PNO-I-94-074, A:on 941221,provides Update to Incident Involving I-131 Therapy Patient Who Left Hosp Prior to Approval by RSO on 941221.Commonwealth of Ma Notified & Region I Ofc Prepared to Respond to Media Inquiries
| ML20149J450 | |
| Person / Time | |
|---|---|
| Site: | 03000239 |
| Issue date: | 12/29/1994 |
| From: | Cahill M, Costello F NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| References | |
| PNO-I-94-074A, PNO-I-94-74A, NUDOCS 9501050215 | |
| Download: ML20149J450 (2) | |
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DCS No: 03000239941221 Date: December 29, 1994 PRELIMINARY NOTIFICATION OF EVENT OR UNUSUAL OCCURRENCE PN1-9474A This preliminary notification constitutes EARLY notice of events of POSSIBLE safety or ,
public interest significance. The information is as initially received without i verification or evaluation, and is basically all that is known by the Region I staff on this date.
Facility: Licensee Emergency Classification:
Massachusetts General Hospital Notification of Unusual Event Department of Radiation Medicine Alert Fruit Street Site Area Emergency Boston, Massachusetts 02114 General Emergency X Not Applicable Docket No.: 030-00239 License No.: 20-03814-14 Event No.: NONE Event Location Code: MAT
SUBJECT:
IODINE 131 INCIDENT - UPDATE The Radiation Safety Officer (RS0) of the Massachusetts General Hospital provided written reports dated December 22 and 28, 1994, to the NRC Region I office regarding an incident involving an iodine-131 therapy patient who left the hospital prior to approval by the RS0 on December 21, 1994. In addition to the information reported by the RSO on December 21, 1994, the licensee's reports estimate the exposure rate at one meter from the patient as approximately 4.9 millirem per hour at the time of release, and the activity remaining in the patient was 22 millicuries. The requirement for release of a patient is that the measured dose rate at one meter from the patient be less than 5 millirem per hour or the activity remaining in the patient be less than 30 millicuries. The licensee has also evaluated the potential dose to a passenger seated next to the patient during a flight the patient took to Palm Beach, Florida on December 22, 1994. Based on an estimated dose rate of 2.2 millirem per hour at one meter from the patient at the time of the flight, the licensee indicated that the dose to the passenger could be as high as 108 millirem for a three hour flight. The estimated dose is higher than the public dose limit of 100 millirem per year stated in 10 CFR 20.1301.
However, in this case, as discussed in Information Notice 94-09 " Release of Patients with Residual Radioactivity from Medical Treatment and Control of Areas due to Presence of Patients Containing Radioactivity Following Implementation of Revised 10 CFR 20",
the more specific release criteria of 10 CFR 35.75 preside.
The licensee,'s actions to prevent recurrence of a similar incident include providing written instructions to patients prior to administration of iodine-131 doses and better pre-treatment screening of patients. The licensee's written instructions inform the patient to maintain a distance of 2-3 feet from other persons to minimize their dose .
The Commonwealth of Massachusetts has been notified. The Region I Office of Public Affairs is prepared to respond to media inquiries. Region I will follow-up on the incident during the next scheduled inspection at the licensee's facility.
This information is current as of 10:00 a.m. on December 29, 1994.
CONTACTS: F. Costello M. Cahill 610-337-5169 610-337-5109 9501050215 941229 C:
N-I -074A PDR 16-
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DCS No: 03000239941221 Date: December 29,1 1994 !
PRELIMINARY NOTIFICATION OF EVENT OR UNUSUAL OCCURRENCE PN1-9474A DISTRIBUTION:
0WFN TWFN LST Mail: DCD Chairman Selin AE00 POR D0T:Trans only** !
Comm. Rogers IRM Comm. de Planque ACRS NRC Ops Ctr 0CAA NMSS OIP OIG INP0** % Q >
OCA RES NSAC** W.\5 0GC i 0PA ED0 OE OSP NRR** (Phone Verif: A. Byrdsong 504-1168 or 504-1166)
Regional Offices RI Resident Office Licensee:
" General itst for sending PPes by FAA (Reactor Licensees) .
Region I Form 83 (Rev. October 1994) i
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