ENS Event | |
|---|---|
14:30 Jul 24, 2024 | |
| Title | Lost and Recovered Source |
| Event Description | The following information was provided by the licensee via phone and email:
A Class 7 package (approximately 10 Ci of Ir-192 for use in a high dose rate remote afterloader for radiation oncology) was delivered to Saint Francis Hospital, [in] Hartford, CT. The package was delivered to hospital shipping/receiving and signed for at 1030 [EDT]. The package was then routed to [the] oncology department. When reaching oncology, it appears the package was mistaken for a 'chemotherapy' package instead of a 'radiation oncology' package and placed in storage in the chemotherapy department. Later, a medical physicist anticipating delivery of the package today inquired about the package with the delivery service and was informed that the package had been delivered. The physicist then began searching for the package and was able to locate it in the chemotherapy department. The physicist retrieved the package and began the check-in process at about 1500 per standard operating procedures. The physicist stated that the package was unopened, undamaged, and still sealed. The RSO received notification from radiation oncology that the package was missing prior to when the package was eventually found. The package was stored in a secured area, but its location was unknown to trained staff for the interim period, so the decision was made to make notification of the incident. This is an initial assessment. The radiation safety staff along with management will be conducting an investigation to determine more precise timelines, details, and evaluating corrective action options to prevent recurrence. THIS MATERIAL EVENT CONTAINS A 'Category 3' LEVEL OF RADIOACTIVE MATERIAL Category 3 sources, if not safely managed or securely protected, could cause permanent injury to a person who handled them, or were otherwise in contact with them, for some hours. It could possibly - although it is unlikely - be fatal to be close to this amount of unshielded radioactive material for a period of days to weeks. These sources are typically used in practices such as fixed industrial gauges involving high activity sources (for example: level gauges, dredger gauges, conveyor gauges and spinning pipe gauges) and well logging. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf |
| Where | |
|---|---|
| Saint Francis Hospital Hartford, Connecticut (NRC Region 1) | |
| License number: | 06-00854-03 |
| Organization: | Saint Francis Hospital |
| Reporting | |
| 10 CFR 20.2201(a)(1)(i) | |
| Time - Person (Reporting Time:+3.32 h0.138 days <br />0.0198 weeks <br />0.00455 months <br />) | |
| Opened: | Gregory Hisel 17:49 Jul 24, 2024 |
| NRC Officer: | Josue Ramirez |
| Last Updated: | Jul 24, 2024 |
| 57240 - NRC Website | |
Saint Francis Hospital with 10 CFR 20.2201(a)(1)(i) | |
WEEKMONTHYEARENS 572402024-07-24T14:30:00024 July 2024 14:30:00
[Table view]10 CFR 20.2201(a)(1)(i) Lost and Recovered Source 2024-07-24T14:30:00 | |