ENS 54548: Difference between revisions
Jump to navigation
Jump to search
StriderTol (talk | contribs) (StriderTol Bot insert) |
StriderTol (talk | contribs) (StriderTol Bot change) |
||
| (One intermediate revision by the same user not shown) | |||
| Line 1: | Line 1: | ||
{{ENS notification | {{ENS notification | ||
| event number = 54548 | | event number = 54548 | ||
| facility = | | facility = | ||
| Organization = Florida Bureau Of Radiation Control | | Organization = Florida Bureau Of Radiation Control | ||
| license number = 3748-2 | | license number = 3748-2 | ||
| Line 10: | Line 10: | ||
| utype = | | utype = | ||
| cfr = Agreement State | | cfr = Agreement State | ||
| emergency class = | | emergency class = Non Emergency | ||
| notification date = 02/27/2020 15:54 | | notification date = 02/27/2020 15:54 | ||
| notification by = Mark Seidensticker | | notification by = Mark Seidensticker | ||
| Line 18: | Line 18: | ||
| title = Medical Event - Hdr Underdose to Patient | | title = Medical Event - Hdr Underdose to Patient | ||
| event text = The following information was received from the state of Florida via E-mail: | | event text = The following information was received from the state of Florida via E-mail: | ||
[The licensee] reported to the BRC [Bureau of Radiation Control] on 25 Feb 2020, and e-mailed an incident report on 26 Feb 2020 at 1224 EST that on 24 Feb 2020 at 1315 EST an HDR [high dose rate] incident occurred to a patient receiving skin therapy. | [The licensee] reported to the BRC [Bureau of Radiation Control] on 25 Feb 2020, and e-mailed an incident report on 26 Feb 2020 at 1224 EST that on 24 Feb 2020 at 1315 EST an HDR [high dose rate] incident occurred to a patient receiving skin therapy. | ||
The patient was prescribed 7.5 Gray x 5 fractions, on five different parts of the left hand. On the first dose of the first fraction, it was observed that catheter numbers 1 - 15 were reversed, causing an underdose to the patient by 56.25 percent. No Authorized Users were exposed to the source or otherwise contaminated. | The patient was prescribed 7.5 Gray x 5 fractions, on five different parts of the left hand. On the first dose of the first fraction, it was observed that catheter numbers 1 - 15 were reversed, causing an underdose to the patient by 56.25 percent. No Authorized Users were exposed to the source or otherwise contaminated. | ||
Florida Incident Number: | Florida Incident Number: FL20-022 | ||
A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. | A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient. | ||
| URL = https://www.nrc.gov/reading-rm/doc-collections/event-status/event/2020/ | | URL = https://www.nrc.gov/reading-rm/doc-collections/event-status/event/2020/20200309en.html#en54548 | ||
}} | }} | ||
{{ENS-Nav}} | {{ENS-Nav}} | ||
Latest revision as of 12:52, 15 January 2021
| Where | |
|---|---|
| Florida Bureau Of Radiation Control Weston, Florida (NRC Region 1) | |
| License number: | 3748-2 |
| Organization: | Florida Bureau Of Radiation Control |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+82.9 h3.454 days <br />0.493 weeks <br />0.114 months <br />) | |
| Opened: | Mark Seidensticker 15:54 Feb 27, 2020 |
| NRC Officer: | Donald Norwood |
| Last Updated: | Feb 27, 2020 |
| 54548 - NRC Website | |