Event Notification Report for May 25, 2005
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
05/24/2005 - 05/25/2005
EVENT NUMBERS
41756
General Information or Other
Event Number: 41756
Rep Org: FLORIDA BUREAU OF RADIATION CONTROL
Licensee: UNIVERSITY OF FLORIDA SHANDS HOSPITAL
Region: 1
City: GAINSVILLE State: FL
County:
License #: 0031-1
Agreement: Y
Docket:
NRC Notified By: CHARLES ADAMS
HQ OPS Officer: BILL GOTT
Licensee: UNIVERSITY OF FLORIDA SHANDS HOSPITAL
Region: 1
City: GAINSVILLE State: FL
County:
License #: 0031-1
Agreement: Y
Docket:
NRC Notified By: CHARLES ADAMS
HQ OPS Officer: BILL GOTT
Notification Date: 06/08/2005
Notification Time: 08:08 [ET]
Event Date: 05/25/2005
Event Time: 00:00 [EDT]
Last Update Date: 06/08/2005
Notification Time: 08:08 [ET]
Event Date: 05/25/2005
Event Time: 00:00 [EDT]
Last Update Date: 06/08/2005
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
TODD JACKSON (R1)
TOM ESSIG (NMSS)
TODD JACKSON (R1)
TOM ESSIG (NMSS)
AGREEMENT STATE REPORT
The State provided the following information via email:
"The patient was to receive 2 GigaBecquerel (GBq) (Yttrium-90) from siraspheres. Backpressure from the liver catheter popped the tubing off the 3-way stopcock; approximately 25% of the material was spilled before the tubing could be re-attached. A lower flow rate was used and no further problems were encountered. The spill was contained in the case around the stopcock. Patient received approximately 75% of the material/intended dose. The licensee will send a letter explaining the event. Determination of whether this qualifies as a medical event is the reason for the late NRC notification. Florida continues to investigate.
Florida event number: FL05-086
The State provided the following information via email:
"The patient was to receive 2 GigaBecquerel (GBq) (Yttrium-90) from siraspheres. Backpressure from the liver catheter popped the tubing off the 3-way stopcock; approximately 25% of the material was spilled before the tubing could be re-attached. A lower flow rate was used and no further problems were encountered. The spill was contained in the case around the stopcock. Patient received approximately 75% of the material/intended dose. The licensee will send a letter explaining the event. Determination of whether this qualifies as a medical event is the reason for the late NRC notification. Florida continues to investigate.
Florida event number: FL05-086