remaining |
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| |
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| were reported.
| | terminate with completion of the catheter being treated, leaving on an inoperative |
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| |
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| In each case the treatment
| | display |
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| |
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| unit continued
| | untreated. Most users, however, when faced with a blank or frozen |
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| |
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| to operate, as designed, when communications
| | Stop" button on the control |
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| |
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| with the control unit was lost. In this event, the microprocessor
| | control unit, immediately abort the treatment, using the "Emergency |
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| |
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| in the treatment | | on the Safety Alert procedures) |
| | unit. The "Treatment Interrupt" button (called for in the 1" step |
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| |
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| unit continues
| | Irrespective of the method |
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| |
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| the preprogrammed | | on the control unit is rendered inoperative by the control unit failure. |
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| |
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| treatment
| | can subsequently be read from |
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| |
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| to the catheter being treated when the failure occurs, halting upon completion.
| | of terminating the patient's treatment, the actual treatment data |
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| |
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| If the failure occurs during a single catheter treatment
| | the treatment unit, using a handheld terminal device. |
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| |
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| or during the last catheter in a multi-catheter
| | of a control unit failure and, at |
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| |
|
| operation, then the treatment
| | Most patients receive less than the prescribed dose in the event |
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| |
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| will proceed to completion.
| | must be revised to reflect the |
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| |
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| Otherwise, it will terminate
| | the discretion of the Authorized User, either the Written Directive |
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| |
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| with completion
| | after repair or replacement of |
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| |
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| of the catheter being treated, leaving any remaining | | actual dose given or the remaining portion of the treatment given |
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| |
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| catheters untreated.
| | unit failures has resulted in |
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| |
|
| Most users, however, when faced with a blank or frozen display on an inoperative
| | the defective control unit. To date, none of the reported control |
|
| |
|
| control unit, immediately | | the control unit removes the first |
|
| |
|
| abort the treatment, using the "Emergency
| | overexposures or misadministrations. However, the failure of |
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| |
|
| Stop" button on the control unit. The "Treatment
| | of excessive radiation exposures |
|
| |
|
| Interrupt" button (called for in the 1" step on the Safety Alert procedures)
| | layer of radiation safety protection. At this point, the avoidance |
| on the control unit is rendered inoperative
| |
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| |
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| by the control unit failure. Irrespective
| | unit or operator |
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| |
|
| of the method of terminating | | depends upon either the continued proper operation of the treatment |
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| |
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| the patient's
| | intervention. |
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| |
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| treatment, the actual treatment
| | and included a copy of the |
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| |
|
| data can subsequently
| | NRC previously issued Information Notice 96-21 on April 10, 1996, as an attachment. This Safety |
|
| |
|
| be read from the treatment
| | Nucletron issued Safety Alert, addressing the control unit failures, the Control Unit stops |
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| |
|
| unit, using a handheld terminal device.Most patients receive less than the prescribed
| | Alert sets forth a series of four steps to be taken if, for any reason, should ensure that the treatment |
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| |
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| dose in the event of a control unit failure and, at the discretion
| | updating the status of the treatment in progress. These steps |
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| |
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| of the Authorized
| | enter the treatment room. You |
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| |
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| User, either the Written Directive
| | is interrupted and the source retracted before licensee personnel |
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| |
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| must be revised to reflect the actual dose given or the remaining
| | vendor, as contained in its |
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| |
|
| portion of the treatment
| | are encouraged to follow these recommendations from the device |
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| |
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| given after repair or replacement
| | to these control unit failures |
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| |
|
| of the defective | | Safety Alert of March 4, 1996. Any questions you may have related |
|
| |
|
| control unit. To date, none of the reported control unit failures has resulted in overexposures
| | should be addressed to your |
|
| |
|
| or misadministrations. | | and related corrective actions, or to get a copy of the Safety Alert, Nucletron Corporation representative. |
|
| |
|
| However, the failure of the control unit removes the first layer of radiation
| | IN 99-23 July 6, 1999 If you have any |
|
| |
|
| safety protection.
| | This information notice requires no specific action nor written response. |
|
| |
|
| At this point, the avoidance
| | technical contact listed below |
|
| |
|
| of excessive
| | questions about the information in this notice, please contact the |
|
| |
|
| radiation
| | or the appropriate regional office. |
|
| |
|
| exposures depends upon either the continued
| | Donald A. Cool, Director |
|
| |
|
| proper operation
| | Division of Industrial and |
|
| |
|
| of the treatment
| | Medical Nuclear Safety |
|
| |
|
| unit or operator intervention.
| | Office of Nuclear Material Safety |
|
| |
|
| NRC previously
| | and Safeguards |
|
| |
|
| issued Information
| | Contact: Robert L. Ayres, NMSS |
|
| |
|
| Notice 96-21 on April 10, 1996, and included a copy of the Nucletron
| | (301) 415-5746 E-mail: rxal nrc.gov |
|
| |
|
| issued Safety Alert, addressing
| | Attachments: |
| | 1. List of Recently Issued NMSS Information Notices |
|
| |
|
| the control unit failures, as an attachment.
| | 2. List of Recently Issued NRC Information Notices |
|
| |
|
| This Safety Alert sets forth a series of four steps to be taken if, for any reason, the Control Unit stops updating the status of the treatment
| | ItWt4 a,-TV |
|
| |
|
| in progress.
| | K-' I |
|
| |
|
| These steps should ensure that the treatment is interrupted
| | Attachment 1 IN 99-23 July 6, 1999 LIST OF RECENTLY ISSUED |
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| |
|
| and the source retracted
| | NMSS INFORMATION NOTICES |
|
| |
|
| before licensee personnel
| | Information Date of |
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| |
|
| enter the treatment
| | Subject Issuance Issued to |
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| |
|
| room. You are encouraged
| | Notice No. |
|
| |
|
| to follow these recommendations
| | 10 CFR 34.43(a)(1): Effective 6/25/99 Industrial Radiography Licensees |
|
| |
|
| from the device vendor, as contained
| | 99-22 Date for Radiographer Certification |
|
| |
|
| in its Safety Alert of March 4, 1996. Any questions
| | and Plans for Enforcement Discretion |
|
| |
|
| you may have related to these control unit failures and related corrective
| | 6/25/99 All material and fuel cycle |
|
| |
|
| actions, or to get a copy of the Safety Alert, should be addressed
| | 99-20 Contingency Planning for the |
|
| |
|
| to your Nucletron
| | Year 2000 Computer Problem licensees and certificate holders |
|
| |
|
| Corporation
| | Update on NRC's Year 2000 6/14/99 All material and fuel cycle |
|
| |
|
| representative.
| | 99-18 Activities for Materials Licensees licensees and certificate |
|
| |
|
| IN 99-23 July 6, 1999 This information
| | and Fuel Cycle Licensees and holders |
|
| |
|
| notice requires no specific action nor written response.
| | Certificate Holders |
|
| |
|
| If you have any questions
| | Federal Bureau of Investigation's 5/28 All U.S. Nuclear Regulatory |
|
| |
|
| about the information
| | 99-16- Nuclear Site Security Program Commission fuel cycle, power |
|
| |
|
| in this notice, please contact the technical
| | reactor, and non-power reactor |
|
| |
|
| contact listed below or the appropriate
| | licensees |
|
| |
|
| regional office.Donald A. Cool, Director Division of Industrial
| | Incident Involving the Use of 4/16199 All medical use licensees |
|
| |
|
| and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
| | 99-11 Radioactive lodine-1 31 Problems Encountered When 3/24/99 All medical licensees authorized |
|
| |
|
| Contact: Robert L. Ayres, NMSS (301) 415-5746 E-mail: rxal nrc.gov Attachments:
| | 99-09 to conduct high-dose-rate (HDR) |
| 1. List of Recently Issued NMSS Information
| | Manually Editing treatment Data |
|
| |
|
| Notices 2. List of Recently Issued NRC Information
| | on the Nucletron Microselectron- remote after loading |
|
| |
|
| Notices ItWt4 a,-TV
| | HDR (New) Model 105-999 brachytherapy treatments |
|
| |
|
| K-'I Attachment
| | 1998 Enforcement Sanctions as 3/19/99 All U. S. Nuclear Regulatory |
|
| |
|
| 1 IN 99-23 July 6, 1999 LIST OF RECENTLY ISSUED NMSS INFORMATION
| | 99-06 Commission licensees |
|
| |
|
| NOTICES Information
| | a Result of Deliberate Violations |
|
| |
|
| Date of Notice No. Subject Issuance Issued to 99-22 10 CFR 34.43(a)(1):
| | of NRC Employee Protection |
| Effective
| |
|
| |
|
| 6/25/99 Industrial
| | Requirements |
|
| |
|
| Radiography
| | Inadvertent Discharge of Carbon 3/8/99 All holders of licenses for nuclear |
|
| |
|
| Licensees Date for Radiographer
| | 99-05 power, research, and test reactor, Dioxide Fire Protection System |
|
| |
|
| ===Certification===
| | and fuel cycle facilities |
| and Plans for Enforcement | |
|
| |
|
| Discretion
| | and Gas Migration |
|
| |
|
| 99-20 99-18 99-16-99-11 99-09 99-06 99-05 99-04 99-03 Contingency | | Unplanned Radiation Exposures 3/8/99 All radiography licensees |
|
| |
|
| Planning for the 6/25/99 Year 2000 Computer Problem Update on NRC's Year 2000 6/14/99 Activities
| | 99-04 to Radiographers, Resulting From |
|
| |
|
| for Materials
| | Failures to Follow Proper Radiation |
|
| |
|
| Licensees and Fuel Cycle Licensees
| | Safety Procedures |
|
| |
|
| and Certificate
| | Exothermic Reactions Involving 1/29/99 All operating uranium recovery |
|
| |
|
| Holders Federal Bureau of Investigation's
| | 99-03 Dried Uranium Oxide Powder facilities that produce oxide |
|
| |
|
| 5/28 Nuclear Site Security Program Incident Involving
| | (Yellowcake) powder (U308) (yellowcake) |
|
| |
|
| the Use of 4/16199 Radioactive
| | v> Attachment 2 IN 99-23 July 6, 1999 LIST OF RECENTLY ISSUED |
|
| |
|
| lodine-1 31 Problems Encountered
| | NRC INFORMATION NOTICES |
|
| |
|
| When 3/24/99 Manually Editing treatment
| | Information Date of |
|
| |
|
| Data on the Nucletron
| | Subject Issuance Issued to |
|
| |
|
| Microselectron- HDR (New) Model 105-999 1998 Enforcement
| | Notice No. |
|
| |
|
| Sanctions
| | 99-22 10 CFR 34.43(a)(1); Effective 7/6/99 Industrial Radiography Licensees |
|
| |
|
| as 3/19/99 a Result of Deliberate
| | Date for Radiographer Certification |
|
| |
|
| Violations
| | and Plans for Enforcement Discretion |
|
| |
|
| of NRC Employee Protection | | Recent Plant Events Caused 6/25/99 All holders of licenses for nuclear |
|
| |
|
| ===Requirements===
| | 99-21 power, test, and research reactors |
| Inadvertent
| |
|
| |
|
| Discharge
| | By Human Performance Errors |
|
| |
|
| of Carbon 3/8/99 Dioxide Fire Protection
| | 6/25/99 All material and fuel cycle |
|
| |
|
| System and Gas Migration Unplanned
| | 99-20 Contingency Planning for the |
|
| |
|
| Radiation
| | Year 200 Computer Problem licensees and certificate holders |
|
| |
|
| Exposures
| | Rupture of the Shell Side of a 6/23/99 All holders of operating licenses |
|
| |
|
| 3/8/99 to Radiographers, Resulting
| | 99-19 or construction permits for nuclear |
|
| |
|
| From Failures to Follow Proper Radiation Safety Procedures
| | Feedwater Heater at the Point |
|
| |
|
| Exothermic
| | Beach Nuclear Plant power reactors |
|
| |
|
| Reactions
| | Update on NRC's Year 2000 6/14/99 All material and fuel cycle |
|
| |
|
| Involving
| | 99-18 licensees and certificate holders |
|
| |
|
| 1/29/99 Dried Uranium Oxide Powder (Yellowcake)
| | Activities for Materials Licensees |
| All material and fuel cycle licensees
| |
|
| |
|
| and certificate | | and Fuel Cycle Licensees and |
|
| |
|
| holders All material and fuel cycle licensees
| | Certificate Holders |
|
| |
|
| and certificate
| | Problems Associated with Post-Fire 6/3/99 All holders of OL for nuclear |
|
| |
|
| holders All U.S. Nuclear Regulatory
| | 99-17 Safe-Shutdown Circuit Analyses power reactors, except those who |
|
| |
|
| Commission
| | have permanently ceased |
|
| |
|
| fuel cycle, power reactor, and non-power
| | operations and have certified that |
|
| |
|
| reactor licensees All medical use licensees All medical licensees
| | the fuel has been permanently |
|
| |
|
| authorized
| | removed from the reactor |
|
| |
|
| to conduct high-dose-rate (HDR)remote after loading brachytherapy
| | Federal Bureau of Investigation's 5/28 All U.S. Nuclear Regulatory |
|
| |
|
| treatments
| | 99-16- Nuclear Site Security Program Commission fuel cycle, power |
|
| |
|
| ===All U. S. Nuclear Regulatory===
| | reactor, and non-power reactor |
| Commission
| |
|
| |
|
| licensees All holders of licenses for nuclear power, research, and test reactor, and fuel cycle facilities | | licensees |
|
| |
|
| All radiography | | Misapplication of 10 CFR Part 71 5/27/99 All holders of operating licenses or |
|
| |
|
| licensees All operating
| | 99-15 construction permits for nuclear |
|
| |
|
| uranium recovery facilities
| | Transportation Shipping Cask |
|
| |
|
| that produce oxide powder (U 3 0 8) (yellowcake)
| | Licensing Basis to 10 CFR Part 50 power reactors |
| v>Attachment
| |
|
| |
|
| 2 IN 99-23 July 6, 1999 LIST OF RECENTLY ISSUED NRC INFORMATION
| | Design Basis |
|
| |
|
| NOTICES Information
| | OL = Operating License |
|
| |
|
| Date of Notice No. Subject Issuance Issued to 99-22 10 CFR 34.43(a)(1);
| | CP = Construction Permit |
| Effective
| |
|
| |
|
| 7/6/99 Industrial
| | -1,-23 |
| | <lI >, 6, 1999 response. If you have any |
|
| |
|
| Radiography
| | This information notice requires no specific action nor written |
|
| |
|
| Licensees Date for Radiographer
| | the technical contact listed below |
|
| |
|
| ===Certification===
| | questions about the information in this notice, please contact |
| and Plans for Enforcement
| |
|
| |
|
| Discretion
| | or the appropriate regional office. |
|
| |
|
| 99-21 99-20 99-19 99-18 99-17 99-16-99-15 Recent Plant Events Caused By Human Performance
| | (ORIG. SIGNED BY) |
| | Donald A. Cool, Director |
|
| |
|
| Errors Contingency
| | Division of Industrial and |
|
| |
|
| Planning for the Year 200 Computer Problem Rupture of the Shell Side of a Feedwater
| | Medical Nuclear Safety |
|
| |
|
| Heater at the Point Beach Nuclear Plant Update on NRC's Year 2000 Activities
| | Office of Nuclear Material Safety |
|
| |
|
| for Materials
| | and Safeguards |
|
| |
|
| Licensees and Fuel Cycle Licensees
| | Contact: Robert L. Ayres, NMSS |
|
| |
|
| and Certificate
| | (301) 415-5746 E-mail: rxal nrc.gov |
|
| |
|
| Holders 6/25/99 6/25/99 6/23/99 6/14/99 All holders of licenses for nuclear power, test, and research reactors All material and fuel cycle licensees
| | Attachments: |
| | 1. List of Recently Issued NMSS Information Notices |
|
| |
|
| and certificate
| | 2. List of Recently Issued NRC Information Notices |
|
| |
|
| holders All holders of operating
| | DOCUMENT NAME: A & G:%AYRES\IN99C-XX.WPD |
|
| |
|
| licenses or construction
| | * See previous concurrence |
| | |
| permits for nuclear power reactors All material and fuel cycle licensees
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| removed from the reactor All U.S. Nuclear Regulatory
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| Circuit Analyses Federal Bureau of Investigation's
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| 5/28 Nuclear Site Security Program Misapplication
| | AJ June XX, 1999 This information notice requires no specific action nor written response. If you have any |
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| of 10 CFR Part 71 Transportation
| | questions about the information in this notice, please contact the technical contact listed below |
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| Shipping Cask Licensing
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| Basis to 10 CFR Part 50 Design Basis 5/27/99 OL = Operating
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| <lI-1,-23>, 6, 1999 This information
| | Office of Nuclear Material Safety |
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| notice requires no specific action nor written response.
| | and Safeguards |
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| If you have any questions
| | Contact: Robert L. Ayres, NMSS |
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| about the information
| | (301) 415-5746 E-mail: rxal @nrc.gov / |
| | Attachments: |
| | 1. List of Recently Issued NMSS Information Notices |
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| in this notice, please contact the technical
| | 2. List of Recently Issued NRC Information Notices A |
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| regional office.(ORIG. SIGNED BY)Donald A. Cool, Director Division of Industrial
| | DOCUMENT NAME: A & G:\AYRES\IN99C-XX.WPD |
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| and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
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| Contact: Robert L. Ayres, NMSS (301) 415-5746 E-mail: rxal nrc.gov Attachments:
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| 1. List of Recently Issued NMSS Information
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| Notices 2. List of Recently Issued NRC Information
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| Notices DOCUMENT NAME: A & G:%AYRES\IN99C-XX.WPD
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| * See previous concurrence | | * See previous concurrence |
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| OFFICE JMSIB C Editor* I MSIB* N Ms MSIB* I N NAME RAyres/liucy | | OFFICE MSIB IC Editor I MSIB* I lISIB l MSIB IN |
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| EKraus FSturz LCamper DCool DATE 6/ 09 /99 6109 /99 6115/99 6/15/99 6/28/99 s ^=rloEIf AI aMen n rn0PV A4~w O r K~~~AML REGO~ I u %L W
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| notice requires no specific action nor written response.
| | NAME RAyrestic EKraus FSturz LCamper DC_______ |
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| | .z~ IN 99-XX |
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| | June xx, 1999 DOCUMENT NAME: A & G:\AYRES\IN99C-XX.WPD tfqff / |
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| | OFFICE MSIB C Editor I MSIB MSIB N MSIB l NN/ |
| | NAME RAyres/jcy EKraus FSturz LCamper DCooI |
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| regional office.Donald A. Cool, Director Division of Industrial
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| | DATE 16/ 9 /99 6/ 09 /99 6/ IU< /99 6/ IS /99 16/ ,199 OFFICIAL RECORD COPY |
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| and Medical Nuclear Safety Office of Nuclear Material Safety and Safeguards
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| Contact: Robert L. Ayres, NMSS (301) 415-5746 E-mail: rxal @nrc.gov /Attachments:
| | 6 I~- IN 99-XX |
| 1. List of Recently Issued NMSS Information
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| Notices 2. List of Recently Issued NRC Information
| | L/ June xx, 1999 DOCUMENT NAME: A & G:\AYRES\1N99C-XX.WPD |
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| Notices A''<//DOCUMENT NAME: A & G:\AYRES\IN99C-XX.WPD
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| * See previous concurrence | | * See previous concurrence |
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| OFFICE MSIB I C Editor I MSIB* I lISIB l MSIB I N NAME RAyrestic | | OFFICE _ SBIC Eio*I M~- S9fIN MI |
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| EKraus FSturz LCamper DC_______DATE 6/ 09 /99 6/09 /99 6/15/99 6/15/99 6/.t1/99 OFFICIAL RECORD COPY
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| .z~ IN 99-XX June xx, 1999 DOCUMENT NAME: A & G:\AYRES\IN99C-XX.WPD
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| tfqff /£fL411V5.
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| --/ 0 :"//* See orevious concurrence
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| OFFICE MSIB C Editor I MSIB MSIB N MSIB l NN /NAME RAyres/jcy
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| EKraus FSturz LCamper DCooI ,, DATE 16/ 9 /99 6/ 09 /99 6/ IU< /99 6/ IS /99 16/ ,199 OFFICIAL RECORD COPY I//', , Ii
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| OFFICE _ SBIC Eio*I M~- S9fIN MI NAME RAyres/kicy
| | NAME RAyres/kicy EKraus - erCool D |
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| EKraus D -erCool DATE 1 6/ 09 /99 6/09 /99 Is__ 199 6/ ____99__ 6/ /99 OFFICIAL RECORD COPY}}
| | DATE 16/ 09 /99 6/09 /99 Is__ 199 6/ |
| | ____99__ 6/ /99 OFFICIAL RECORD COPY}} |
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| {{Information notice-Nav}} | | {{Information notice-Nav}} |
Safety Concerns Related to Repeated Control Unit Failures of the Nucletron Classic Model High-Dose-Rate Remote Afterloading Brachytherapy DevicesML031040399 |
Person / Time |
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Site: |
Beaver Valley, Millstone, Hatch, Monticello, Calvert Cliffs, Dresden, Davis Besse, Peach Bottom, Browns Ferry, Salem, Oconee, Mcguire, 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: |
07/06/1999 |
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From: |
Cool D NRC/NMSS/IMNS |
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To: |
|
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References |
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IN-99-023, NUDOCS 9907010001 |
Download: ML031040399 (9) |
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Similar Documents at Beaver Valley, Millstone, Hatch, Monticello, Calvert Cliffs, Dresden, Davis Besse, Peach Bottom, Browns Ferry, Salem, Oconee, Mcguire, 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 Contamination2006-07-13013 July 2006 E-mail from M. 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 [[:Mcguire]] 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 [[:Mcguire]] 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. 20555-0001 July 6, 1999 NRC INFORMATION NOTICE 99-23: SAFETY CONCERNS RELATED TO REPEATED
CONTROL UNIT FAILURES OF THE NUCLETRON
CLASSIC MODEL HIGH-DOSE-RATE REMOTE
AFTERLOADING BRACHYTHERAPY DEVICES
Addressees
authorized to use
All U.S. Nuclear Regulatory Commission (NRC) medical licensees
remote afterloaders.
brachytherapy sources in Nucletron Classic Model high-dose-rate (HDR)
Purpose
unit failures with Nucletron
NRC is issuing this information notice to alert you to ongoing control to your facilities
for applicability
Classic Model HDR devices. You should review this information patient
failures on
and consider actions, as appropriate, to minimize the impact of such
suggestions contained in this information notice
treatments and personnel exposures. However, response is required.
are not NRC requirements; therefore, no specific action nor written
Description of Circumstances
Classic Model HDR
By January 1996, NRC was aware of three incidents where the Nucletron
unit failures exposed a
control units failed (locked up) for unexplained reasons. These control
Classic Model HDR.
deficiency in the design of the door interlock circuitry for the Nucletron
and providing
Nucletron issued a Safety Alert on March 4, 1996, describing this problem
This safety alert was also issued
information on the proper operator response to such failures. discussed
10, 1996, that
as an attachment to NRC Information Notice 96-21, issued on April
these three reported
both the door interlock problem and the control unit failures. Following
field modifications to these devices to
failures of the control unit, Nucletron Corporation made
unexplained control unit
correct the door interlock failure mechanism and to eliminate the
failures.
four in 1998, and three
Following these modifications, two similar failures were reported in 1997, since the 1996 corrective
to date in 1999. These additional nine control unit failures, reported
However, no further
action, indicate a ongoing problem with unexplained control unit failures. has continued
interlocks. Nucletron
problems have been reported with the operation of the door cause of
the root
to investigate the ongoing control unit failures and now believes it has found
We understand that
the failures and subsequently developed appropriate corrective measures.
before
the newly developed corrective measures are presently undergoing testing
implementation.
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IN 99-23 July 6, 1999 Discussion:
were reported. In
In all 12 reported control unit failures no patient or personnel overexposures
when communications with the
each case the treatment unit continued to operate, as designed, unit continues the
control unit was lost. In this event, the microprocessor in the treatment
the failure occurs, halting upon
preprogrammed treatment to the catheter being treated when
or during the last catheter in
completion. If the failure occurs during a single catheter treatment Otherwise, it will
a multi-catheter operation, then the treatment will proceed to completion. catheters
any remaining
terminate with completion of the catheter being treated, leaving on an inoperative
display
untreated. Most users, however, when faced with a blank or frozen
Stop" button on the control
control unit, immediately abort the treatment, using the "Emergency
on the Safety Alert procedures)
unit. The "Treatment Interrupt" button (called for in the 1" step
Irrespective of the method
on the control unit is rendered inoperative by the control unit failure.
can subsequently be read from
of terminating the patient's treatment, the actual treatment data
the treatment unit, using a handheld terminal device.
of a control unit failure and, at
Most patients receive less than the prescribed dose in the event
must be revised to reflect the
the discretion of the Authorized User, either the Written Directive
after repair or replacement of
actual dose given or the remaining portion of the treatment given
unit failures has resulted in
the defective control unit. To date, none of the reported control
the control unit removes the first
overexposures or misadministrations. However, the failure of
of excessive radiation exposures
layer of radiation safety protection. At this point, the avoidance
unit or operator
depends upon either the continued proper operation of the treatment
intervention.
and included a copy of the
NRC previously issued Information Notice 96-21 on April 10, 1996, as an attachment. This Safety
Nucletron issued Safety Alert, addressing the control unit failures, the Control Unit stops
Alert sets forth a series of four steps to be taken if, for any reason, should ensure that the treatment
updating the status of the treatment in progress. These steps
enter the treatment room. You
is interrupted and the source retracted before licensee personnel
vendor, as contained in its
are encouraged to follow these recommendations from the device
to these control unit failures
Safety Alert of March 4, 1996. Any questions you may have related
should be addressed to your
and related corrective actions, or to get a copy of the Safety Alert, Nucletron Corporation representative.
IN 99-23 July 6, 1999 If you have any
This information notice requires no specific action nor written response.
technical contact listed below
questions about the information in this notice, please contact the
or the appropriate regional office.
Donald A. Cool, Director
Division of Industrial and
Medical Nuclear Safety
Office of Nuclear Material Safety
and Safeguards
Contact: Robert L. Ayres, NMSS
(301) 415-5746 E-mail: rxal nrc.gov
Attachments:
1. List of Recently Issued NMSS Information Notices
2. List of Recently Issued NRC Information Notices
ItWt4 a,-TV
K-' I
Attachment 1 IN 99-23 July 6, 1999 LIST OF RECENTLY ISSUED
NMSS INFORMATION NOTICES
Information Date of
Subject Issuance Issued to
Notice No.
10 CFR 34.43(a)(1): Effective 6/25/99 Industrial Radiography Licensees
99-22 Date for Radiographer Certification
and Plans for Enforcement Discretion
6/25/99 All material and fuel cycle
99-20 Contingency Planning for the
Year 2000 Computer Problem licensees and certificate holders
Update on NRC's Year 2000 6/14/99 All material and fuel cycle
99-18 Activities for Materials Licensees licensees and certificate
and Fuel Cycle Licensees and holders
Certificate Holders
Federal Bureau of Investigation's 5/28 All U.S. Nuclear Regulatory
99-16- Nuclear Site Security Program Commission fuel cycle, power
reactor, and non-power reactor
licensees
Incident Involving the Use of 4/16199 All medical use licensees
99-11 Radioactive lodine-1 31 Problems Encountered When 3/24/99 All medical licensees authorized
99-09 to conduct high-dose-rate (HDR)
Manually Editing treatment Data
on the Nucletron Microselectron- remote after loading
HDR (New) Model 105-999 brachytherapy treatments
1998 Enforcement Sanctions as 3/19/99 All U. S. Nuclear Regulatory
99-06 Commission licensees
a Result of Deliberate Violations
of NRC Employee Protection
Requirements
Inadvertent Discharge of Carbon 3/8/99 All holders of licenses for nuclear
99-05 power, research, and test reactor, Dioxide Fire Protection System
and fuel cycle facilities
and Gas Migration
Unplanned Radiation Exposures 3/8/99 All radiography licensees
99-04 to Radiographers, Resulting From
Failures to Follow Proper Radiation
Safety Procedures
Exothermic Reactions Involving 1/29/99 All operating uranium recovery
99-03 Dried Uranium Oxide Powder facilities that produce oxide
(Yellowcake) powder (U308) (yellowcake)
v> Attachment 2 IN 99-23 July 6, 1999 LIST OF RECENTLY ISSUED
NRC INFORMATION NOTICES
Information Date of
Subject Issuance Issued to
Notice No.
99-22 10 CFR 34.43(a)(1); Effective 7/6/99 Industrial Radiography Licensees
Date for Radiographer Certification
and Plans for Enforcement Discretion
Recent Plant Events Caused 6/25/99 All holders of licenses for nuclear
99-21 power, test, and research reactors
By Human Performance Errors
6/25/99 All material and fuel cycle
99-20 Contingency Planning for the
Year 200 Computer Problem licensees and certificate holders
Rupture of the Shell Side of a 6/23/99 All holders of operating licenses
99-19 or construction permits for nuclear
Feedwater Heater at the Point
Beach Nuclear Plant power reactors
Update on NRC's Year 2000 6/14/99 All material and fuel cycle
99-18 licensees and certificate holders
Activities for Materials Licensees
and Fuel Cycle Licensees and
Certificate Holders
Problems Associated with Post-Fire 6/3/99 All holders of OL for nuclear
99-17 Safe-Shutdown Circuit Analyses power reactors, except those who
have permanently ceased
operations and have certified that
the fuel has been permanently
removed from the reactor
Federal Bureau of Investigation's 5/28 All U.S. Nuclear Regulatory
99-16- Nuclear Site Security Program Commission fuel cycle, power
reactor, and non-power reactor
licensees
Misapplication of 10 CFR Part 71 5/27/99 All holders of operating licenses or
99-15 construction permits for nuclear
Transportation Shipping Cask
Licensing Basis to 10 CFR Part 50 power reactors
Design Basis
OL = Operating License
CP = Construction Permit
-1,-23
, 6, 1999 response. If you have any
This information notice requires no specific action nor written
the technical contact listed below
questions about the information in this notice, please contact
or the appropriate regional office.
(ORIG. SIGNED BY)
Donald A. Cool, Director
Division of Industrial and
Medical Nuclear Safety
Office of Nuclear Material Safety
and Safeguards
Contact: Robert L. Ayres, NMSS
(301) 415-5746 E-mail: rxal nrc.gov
Attachments:
1. List of Recently Issued NMSS Information Notices
2. List of Recently Issued NRC Information Notices
DOCUMENT NAME: A & G:%AYRES\IN99C-XX.WPD
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IN 99-XX
AJ June XX, 1999 This information notice requires no specific action nor written response. If you have any
questions about the information in this notice, please contact the technical contact 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
Contact: Robert L. Ayres, NMSS
(301) 415-5746 E-mail: rxal @nrc.gov /
Attachments:
1. List of Recently Issued NMSS Information Notices
2. List of Recently Issued NRC Information Notices A
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DOCUMENT NAME: A & G:\AYRES\IN99C-XX.WPD
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DATE 6/ 09 /99 6/09 /99 6/15/99 6/15/99 6/.t1/99 OFFICIAL RECORD COPY
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DATE 16/ 09 /99 6/09 /99 Is__ 199 6/
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list | - Information Notice 1999-01, Deterioration of High-Efficiency Particulate Air Filters in a Pressurized Water Reactor Containment Fan Cooler Unit (20 January 1999)
- Information Notice 1999-02, Guidance to Users on the Implementation of a New Single-Source Dose-Calculation Formalism and Revised Air-Kerma Strength Standard for Iodine-125 Sealed Sources (21 January 1999, Topic: Brachytherapy)
- Information Notice 1999-03, Exothermic Reactors Involving Dried Uranium Oxide Powder (Yellowcake) (29 January 1999, Topic: Brachytherapy)
- Information Notice 1999-04, Unplanned Radiation Exposures to Radiographers, Resulting from Failures to Follow Proper Radiation Safety Procedures (1 March 1999, Topic: Brachytherapy)
- Information Notice 1999-05, Inadvertent Discharge of Carbon Dioxide Fire Protection System and Gas Migration (8 March 1999, Topic: Brachytherapy)
- Information Notice 1999-06, 1998 Enforcement Sanctions as a Result of Deliberate Violations of NRC Employee Protection Requirements (19 March 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-06, 1998 Enforcement Sanctions As a Result of Deliberate Violations of NRC Employee Protection Requirements (19 March 1999, Topic: Enforcement Discretion)
- Information Notice 1999-07, Failed Fire Protection Deluge Valves & Potential Testing Deficiencies in Preaction Sprinkler Systems (22 March 1999, Topic: Safe Shutdown)
- Information Notice 1999-08, Urine Specimen Adulteration (26 March 1999, Topic: Brachytherapy)
- Information Notice 1999-09, Problems Encountered When Manually Editing Treatment Data on the Nucletron Microselectron-HDR (New) Model 105-999 (24 March 1999, Topic: Brachytherapy)
- Information Notice 1999-10, Degradation of Prestressing Tendon Systems in Prestresssed Concrete Containments (13 April 1999)
- Information Notice 1999-11, Incidents Involving the Use of Radioactive Iodine-131 (16 April 1999, Topic: Brachytherapy)
- Information Notice 1999-12, Year 2000 Computer Systems Readiness Audits (28 April 1999, Topic: Brachytherapy)
- Information Notice 1999-13, Insights from NRC Inspections of Low-and Medium-Voltage Circuit Breaker Maintenance Programs (29 April 1999, Topic: Brachytherapy)
- Information Notice 1999-14, Unanticipated Reactor Water Draindown at Quad Cities Unit 2, Arkansas Nuclear One Unit 2, & FitzPatrick (5 May 1999, Topic: Reactor Vessel Water Level, Brachytherapy)
- Information Notice 1999-15, Misapplication for 10CFR Part 71 Transportation Shipping Cask Licensing Basis to 10CFR Part 50 Design Basis (27 May 1999, Topic: Brachytherapy)
- Information Notice 1999-16, Federal Bureau of Investigation'S Nuclear Site Security Program (28 May 1999, Topic: Brachytherapy)
- Information Notice 1999-17, Problems Associated with Post-Fire Safe-Shutdown Circuit Analyses (3 June 1999, Topic: Hot Short, Safe Shutdown, Temporary Modification, Emergency Lighting, Fire Protection Program)
- Information Notice 1999-18, Update on Nrc'S Year 2000 Activities for Material Licensees and Fuel Cycle Licensees and Certificate Holders (14 June 1999, Topic: Brachytherapy)
- Information Notice 1999-19, Rupture of the Shell Side of a Feedwater Heater at the Point Beach Nuclear Plant (23 June 1999)
- Information Notice 1999-20, Contingency Planning for the Year 2000 Computer Problem (25 June 1999, Topic: Brachytherapy)
- Information Notice 1999-21, Recent Plant Events Caused by Human Performance Errors (25 June 1999, Topic: Probabilistic Risk Assessment)
- Information Notice 1999-22, 10CFR 34.43(a)(1); Effective Date for Radiographer Certification and Plans for Enforcement Discretion (25 June 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-23, Safety Concerns Related to Repeated Control Unit Failures of the Nucletron Classic Model High-Dose-Rate Remote Afterloading Brachytherapy Devices (6 July 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-24, Broad-Scope Licensees' Responsibilities for Reviewing and Approving Unregistered Sealed Sources and Devices (12 July 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-25, Year 2000 Contingency Planning Activities (10 August 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-26, Safety and Economic Consequences of Misleading Marketing Information (24 August 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-27, Malfunction of Source Retraction Mechanism in Cobalt-60 Teletherapy Treatment Units (2 September 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-28, Recall of Star Brand Fire Protection Sprinkler Heads (30 September 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-30, Failure of Double Contingency Based on Administrative Controls Involving Laboratory Sampling and Spectroscopic Analysis of Wet Uranium Waste (8 November 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-30, Failure of Double Contingency Based On Administrative Controls Involving Laboratory Sampling and Spectroscopic Analysis of Wet Uranium Waste (8 November 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-31, Operational Controls to Guard Against Inadventent Nuclear Criticality (17 November 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-31, Operational Controls To Guard Against Inadventent Nuclear Criticality (17 November 1999, Topic: Enforcement Discretion, Brachytherapy)
- Information Notice 1999-32, Effect of Year 2000 Issue on Medical Licenseess (17 December 1999, Topic: Brachytherapy)
- Information Notice 1999-32, Effect of Year 2000 Issue on Medical Licensees (17 December 1999, Topic: Brachytherapy, Overdose, Underdose)
- Information Notice 1999-33, Management Of Wastess Contaminated with Radioactive Materialss (21 December 1999, Topic: Brachytherapy)
- Information Notice 1999-33, Management of Wastes Contaminated with Radioactive Materials (21 December 1999, Topic: Brachytherapy)
- Information Notice 1999-33, Management Of Wastes Contaminated with Radioactive Materials (21 December 1999, Topic: Brachytherapy)
- Information Notice 1999-33, Management Of Wastes Contaminated With Radioactive Materials (21 December 1999, Topic: Brachytherapy)
- Information Notice 1999-34, Potential Fire Hazard in the Use of Polyalphaolefin in Testing of Air Filter (28 December 1999)
- Information Notice 1999-34, PotentialPotentialPotential FireFireFire HazardHazardHazard ininIn thetheThe UseUseUse ofofOf PolyalphaolefinPolyalphaolefinPolyalphaolefin ininIn TestingTestingTesting ofofOf AirAirAir FilterFilterFilter (28 December 1999)
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