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Event Notification Report for July 18, 2016

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
07/15/2016 - 07/18/2016

** EVENT NUMBERS **


52071 52075 52077 52078

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Non-Agreement State Event Number: 52071
Rep Org: QAL-TEK ASSOCIATES
Licensee: QAL-TEK ASSOCIATES
Region: 4
City: IDAHO FALLS State: ID
County:
License #: 11-27610-01
Agreement: N
Docket:
NRC Notified By: MICHAEL ALBANESE
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 07/07/2016
Notification Time: 11:45 [ET]
Event Date: 06/29/2016
Event Time: [MDT]
Last Update Date: 07/07/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
30.50(b)(1) - UNPLANNED CONTAMINATION
Person (Organization):
JAMES DRAKE (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
FRED BOWER (R1DO)

Event Text

LEAKING Ni-63 SOURCES

"On June 29th, 2016 around 10:00 [MDT] a Qal-Tek Associates radiation technician identified two Varian ECD's [electron capture devices] (both registered Ni-63 electro-plated sealed sources) with positive leak tests results above the critical levels of the gas flow proportional counter (sn: 44643 - 7.1% efficiency for Ni-63). The net cpm for the 8 mCi ECD (model: 02-001972-00, serial number: A544) was 1840 cpm (0.0117uCi) and for the 15 mCi ECD (model: 02-001972-00, serial number A8118) the net cpm was 4060 cpm (0.026 uCi).

"The radiation technician was verifying the contents of a client's package in the Building 3 confinement facility that was shipped to Qal-Tek Associates address at: 3998 Commerce Circle, Idaho Falls, ID 83401. The outside of the package did not indicate any contamination when Qal-Tek received the package. Only the inside bottom face of the box indicated contamination of 60 net cpm. This portion of the box was removed for proper DAW [dry active waste] disposal at a licensed facility.

"The radiation technician halted work, notified her co-worker, contacted the supervisor and confirmed that contamination was not present on her person or on surfaces of the work area, per the procedure, in order to prevent the spread of contamination. The Varian ECD (sn: A544) sealed source was decontaminated, the port holes in the device where taped shut, sealed in a plastic bag labeled with caution-radioactive material: Ni-63 leaker, and isolated from the work area in the biosafety cabinet. When no contamination was confirmed on personnel or facilities, the RSO was notified. The RSO re-checked facility surfaces for contamination. The work bench still had some contamination of about 105 net cpm. This was communicated to the RT's [radiation technicians] and their manager for further decontamination. The radiation technician took extra personal protective precautions to isolate the contamination and proceeded with verifying the rest of the package contents (14 ECD's). Once again, during the package content verification process, a 15 mCi Varian ECD (sn: A8118) also had a positive leak test above the instrument critical level. The radiation technician halted work, notified her co-worker, contacted the supervisor and confirmed that contamination was not present on her person or on surfaces of the work area, per the procedure, in order to prevent the spread of contamination. The source was sealed in a plastic bag labeled with caution-radioactive material: Ni-63 leaker, and placed in the biosafety cabinet for isolation from the work area. When no contamination was confirmed on personnel or facilities the RSO was notified by the manager. The RSO asked the Qal-Tek client manager to notify them of the leaking Ni-63 sources with a strong recommendation that they survey their facilities for contamination. The sources will be sealed in another bag and placed in a drum for proper disposal at a licensed LLRW [low level radioactive waste] disposal facility."

The package was received from a client in Arcade, New York.

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Agreement State Event Number: 52075
Rep Org: CALIFORNIA DEPT OF PUBLIC HEALTH
Licensee: UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYSTEM
Region: 4
City: SACRAMENTO State: CA
County:
License #: 1334-57
Agreement: Y
Docket:
NRC Notified By: L. ROBERT GREGER
HQ OPS Officer: BETHANY CECERE
Notification Date: 07/08/2016
Notification Time: 20:53 [ET]
Event Date: 07/07/2016
Event Time: [PDT]
Last Update Date: 07/08/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JAMES DRAKE (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)

Event Text

AGREEMENT STATE REPORT - TOTAL DOSE DELIVERED DIFFERS FROM THE PRESCRIBED DOSE

The following report was received from the California Department of Public Health, Radiation Health Branch (RHB) via email:

"RHB North was informed by the Radiation Safety Officer of UC [University of California] Davis Medical Center, of a Medical Event that took place on July 7, 2016. The Medical Event involved a SirSphere case. The patient received 29 per cent more than the prescribed dose. The physicians working on the case as well as the referring physician and the patient have been notified. There are no expected negative impacts on the patient.

"Prescribed dosage: 13.5 mCi. Administered dosage: 17.4 mCi.

"The apparent reason of the misadministration is that the CNMT [Certified Nuclear Medicine Technologist] miscalculated the dosage required."

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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Agreement State Event Number: 52077
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: RRC POWER AND ENERGY LLC
Region: 4
City: ROUND ROCK State: TX
County:
License #: L06105
Agreement: Y
Docket:
NRC Notified By: KAREN BLANCHARD
HQ OPS Officer: BETHANY CECERE
Notification Date: 07/09/2016
Notification Time: 16:44 [ET]
Event Date: 07/08/2016
Event Time: 16:30 [CDT]
Last Update Date: 07/11/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JAMES DRAKE (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
CNSNS (MEXICO) (EMAI)

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

Event Text

AGREEMENT STATE REPORT - LOST MOISTURE DENSITY GAUGE

The following information was received from the State of Texas via email:

"On July 9, 2016, the licensee reported that on July 8, 2016, at approximately 1630 hours (CDT), one of its InstroTek 3500 Xplorer (SN: 1845) moisture/density gauges had been lost at a temporary job site. The licensee reported its technician had completed work for the day. The gauge was muddy so the technician placed it inside its transport case in the back of his pickup and left the case's lid up. He then got busy finishing up paperwork and talked to a site supervisor. The technician failed to close the case lid, secure the case in the vehicle, or raise the tailgate before leaving the site. When he got to the main road, he realized this and checked the gauge. It was not in the truck. He backtracked his route and checked at the work site but his search was unsuccessful. The source rod on the device is locked. The licensee stated there is a lot of oilfield traffic in the area the gauge was lost. The licensee's name and phone numbers are on the device and they are hopeful it may have been picked up and will be returned on Monday. More information will be provided as it is obtained in accordance with SA-300.

"Event Location: County Road 285, approximately 15 miles northwest of Mentone, Texas.

"Notifications: County Sheriff's Offices (both Loving and Reeves Counties)."

The State reported that the gauge contains 10 mCi of Cs-137 and 40 mCi of Am-241.

* * * UPDATE ON 7/11/16 AT 0919 EDT FROM KAREN BLANCHARD TO BETHANY CECERE * * *

The following updated information was received from the State of Texas via email:

"Texas has assigned its incident number I-9419 to this event.

"Also, correct spelling of gauge manufacturer is InstroTek."

R4DO (Gaddy), NMSS Events, and CNSNS (Mexico) have been notified by email.

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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Non-Agreement State Event Number: 52078
Rep Org: PRIME NDT SERVICES
Licensee: PRIME NDT SERVICES
Region: 3
City: MARTINSVILLE State: IN
County:
License #: 37-23370-01
Agreement: N
Docket:
NRC Notified By: DON SCHUMWAY
HQ OPS Officer: HOWIE CROUCH
Notification Date: 07/09/2016
Notification Time: 18:11 [ET]
Event Date: 07/08/2016
Event Time: 19:30 [EDT]
Last Update Date: 07/09/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
30.50(b)(2) - SAFETY EQUIPMENT FAILURE
Person (Organization):
FRED BOWER (R1DO)
PATTY PELKE (R3DO)
NMSS_EVENTS_NOTIFIC (EMAI)

Event Text

SOURCE FAILED TO RETRACT INTO RADIOGRAPHY CAMERA

While conducting radiography at a field location in Indiana, the radiographer determined that the source could not be retracted. He immediately contacted the company's radiation safety officer (RSO), located in Pennsylvania. The RSO, who is licensed to retrieve sources, directed the radiographer to establish a 2 mR/hr boundary and await his arrival. Additionally, another crew was dispatched to assist the original crew in maintaining the boundary secure.

Upon the RSO's arrival, the RSO and radiographers determined that the source was still in the collimator. They then used sandbags to reduce the work area dose rates. The RSO was able to retrieve the source and return it to the shielded position in the camera. The RSO conducted field testing and found no mechanical issues with the camera and could not replicate the problem. The RSO believes the problem was due to a source misconnect. The camera is currently enroute to the company's Ohio facility for additional testing prior to returning it to service. The RSO received 2 mR during the retrieval. The radiographer and assistant radiographer received 20 mR and 5 mR, respectively, during the retrieval.

The camera was a QSA 880 Delta containing a 55 Ci Ir-192 source.

No members of the public received any dose due to this event.

Page Last Reviewed/Updated Monday, July 18, 2016
Monday, July 18, 2016