ENS 53539

v t e ENS Event
04:00 Aug 2, 2018
Title	Agreement State Report - Patient Overexposure
Event Description	The following information was received via E-mail: The licensee reported to the [Ohio] Department [of Health] on 8/3/2018 that a potential medical event had occurred due to a delay in a surgical procedure. The delay was caused by the insurance company rescinding approval to remove a breast tumor until three medical opinions were obtained. The licensee implanted a 472 microCi I-125 seed [radioactive seed localization] (RSL) in the tumor on 5/29/2018 after receiving approval from the insurance company. The surgery was scheduled for 6/4/2018. The expected dose to the patient was 12.65 Rem to the tissue and 1.52 Rem EDE [Effective Dose Equivalent]. The surgery was delayed until approval from the insurance company was obtained, and was performed on 8/2/2018. The delay resulted in a tissue dose of 99.45 Rem and EDE of 11.93 Rem. A follow-up will be conducted with the routine inspection in September. Ohio State Report: OH180006 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.

ENS 53539 +/-
Where
Kettering Medical Center Kettering, Ohio (NRC Region 3)
License number:	02120580021
Organization:	Ohio Bureau Of Radiation Protection
Reporting

Agreement State
Time - Person (Reporting Time:+156.77 h6.532 days <br />0.933 weeks <br />0.215 months <br />)
Opened:	Michael J Rubadue 16:46 Aug 8, 2018
NRC Officer:	Brian Lin
Last Updated:	Aug 8, 2018
53539 - NRC Website
v • d • e

v t e Emergency Notification System
Kettering Medical Center with Agreement State
WEEKMONTHYEAR2018-08-02T04:00:00 [Table view]
[ENS list for Kettering Medical Center]

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