Event Notification Report for December 04, 2002
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
12/03/2002 - 12/04/2002
EVENT NUMBERS
39425
Hospital
Event Number: 39425
Rep Org: LEHEIGH VALLEY HOSPITAL
Licensee: LEHEIGH VALLEY HOSPITAL
Region: 1
City: ALLENTOWN State: PA
County:
License #: 37-01548-01
Agreement: N
Docket:
NRC Notified By: CYNTHIA GOODMAN
HQ OPS Officer: FANGIE JONES
Licensee: LEHEIGH VALLEY HOSPITAL
Region: 1
City: ALLENTOWN State: PA
County:
License #: 37-01548-01
Agreement: N
Docket:
NRC Notified By: CYNTHIA GOODMAN
HQ OPS Officer: FANGIE JONES
Notification Date: 12/05/2002
Notification Time: 12:10 [ET]
Event Date: 12/04/2002
Event Time: 17:00 [EST]
Last Update Date: 12/05/2002
Notification Time: 12:10 [ET]
Event Date: 12/04/2002
Event Time: 17:00 [EST]
Last Update Date: 12/05/2002
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(3) - DOSE TO OTHER SITE > SPECIFIED LIMITS
10 CFR Section:
35.3045(a)(3) - DOSE TO OTHER SITE > SPECIFIED LIMITS
Person (Organization):
MICHELE EVANS (R1)
ROBERT PIERSON (NMSS)
MICHELE EVANS (R1)
ROBERT PIERSON (NMSS)
MEDICAL EVENT - DOSE TO SKIN OTHER THAN TREATMENT SITE
The attending physician, also the Radiation Oncologist, discovered that one of the catheters containing 3 seeds of iridium-192 was out of position. The treatment was a 48 hour dose to the lip area for a carcinoma. The physician had checked the location at 1700 EST on 12/3/02 and when checking at 1700 EST on 12/4/02 discovered the one catheter under the patient under a bed pad. The estimated dose to the skin of the back, conservatively using the entire 24 hours, is 240 rem. The possible result is some erythmea, reddening of the skin. The patient has been informed. The actual treatment site dose is only 4.3 % under the planned so no further treatment is necessary or reportable.
The Radiation Safety Officer intends to notify NRC Region 1.
The attending physician, also the Radiation Oncologist, discovered that one of the catheters containing 3 seeds of iridium-192 was out of position. The treatment was a 48 hour dose to the lip area for a carcinoma. The physician had checked the location at 1700 EST on 12/3/02 and when checking at 1700 EST on 12/4/02 discovered the one catheter under the patient under a bed pad. The estimated dose to the skin of the back, conservatively using the entire 24 hours, is 240 rem. The possible result is some erythmea, reddening of the skin. The patient has been informed. The actual treatment site dose is only 4.3 % under the planned so no further treatment is necessary or reportable.
The Radiation Safety Officer intends to notify NRC Region 1.