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Event Notification Report for April 4, 2018

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
04/03/2018 - 04/04/2018

** EVENT NUMBERS **


53289 53292 53293 53310

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Agreement State Event Number: 53289
Rep Org: NV DIV OF RAD HEALTH
Licensee: AZTECH MATERIALS AND TESTING, LLC
Region: 4
City: LAS VEGAS State: NV
County:
License #: 00-11-0482-01
Agreement: Y
Docket:
NRC Notified By: JOHN FOLLETTE
HQ OPS Officer: DAVID AIRD
Notification Date: 03/26/2018
Notification Time: 17:02 [ET]
Event Date: 03/26/2018
Event Time: 10:00 [PDT]
Last Update Date: 03/28/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
VINCENT GADDY (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)
JIM WHITNEY (ILTA)

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

Event Text

AGREEMENT STATE REPORT - STOLEN MOISTURE-DENSITY GAUGE

The following is an excerpt from a report received from the State of Nevada:

"At 1000 PDT on March 26, 2018, the State of Nevada Radiation Control Program was informed by Aztech Materials and Testing, LLC, that a Humboldt, Model 5001EZ, Serial Number 3491, containing 10 mCi of cesium-137 and 40 mCi americium-241:beryllium, was stolen from the licensee's vehicle. The gauge was secured with two locks in the back of a pickup truck. The State is following the incident and working with local authorities to develop a press release. Local law enforcement and the FBI have been notified. Follow-up information will be provided to NRC on the recovery of the stolen gauge and entered into NMED (Nuclear Material Events Database)."


* * * UPDATE FROM JOHN FOLLETTE TO DONALD NORWOOD AT 1730 EDT ON 3/28/2018 * * *

The following information was received via E-mail:

"The State of Nevada Radiation Control Program has been informed by the Las Vegas Metropolitan Police Department that the stolen portable nuclear gauge has been recovered. Below is the notification:

"'All items were recovered in a stolen vehicle (abandoned, no suspects located). Patrol officers will be releasing the items back to Aztech.'

"The NMED report will also be updated."

Notified R4DO (Gaddy). Notified via E-mail ILTAB (Whitney) and NMSS Events Notification.

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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Agreement State Event Number: 53292
Rep Org: ILLINOIS EMERGENCY MGMT. AGENCY
Licensee: UNIVERSITY OF ILLINOIS - CHICAGO
Region: 3
City: CHICAGO State: IL
County:
License #: IL-01883-01
Agreement: Y
Docket:
NRC Notified By: GARY FORSEE
HQ OPS Officer: DAVID AIRD
Notification Date: 03/27/2018
Notification Time: 14:33 [ET]
Event Date: 03/27/2018
Event Time: [CDT]
Last Update Date: 03/27/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
PATRICIA PELKE (R3DO)
NMSS_EVENTS_NOTIFICA (EMAI)

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

Event Text

AGREEMENT STATE REPORT - MISSING SOURCE

The following was received from the State of Illinois via email:

"On March 27, 2018, the agency [Illinois Emergency Management Agency] was contacted by the licensee's radiation safety officer to report a missing 10 microCi Am-241 source. The source assay date was not immediately available. Reportedly, forms were distributed to the authorized users who would perform the physical inventory. An investigation is ongoing to determine the last physical inventory and responsible individuals. A full report is pending from the licensee by April 26, 2018. A comprehensive source inventory is to be completed within the week. Additional updates will be provided as they become available."

Item Number: IL 180024

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.

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Agreement State Event Number: 53293
Rep Org: OHIO BUREAU OF RADIATION PROTECTION
Licensee: SUMMA HEALTH SYSTEMS
Region: 3
City: AKRON State: OH
County:
License #: 2120780022
Agreement: Y
Docket:
NRC Notified By: MICHAEL RUBADUE
HQ OPS Officer: DAVID AIRD
Notification Date: 03/27/2018
Notification Time: 15:59 [ET]
Event Date: 09/05/2017
Event Time: [EDT]
Last Update Date: 03/27/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
PATRICIA PELKE (R3DO)
NMSS_EVENTS_NOTIFICA (EMAI)

Event Text

AGREEMENT STATE REPORT - DELIVERED DOSAGE DIFFERENT FROM PRESCRIBED

The following is an excerpt from a report received from the State of Ohio via email:

The criteria for a medical event supported by ODH (Ohio Department of Health) is if the 90% prostate volume receives less than 80% of the prescribed dose or more than 120% of the prescribed dose. Upon generating the post treatment plans for nine patients, the Dosimetry staff discovered that four were below 80%.

Summary of Prostate Implant Incidents:

Case #. Implant Date, Discovery Date, Prescribed Dose (Gy), Estimated D90 (Gy)

1. 9/05/2017, 3/26/2018, 110 Gy, 58.15 Gy
2. 9/28/2017, 3/26/2018, 145 Gy, 100.19 Gy
3. 2/13/2017, 3/26/2018, 110 Gy, 81.28 Gy
4. 2/19/2017, 3/26/2018, 145 Gy, 103.7 Gy

Manufacturer: Theragenics
Model Number: AgX100
Radionuclide: I-125

Item Number: OH180002

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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Power Reactor Event Number: 53310
Facility: SUSQUEHANNA
Region: 1 State: PA
Unit: [1] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: TOM RYDZEWSKI
HQ OPS Officer: DAVID AIRD
Notification Date: 04/03/2018
Notification Time: 02:53 [ET]
Event Date: 04/03/2018
Event Time: 00:19 [EDT]
Last Update Date: 04/03/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(C) - POT UNCNTRL RAD REL
Person (Organization):
FRANK ARNER (R1DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N N 0 Refueling 0 Refueling
2 N Y 100 Power Operation 100 Power Operation

Event Text

LOSS OF SECONDARY CONTAINMENT FOLLOWING SURVEILLANCE TESTING

"On April 3, 2018 at 0019 [EDT], the Susquehanna control room received indication that a loss of Secondary Containment Zone 3 differential pressure had occurred. Control room operators noted the loss following completion of surveillance testing. The cause is under investigation. Zone 3 differential pressure was restored to greater than 0.25 inches WC [water column] at 0145 [EDT].

"Zone 3 differential pressures being less than 0.25 inches WC constitutes a loss of Secondary Containment based on not meeting requirements of SR [Surveillance Requirement] 3.6.4.1.1.

"This event is being reported under 10 CFR 50.72(b)(3)(v)(C) and per the guidance of NUREG-1022, Revision 3, Section 3.2.7, as a loss of a Safety Function. There is no redundant Susquehanna Secondary Containment system."

The NRC Resident Inspector has been notified.

Page Last Reviewed/Updated Wednesday, April 04, 2018
Wednesday, April 04, 2018