ENS Event | |
|---|---|
06:00 Nov 1, 2017 | |
| Title | Agreement State Report - Total Dose Delivered Differed from Prescribed Dose by Greater than 20% |
| Event Description | The following information was received from the State of Wisconsin via email:
On December 28, 2017, the Wisconsin Department of Health Services (DHS) received notice that the licensee identified a prostate manual brachytherapy procedure where the total dose delivered differed from the prescribed dose by 20% or more. The implant occurred in November 2017 and post-implant dosimetric analysis was performed on December 27, 2017. The prescribed dose was 110 Gy; the dose delivered to the treatment site (D90) was 56.5% of the intended dose. DHS inspectors will investigate this medical event. Event Report ID No.: WI170023 The licensee will compensate for the underdose with subsequent scheduled beam therapy. 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 | |
|---|---|
| Wheaton Franciscan Healthcare-Elmbrook Memorial Brookfield, Wisconsin (NRC Region 3) | |
| License number: | 079-1092-01 |
| Organization: | Wisconsin Radiation Protection |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+1373.83 h57.243 days <br />8.178 weeks <br />1.882 months <br />) | |
| Opened: | Megan Shober 12:50 Dec 28, 2017 |
| NRC Officer: | Steve Sandin |
| Last Updated: | Dec 28, 2017 |
| 53138 - NRC Website | |
Wheaton Franciscan Healthcare-Elmbrook Memorial with Agreement State | |
WEEKMONTHYEARENS 531382017-11-01T06:00:0001 November 2017 06:00:00
[Table view]Agreement State Agreement State Report - Total Dose Delivered Differed from Prescribed Dose by Greater than 20% 2017-11-01T06:00:00 | |