ENS 50500
ENS Event | |
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15:00 Sep 24, 2014 | |
Title | Agreement State Report - Unable to Retract Radiography Camera Source |
Event Description | The following information was obtained from the State of Arkansas via email:
Mistras Group, Inc., ARK-1034-03310, reported the inability to retract a 2.738 TBq (74 Ci) Ir-192 source (Source QSA Global Model A424-9, Serial 10270G) into the radiography exposure device (QSA Global, Model 880 Delta, Serial D9086) on 9/24/2014. During the morning of September 24, 2014, the radiographer's written statements indicated that a piece of pipe shifted and rolled onto the guide tube during an exposure. This action caused a crimp in the guide tube and the source was not retractable. The radiography crew reset the boundaries to 2.0 mR/hr and contacted the home office. The RSO of the Baton Rouge, Louisiana office responded to the site. The RSO reported that upon arrival, the radiography crew had reset the boundaries to 2.0 mR/hr. The source was located in the collimator and the crimp location was 6 inches from the collimator. The RSO placed 50 pounds of lead shot over the collimator and placed a metal plate under the crimp. The RSO then used a hammer to 'round out' the guide tube allowing the source to be retracted into the camera. The guide tube was removed from service and the crank-out was inspected for any damage. The RSO stated that he wore an SRD [self-reading dosimeter] with a 0-200 mR range and this was found to be off-scale. The RSO was instructed by the State to submit the dosimetry badge for immediate processing. The pocket dosimeters for the radiography crew were reported to read 1 mR and 0 mR respectively. No other survey readings, other than the 2 mR/hr boundary, have been reported. The State is tracking this event under Arkansas Event Number AR-2014-007 and is continuing to investigate this incident.
The following report was received from the State of Arkansas via email: The State of Arkansas is providing the following update to event 50500. Dosimetry results for the individual performing the source retrieval were received and indicated that a dose of 1.0 millirem had been received. A dose reconstruction performed by the licensee indicated that the highest possible dose received during the source retrieval was 4.538 millirem. The State of Arkansas agrees that there was no overexposure as a result of this source retrieval. The licensee provided corrective actions that included review of the licensee's source retrieval procedures and reporting procedures. The [State of Arkansas] Department considers this event to be closed. Notified R4DO (Kellar) and NMSS Events Notification via email. |
Where | |
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Mistras Group. Inc. El Dorado, Arkansas (NRC Region 4) | |
License number: | Ark-1034-0331 |
Organization: | Arkansas Department Of Health |
Reporting | |
Agreement State | |
Time - Person (Reporting Time:+166.08 h6.92 days <br />0.989 weeks <br />0.227 months <br />) | |
Opened: | Steve Mack 13:05 Oct 1, 2014 |
NRC Officer: | Howie Crouch |
Last Updated: | Dec 4, 2014 |
50500 - NRC Website | |
Mistras Group. Inc. with Agreement State | |
WEEKMONTHYEARENS 505002014-09-24T15:00:00024 September 2014 15:00:00
[Table view]Agreement State Agreement State Report - Unable to Retract Radiography Camera Source 2014-09-24T15:00:00 | |