ENS Event | |
|---|---|
05:00 Aug 23, 2018 | |
| Title | Illinois Agreement State Report - Medical Event |
| Event Description | The following information was received from the State of Illinois via email:
The RSO [Radiation Safety Officer] for Rush University Medical Center in Chicago (IL-01766-01) notified the Agency [Illinois Emergency Management Agency, Bureau of Radiation Safety] at approximately 1600 [CDT] today that a reportable event transpired while attempting to administer Y-90 TheraSpheres. The licensee attempted to administer Y-90 to a patient this morning and was unable to move the dose through the tubing to the patient. A different administration route was selected and also met with inability to deliver the dose. This treatment was aborted. A second patient was scheduled for Y-90 administration this afternoon. The licensee encountered resistance in the second delivery system and was unable to deliver the Y-90 dose. This treatment was also aborted. Both patients were imaged and verified to not have been administered any Y-90. The licensee is currently performing a PET [Positron Emission Tomography] scan on the delivery systems to look for occlusions that may have impeded delivery. IEMA [Illinois Emergency Management Agency] staff has requested information on lot numbers for the individual doses. Details are pending from the licensee on root cause and lot numbers. The licensee will not administer any additional doses from this lot number until root cause is identified. Further details are pending. Illinois Item No.: IL180033 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 | |
|---|---|
| Rush University Medical Center Chicago, Illinois (NRC Region 3) | |
| License number: | IL-01766-01 |
| Organization: | Illinois Emergency Mgmt. Agency |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+13.2 h0.55 days <br />0.0786 weeks <br />0.0181 months <br />) | |
| Opened: | Gary Forsee 18:12 Aug 23, 2018 |
| NRC Officer: | Dong Park |
| Last Updated: | Aug 23, 2018 |
| 53560 - NRC Website | |
Rush University Medical Center with Agreement State | |
WEEKMONTHYEARENS 569422024-01-31T06:00:00031 January 2024 06:00:00
[Table view]Agreement State Medical Underdose ENS 567662023-09-28T05:00:00028 September 2023 05:00:00 Agreement State Underdose to Patient ENS 535602018-08-23T05:00:00023 August 2018 05:00:00 Agreement State Illinois Agreement State Report - Medical Event ENS 465432010-11-23T06:00:00023 November 2010 06:00:00 Agreement State Agreement State Report Involving a Medical Event 2024-01-31T06:00:00 | |