ENS 44321: Difference between revisions
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| event date = 06/23/2008 PDT | | event date = 06/23/2008 PDT | ||
| last update date = 06/27/2008 | | last update date = 06/27/2008 | ||
| title = Potential Underdose | | title = Potential Underdose to Patient Undergoing Whole Body Radiation | ||
| event text = The following report was received from the state via e-mail: | | event text = The following report was received from the state via e-mail: | ||
On June 25, 2008 at approximately 3 pm, RHB received preliminary notification of a medical event, which occurred June 23, 2008, involving a 50% under-dose to a patient undergoing whole-body irradiation with a Co-60 teletherapy unit. The event was discovered at approximately 2 pm on June 25, 2008. RHB held the initial report to NRC until additional details could be provided by the licensee, who was still reviewing the situation with the radiation oncology department. The prescription was for total body irradiation at 17.12 minutes AP (anterior posterior), then 17.13 minutes AP, then 17.12 minutes PA (posterior anterior), then 17.13 minutes PA, for a total of 34.25 minutes AP and 34.25 minutes PA, and a total of 300 cGy. The therapist only treated 17.13 minutes AP and 17.13 minutes PA for a total dose of 150 cGy. The patient was seen by the attending physician on 6/25/08, with no known medical effects observed. There is currently no plan to re-treat the patient per the attending physician. The licensee is following up with a written report. | On June 25, 2008 at approximately 3 pm, RHB received preliminary notification of a medical event, which occurred June 23, 2008, involving a 50% under-dose to a patient undergoing whole-body irradiation with a Co-60 teletherapy unit. The event was discovered at approximately 2 pm on June 25, 2008. RHB held the initial report to NRC until additional details could be provided by the licensee, who was still reviewing the situation with the radiation oncology department. The prescription was for total body irradiation at 17.12 minutes AP (anterior posterior), then 17.13 minutes AP, then 17.12 minutes PA (posterior anterior), then 17.13 minutes PA, for a total of 34.25 minutes AP and 34.25 minutes PA, and a total of 300 cGy. The therapist only treated 17.13 minutes AP and 17.13 minutes PA for a total dose of 150 cGy. The patient was seen by the attending physician on 6/25/08, with no known medical effects observed. There is currently no plan to re-treat the patient per the attending physician. The licensee is following up with a written report. |
Latest revision as of 22:14, 1 March 2018
Where | |
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Ucla Westwood, California (NRC Region 4) | |
License number: | 1335-19 |
Organization: | California Radiation Control Prgm |
Reporting | |
Agreement State | |
Time - Person (Reporting Time:+100.55 h4.19 days <br />0.599 weeks <br />0.138 months <br />) | |
Opened: | Barbara Hamrick 11:33 Jun 27, 2008 |
NRC Officer: | Pete Snyder |
Last Updated: | Jun 27, 2008 |
44321 - NRC Website | |