United States Nuclear Regulatory Commission - Protecting People and the Environment

Event Notification Report for September 21, 2010

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
09/20/2010 - 09/21/2010

** EVENT NUMBERS **


46249 46252 46259 46261 46262

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General Information or Other Event Number: 46249
Rep Org: WISCONSIN RADIATION PROTECTION
Licensee: MARSHFIELD CLINIC
Region: 3
City: WESTON State: WI
County:
License #: 141-1162-01
Agreement: Y
Docket:
NRC Notified By: CHRIS TIMMERMAN
HQ OPS Officer: VINCE KLCO
Notification Date: 09/14/2010
Notification Time: 12:57 [ET]
Event Date: 09/09/2010
Event Time: [CDT]
Last Update Date: 09/14/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DAVID HILLS (R3DO)
MICHELE BURGESS (FSME)

Event Text

AGREEMENT STATE REPORT - DELIVERED DOSE IS DIFFERENT FROM THE PRESCRIBED DOSE

The following information was received by facsimile:

"On September 14, 2010, the Department [Wisconsin Department of Health Services] received a facsimile from the licensee's Radiation Safety Officer (RSO) that a medical event occurred on September 9, 2010, involving a permanent implant of I-125 seeds for a prostate manual brachytherapy procedure where the total dose delivered differs from the prescribed dose by 20% or more. This is a medical event as described in DHS 157.72(1)(a)1. The prescribed dose was 145 Gy; the dose delivered was 80 Gy. The licensee uses D80 < 80% as their dose based criteria for determining medical events. Using the licensee's dose based criteria of D80 < 80% the dose received by the prostate was 55% of the intended dose. The underdose was identified during the post-implant planning for the procedure. The RSO indicated that the possible cause was the maximum insertion depth was 0.6 cm below the base of the prostate gland and all needles were implanted distal to the base resulting in the area being 'cold'. Possible corrective actions are under review by the licensee's staff and a one month post-implant CT is planned to determine the impact to the patient.

"[Department] inspectors will investigate this medical event on September 16, 2010."

Wisconsin Event Report: WI100015

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.

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General Information or Other Event Number: 46252
Rep Org: MARYLAND DEPT OF THE ENVIRONMENT
Licensee: SINAI HOSPITAL OF LIFEBRIDGE HEALTH
Region: 1
City: BALTIMORE State: MD
County:
License #: MD-07-011-01
Agreement: Y
Docket:
NRC Notified By: ALAN JACOBSON
HQ OPS Officer: BILL HUFFMAN
Notification Date: 09/15/2010
Notification Time: 10:21 [ET]
Event Date: 09/14/2010
Event Time: 14:45 [EDT]
Last Update Date: 09/15/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
GLENN DENTEL (R1DO)
ANGELA MCINTOSH (FSME)
ILTAB E-MAIL ()

This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

AGREEMENT STATE REPORT - MISSING GERMANIUM-68 CHECK SOURCE

The following report was obtained from the State of Maryland via e-mail:

"As follow-up to a telephone discussion [on the] afternoon of Sept. 14, 2010 at 1445, [the RSO sent the State of Maryland] this email as a written notification of a presumed lost sealed source containing radioactive material. The telephone notification and this email serve [as] compliance with Section D.1201a, which requires an immediate report of a theft or loss of a source of radiation.

"The sealed source in question contains Germanium-68, a nuclide of half-life 271 days. This nuclide decays to Gallium-68, which itself then decays (with positron emission) with a half-life of 68 minutes to stable Zinc-68. The annihilation radiation from the positron emission is used for PET scanner quality assurance, as in the case of this source.

"This sealed source originally contained 500 microCi of Ge-68 on March 1, 2000. The contained activity of the lost source has been computed to be 0.03 microCi (59000 dpm) as of the date of this notice. The exposure rate of a 1 microCi point (unsealed) source is 5.4 mR/hr at 1 cm; therefore, the exposure rate estimated for this sealed line source at 0.03 microCi is about 0.1 to 0.2 mR/hr at 1 cm. A description of the physical source is [as follows]. The source was manufactured by IPL (product code HEGL-0109) and is 6 inches in length and 1/8 inches in diameter with steel encapsulation.

"The source had been stored and not used (due to low activity), and was last inventoried (and leak-tested) on July 22, 2010. An investigation is currently underway to determine the disposition of this source, and will be submitted to the MDE RHP [Maryland Department of the Environment, Radiological Health Program] per D.1201b within thirty days of this notice."

The State of Maryland will be conducting a follow-up investigation.


THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL

Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

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Power Reactor Event Number: 46259
Facility: HOPE CREEK
Region: 1 State: NJ
Unit: [1] [ ] [ ]
RX Type: [1] GE-4
NRC Notified By: JIM PRIEST
HQ OPS Officer: HOWIE CROUCH
Notification Date: 09/20/2010
Notification Time: 00:10 [ET]
Event Date: 09/20/2010
Event Time: 07:00 [EDT]
Last Update Date: 09/20/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
GLENN DENTEL (R1DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N Y 100 Power Operation 100 Power Operation

Event Text

ERDS AND SPDS OUT OF SERVICE FOR COMPUTER UPGRADE

"On 9/20/2010 at approximately 0700 EDT, the Hope Creek Safety Parameter Display System (SPDS) and the Emergency Response Data System (ERDS) will be taken out of service for approximately nine days to support a planned modification which will install a new (upgraded) computer system. During this timeframe, ERDS and SPDS will be unavailable. Should the need arise, plant status information will be communicated to the NRC, State and local responders using other available communication systems. SPDS and ERDS are expected to be restored on 9/29/2010. This event is reportable under 10 CFR 50.72(b)(3)(xiii) as a 'Major Loss of Assessment Capability'."

The licensee has notified Lower Alloways Creek Township and the NRC Resident Inspector of the planned outage.

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Power Reactor Event Number: 46261
Facility: PRAIRIE ISLAND
Region: 3 State: MN
Unit: [1] [2] [ ]
RX Type: [1] W-2-LP,[2] W-2-LP
NRC Notified By: DARRELL LAPCINSKI
HQ OPS Officer: DONALD NORWOOD
Notification Date: 09/20/2010
Notification Time: 17:26 [ET]
Event Date: 09/16/2010
Event Time: 13:43 [CDT]
Last Update Date: 09/20/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
Person (Organization):
RICHARD SKOKOWSKI (R3DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N Y 100 Power Operation 100 Power Operation
2 N Y 100 Power Operation 100 Power Operation

Event Text

UNANALYZED CONDITION - DEGRADED FIRE BARRIER IDENTIFIED

"This is a late eight hour report submitted under 10CFR50.72(b)(3)(ii), 'Degraded or Unanalyzed Condition.'

"During walk downs for the Fire Penetration Seal Project on September 16, 2010 at 1343 [hrs. CDT], a degraded fire barrier was identified in the wall between the Unit 1 and Unit 2 sides of the Electrical Piping Area. The wall is listed as an Appendix R wall between Fire Area (FA) 29 and FA 30. The wall separates safety related redundant cables.

"There is an approximately one inch gap filled with loose fitting foam from the top of the wall to the concrete ceiling above it. In one place the foam has a gap approximately one inch wide. This has been identified as a missing fire barrier such that the required degree of separation for redundant safe shutdown trains is lacking.

"A fire watch was established as a compensatory measure on 9/16/10. The discovery of this non-compliance is being reported as an unanalyzed condition as defined by 10 CFR 50.72(b)(3)(ii)(B).

"The licensee has notified the NRC Resident Inspector of this event."

The fire watch remains in place.

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Power Reactor Event Number: 46262
Facility: BRAIDWOOD
Region: 3 State: IL
Unit: [1] [ ] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: KEVIN LUESHEN
HQ OPS Officer: DONALD NORWOOD
Notification Date: 09/20/2010
Notification Time: 19:37 [ET]
Event Date: 09/20/2010
Event Time: 17:04 [CDT]
Last Update Date: 09/20/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
RICHARD SKOKOWSKI (R3DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 A/R Y 100 Power Operation 0 Hot Standby

Event Text

AUTOMATIC REACTOR TRIP

"At 1704 CDT, Braidwood Unit 1 experienced an automatic reactor trip. The reactor trip red first out was Over Temperature Delta Temperature (OTDT). At the time of the reactor trip, the Instrument Maintenance Department was performing a calibration of Power Range Channel N-43 and a calibration of the 1C S/G Narrow Range Level Channel 1L-0538. The cause of the trip is unknown at this time.

"After the reactor trip occurred, all four Steam Generators reached their Low-2 reactor trip setpoint and Pressurizer pressure reached its low pressure reactor trip setpoint which is an expected response on a trip from full power. Steam Generator levels and Pressurizer pressure have been restored. Both the 1A and 1B Auxiliary Feedwater pumps auto started on the Low-2 Steam Generator levels as expected. All control rods fully inserted into the core.

"Train B Main Control Room Filtration system shifted to makeup mode and the Train B Fuel Handling Building ventilation shifted to Emergency Mode due to a spurious actuation signal.

"No secondary relief valves lifted and no secondary steam [was] released as a result of the reactor trip. The Main Steam Dumps are in service to the Main Condenser to provide heat sink cooling. The plant is being maintained at normal operating pressure and temperature. This report is being made per 10CFR50.72(b)(2)(iv)(B) for RPS actuation, 4-hr. notification, and per 10CFR50.72(b)(3)(iv)(A) for automatic actuation of the Auxiliary Feedwater system, 8-hr. notification.

"AC power is being provided by offsite power with the Diesel Generators in standby and all safety systems available. There is no Unit 2 impact."

The licensee notified the NRC Resident Inspector. The licensee also anticipates that there will be a press release issued regarding this event.

Page Last Reviewed/Updated Thursday, March 29, 2012
Thursday, March 29, 2012