ENS Event | |
|---|---|
15:04 Jan 24, 2025 | |
| Title | Medical Event |
| Event Description | The following information was provided by the licensee's radiation safety officer (RSO) via phone:
During an audit performed on 04/16/2025, it was discovered, that on 01/24/2025, a patient had received a dose to the liver that was greater than 20 percent of the prescribed dose. The prescribed activity was 24.3 mCi of Y-90 microsphere, an equivalent dose of 21.95 grays to the liver. The spreadsheet containing the activity verification incorrectly listed the activity as 26.9 mCi. The actual activity administered to the patient was 29.8 mCi, an equivalent dose of 26.9 grays, which is 22.6 percent (4.95 grays) greater than the prescribed dose to the liver. The RSO intends to contact the patient and doctor. 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. |
| Where | |
|---|---|
| Mercy Hospital, St. Louis St. Louis, Missouri (NRC Region 3) | |
| License number: | 24-00794-03 |
| Organization: | Mercy Hospital, St. Louis |
| Reporting | |
| 10 CFR 35.3045(a)(1)(i) | |
| Time - Person (Reporting Time:+1989.07 h82.878 days <br />11.84 weeks <br />2.725 months <br />) | |
| Opened: | Jamie Eisenberg 11:08 Apr 17, 2025 |
| NRC Officer: | Bill Nytko |
| Last Updated: | Apr 17, 2025 |
| 57669 - NRC Website | |
Mercy Hospital, St. Louis with 10 CFR 35.3045(a)(1)(i) | |
WEEKMONTHYEARENS 576692025-01-24T15:04:00024 January 2025 15:04:00
[Table view]10 CFR 35.3045(a)(1)(i) Medical Event 2025-01-24T15:04:00 | |