Event Notification Report for December 08, 2010
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
12/07/2010 - 12/08/2010
EVENT NUMBERS
46572464684646446465
Agreement State
Event Number: 46572
Rep Org: OHIO BUREAU OF RADIATION PROTECTION
Licensee: CLEVELAND CLINIC FOUNDATION
Region: 3
City: CLEVELAND State: OH
County:
License #: 02110180013
Agreement: Y
Docket:
NRC Notified By: STEPHEN JAMES
HQ OPS Officer: DONG HWA PARK
Licensee: CLEVELAND CLINIC FOUNDATION
Region: 3
City: CLEVELAND State: OH
County:
License #: 02110180013
Agreement: Y
Docket:
NRC Notified By: STEPHEN JAMES
HQ OPS Officer: DONG HWA PARK
Notification Date: 01/26/2011
Notification Time: 10:14 [ET]
Event Date: 12/08/2010
Event Time: 00:00 [EST]
Last Update Date: 01/26/2011
Notification Time: 10:14 [ET]
Event Date: 12/08/2010
Event Time: 00:00 [EST]
Last Update Date: 01/26/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
DAVID HILLS (R3DO)
ANGELA MCINTOSH (FSME)
DAVID HILLS (R3DO)
ANGELA MCINTOSH (FSME)
AGREEMENT STATE REPORT - POTENTIAL UNDERDOSE TO PATIENT DUE TO ABORTED TREATMENT
The following information was received from the State of Ohio by email:
"Written directive called for Iodine-125 radioactive seed implant of the prostate with 142 seeds, 0.477 mCi each, total activity 67.7 mCi. Transperineal implantation of the needles were attempted on 12/8/10. After placement of four needles (8 sources) in the first (anterior-most) row, it was subsequently noted that patient's pelvic inlet was too narrow for adequate placement of the lateral two columns of seeds after repeated attempts. Authorized User Physician decided to abort procedure at this point. Patient was taken to the recovery room in satisfactory condition. Patient was notified at time of event. Radiation Safety Officer was not notified at time of event.
"Licensee's RSO discovered event during QMP review on morning of 1/25/11 and notified ODH [Ohio Department of Health] by telephone and e-mail that afternoon. ODH inspector will visit licensee's location on 1/31/11.
"Given: Radionuclide: I-125; Activity: 3.2 mCi (118.4 MBq); Dose: 81.1 rad (0.811 Gy).
"Intended: Radionuclide: I-125; Activity: 67.7 mCi (2504.9 MBq); Dose: 14400 rad (144 Gy)."
The source used was a Brachytherapy sealed source I-125; Model Number STM-1251; Serial Number 2357321SO; Activity .477 Ci (17.649 GBq).
Ohio number: OH110001
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.
The following information was received from the State of Ohio by email:
"Written directive called for Iodine-125 radioactive seed implant of the prostate with 142 seeds, 0.477 mCi each, total activity 67.7 mCi. Transperineal implantation of the needles were attempted on 12/8/10. After placement of four needles (8 sources) in the first (anterior-most) row, it was subsequently noted that patient's pelvic inlet was too narrow for adequate placement of the lateral two columns of seeds after repeated attempts. Authorized User Physician decided to abort procedure at this point. Patient was taken to the recovery room in satisfactory condition. Patient was notified at time of event. Radiation Safety Officer was not notified at time of event.
"Licensee's RSO discovered event during QMP review on morning of 1/25/11 and notified ODH [Ohio Department of Health] by telephone and e-mail that afternoon. ODH inspector will visit licensee's location on 1/31/11.
"Given: Radionuclide: I-125; Activity: 3.2 mCi (118.4 MBq); Dose: 81.1 rad (0.811 Gy).
"Intended: Radionuclide: I-125; Activity: 67.7 mCi (2504.9 MBq); Dose: 14400 rad (144 Gy)."
The source used was a Brachytherapy sealed source I-125; Model Number STM-1251; Serial Number 2357321SO; Activity .477 Ci (17.649 GBq).
Ohio number: OH110001
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.
General Information
Event Number: 46468
Rep Org: NE DIV OF RADIOACTIVE MATERIALS
Licensee: THE SCHEMMER ASSOCIATES INC
Region: 4
City: LINCOLN State: NE
County:
License #: 01-124-01
Agreement: Y
Docket:
NRC Notified By: JIM DEFRAIN
HQ OPS Officer: DONG HWA PARK
Licensee: THE SCHEMMER ASSOCIATES INC
Region: 4
City: LINCOLN State: NE
County:
License #: 01-124-01
Agreement: Y
Docket:
NRC Notified By: JIM DEFRAIN
HQ OPS Officer: DONG HWA PARK
Notification Date: 12/09/2010
Notification Time: 09:33 [ET]
Event Date: 12/08/2010
Event Time: 10:45 [CST]
Last Update Date: 12/09/2010
Notification Time: 09:33 [ET]
Event Date: 12/08/2010
Event Time: 10:45 [CST]
Last Update Date: 12/09/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
MICHAEL HAY (R4DO)
ANGELA MCINTOSH (FSME)
MICHAEL HAY (R4DO)
ANGELA MCINTOSH (FSME)
AGREEMENT STATE REPORT - DAMAGED NUCLEAR MOISTURE/DENSITY GAUGE
The following report was received via facsimile:
"Event date and time: December 8, 2010 - Time: 10:45 am
"Event location: 91st & Heritage Lake Drive, Lincoln, Nebraska, 685
"Event description: The licensee possesses a Humboldt Scientific, Inc. Model 5001-EZ 122 Nuclear Moisture/Density Gauge Serial Number 2027. On December 8, 2010, the gauge was being used at a construction site just east of Lincoln, NE. The operator of the gauge had started a test when he was distracted by another worker asking questions. During that time a front end loader backed into the gauge and broke the stationary guide rod. No other damage was observed to the gauge. The area was secured and radiation surveys as well as a leak test were performed. No unusual readings were observed. The source rod was secured in to safe position in the gauge housing and the gauge was place in the transport case for return to the licensee's office. No personnel were exposed to radiation during this event."
The following report was received via facsimile:
"Event date and time: December 8, 2010 - Time: 10:45 am
"Event location: 91st & Heritage Lake Drive, Lincoln, Nebraska, 685
"Event description: The licensee possesses a Humboldt Scientific, Inc. Model 5001-EZ 122 Nuclear Moisture/Density Gauge Serial Number 2027. On December 8, 2010, the gauge was being used at a construction site just east of Lincoln, NE. The operator of the gauge had started a test when he was distracted by another worker asking questions. During that time a front end loader backed into the gauge and broke the stationary guide rod. No other damage was observed to the gauge. The area was secured and radiation surveys as well as a leak test were performed. No unusual readings were observed. The source rod was secured in to safe position in the gauge housing and the gauge was place in the transport case for return to the licensee's office. No personnel were exposed to radiation during this event."
Power Reactor
Event Number: 46464
Facility: PRAIRIE ISLAND
Region: 3 State: MN
Unit: [1] [2] []
RX Type: [1] W-2-LP,[2] W-2-LP
NRC Notified By: RANDY FORTIER
HQ OPS Officer: HOWIE CROUCH
Region: 3 State: MN
Unit: [1] [2] []
RX Type: [1] W-2-LP,[2] W-2-LP
NRC Notified By: RANDY FORTIER
HQ OPS Officer: HOWIE CROUCH
Notification Date: 12/08/2010
Notification Time: 10:50 [ET]
Event Date: 12/08/2010
Event Time: 08:07 [CST]
Last Update Date: 12/08/2010
Notification Time: 10:50 [ET]
Event Date: 12/08/2010
Event Time: 08:07 [CST]
Last Update Date: 12/08/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
ROBERT DALEY (R3DO)
ROBERT DALEY (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 |
OFFSITE NOTIFICATION DUE TO INADVERTENT ACTUATION OF EMERGENCY SIRENS
"At approximately 0807 CST on December 8, 2010, Pierce County [Wisconsin] Dispatch inadvertently activated the Pierce County sirens during the conduct of the silent siren test. The sirens were deactivated within 30 seconds."
The licensee has notified the NRC Resident Inspector.
"At approximately 0807 CST on December 8, 2010, Pierce County [Wisconsin] Dispatch inadvertently activated the Pierce County sirens during the conduct of the silent siren test. The sirens were deactivated within 30 seconds."
The licensee has notified the NRC Resident Inspector.
Non-Agreement State
Event Number: 46465
Rep Org: CONTINENTAL CEMENT
Licensee: CONTINENTAL CEMENT
Region: 3
City: HANNIBAL State: MO
County:
License #: 24-20263-01
Agreement: N
Docket:
NRC Notified By: WILLIAM E. SHERMAN JR.
HQ OPS Officer: JOE O'HARA
Licensee: CONTINENTAL CEMENT
Region: 3
City: HANNIBAL State: MO
County:
License #: 24-20263-01
Agreement: N
Docket:
NRC Notified By: WILLIAM E. SHERMAN JR.
HQ OPS Officer: JOE O'HARA
Notification Date: 12/08/2010
Notification Time: 14:17 [ET]
Event Date: 12/08/2010
Event Time: 13:00 [CST]
Last Update Date: 12/08/2010
Notification Time: 14:17 [ET]
Event Date: 12/08/2010
Event Time: 13:00 [CST]
Last Update Date: 12/08/2010
Emergency Class: NON EMERGENCY
10 CFR Section:
30.50(b)(2) - SAFETY EQUIPMENT FAILURE
10 CFR Section:
30.50(b)(2) - SAFETY EQUIPMENT FAILURE
Person (Organization):
ROBERT DALEY (R3DO)
ANGELA MCINTOSH (FSME)
ROBERT DALEY (R3DO)
ANGELA MCINTOSH (FSME)
STUCK SHUTTER ON BERTHOLD MODEL P2608-100 DUE TO CEMENT DUST BUILDUP
While performing semi-annual shutter checks on a Berthold Waybelt Scale Process Gauge Model P2608-100 containing 5 milliCuries of Cobalt 60, a technician found the shutter partially open and was not able to fully close the shutter due to cement dust buildup on the shutter mechanism. The gauge is located in a secure guarded location not readily accessible to personnel, and does not present a hazard to personnel. The company will shut down the process line on 12/21/10 and perform repairs to the process gauge at that time.
While performing semi-annual shutter checks on a Berthold Waybelt Scale Process Gauge Model P2608-100 containing 5 milliCuries of Cobalt 60, a technician found the shutter partially open and was not able to fully close the shutter due to cement dust buildup on the shutter mechanism. The gauge is located in a secure guarded location not readily accessible to personnel, and does not present a hazard to personnel. The company will shut down the process line on 12/21/10 and perform repairs to the process gauge at that time.