Event Notification Report for July 25, 2019
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
07/24/2019 - 07/25/2019
EVENT NUMBERS
54184
Agreement State
Event Number: 54184
Rep Org: PA BUREAU OF RADIATION PROTECTION
Licensee: WEST PENN ALLEGHENY HEALTH SYSTEMS INC
Region: 1
City: PITTSBURGH State: PA
County:
License #: PA-0031
Agreement: Y
Docket:
NRC Notified By: JOSHUA MYERS
HQ OPS Officer: JEFFREY WHITED
Licensee: WEST PENN ALLEGHENY HEALTH SYSTEMS INC
Region: 1
City: PITTSBURGH State: PA
County:
License #: PA-0031
Agreement: Y
Docket:
NRC Notified By: JOSHUA MYERS
HQ OPS Officer: JEFFREY WHITED
Notification Date: 07/26/2019
Notification Time: 14:34 [ET]
Event Date: 07/25/2019
Event Time: 00:00 [EDT]
Last Update Date: 07/26/2019
Notification Time: 14:34 [ET]
Event Date: 07/25/2019
Event Time: 00:00 [EDT]
Last Update Date: 07/26/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
10 CFR Section:
AGREEMENT STATE
Person (Organization):
MEL GRAY (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
MEL GRAY (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
AGREEMENT STATE REPORT - SOURCE FAILED TO RETRACT
The following was received via e-mail:
"On Thursday, July 25, 2019, the licensee called to report an equipment failure event where, during a cardiovascular brachytherapy treatment, the source failed to retract at the end of the treatment time due to a kink in the catheter line. The unit being used was a Best Vascular, Inc., A1000 Series using the Novoste Beta-Cath 3.5 Delivery System and a Sr-90 source with a source strength of 79.3 mCi. A service engineer for Best Vascular was present during the time of treatment and was able to unkink the catheter line allowing the source to fully retract into the unit. There was no harm to the patient and no overexposure occurred."
Event Report No.: PA190017
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 was received via e-mail:
"On Thursday, July 25, 2019, the licensee called to report an equipment failure event where, during a cardiovascular brachytherapy treatment, the source failed to retract at the end of the treatment time due to a kink in the catheter line. The unit being used was a Best Vascular, Inc., A1000 Series using the Novoste Beta-Cath 3.5 Delivery System and a Sr-90 source with a source strength of 79.3 mCi. A service engineer for Best Vascular was present during the time of treatment and was able to unkink the catheter line allowing the source to fully retract into the unit. There was no harm to the patient and no overexposure occurred."
Event Report No.: PA190017
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.