Event Notification Report for November 06, 2019

TEXAS AGREEMENT STATE REPORT - UNABLE TO RETRACT RADIOGRAPHY SOURCE

The following information was obtained from the state of Texas via email:

"On November 7, 2019, the licensee's radiation safety officer (RSO) notified the Agency [Texas Department of State Health Services] that at approximately 2000 CST on November 6, 2019, one of their industrial radiography crews had been unable to retract a 113 Curie iridium-192 source (model 702, SN: TT2307) into a QSA 880 Delta exposure device (SN: D7727) at a temporary job site in Sonora, Texas. The RSO stated the drive cable had broken at the ball stop. Source retrieval was performed by authorized employees. The initial radiographers' and another of the licensee employee's self-reading pocket dosimeters read 13 and 14 mR. The two authorized source retrievers' self-reading pocket dosimeters had readings of approximately 300 mR. All dosimetry badges are being sent for immediate processing. There were no other persons in the area so there was no risk of exposure to any member of the public. The RSO and staff will examine the crank assembly and drive cable when it gets to their location on November 8, 2019. The RSO also plans to send the crank assembly/drive cable for evaluation by a third party service/repair company. The exposure device was tested multiple times using a different set of cranks following the retrieval and it operated properly. An investigation into this event is ongoing. More information will be provided as it is obtained in accordance with SA-300."

Texas Incident No: 9723

AGREEMENT STATE REPORT - POTENTIAL LOST SOURCE

The following is a summary of an email received from the Kansas Department of Health and Environment's Radioactive Materials Team:

Apex Environmental reported that they sent their X-ray fluorescence to Massachusetts via a common carrier to be resourced. They have a delivery receipt, but have been unsuccessful in contacting the company. Perhaps the device is being held for payment. The State has requested additional information from Apex and will follow up with Massachusetts' Radiation Control Program and the vendor to determine the status of the device.

Kansas Event Report ID No: KS190010

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

PART 21 NOTIFICATION - DEGRADED SNUBBER HYDRAULIC FLUID

Below is a summary of a Part 21notification received from the vendor via facsimile:

The vendor, via a testing facility, identified another batch of contaminated hydraulic snubber fluid. The fluid batch number is 16DLVS852, manufactured on 4/17/16 by Momentive Performance Materials, Leverkusen, Germany.

Licensees that were supplied the contaminated fluid were identified as: Palisades, Pilgrim, Browns Ferry and Sequoyah.

Previous batches were identified under the Part 21 process by Lake Engineering Co. as follows:

Batch Number (followed by ADAMS Ascension Number)

AD965 - ML070180491 and ML070300154
ZJS1518 - ML19077A096, ML19136A044 and ML19199A034
11KLVS145 - ML18211A302, ML18295A199, ML19008A043 and ML19071A112
14ELVS145 - ML17128A465, ML17212A628, ML17313A471, ML17355A139 and ML19121A155

For further information, please contact:

Walter Paszul, PE
General / Engineering Manager
E-Mail: walter@fronekgrp.com
Phone No: ( 603) 528-1931
Fax No: ( 603) 528-6381

AGREEMENT STATE REPORT - MISADMINISTRATION OF RADIONUCLIDE

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

"[The Oklahoma Department of Environmental Quality (ODEQ)] was notified by phone today that on November 6, Oklahoma licensee Blackwell Hospital Trust Authority (OK-32140-01) had administered a dose of Tc-99m Sestamibi to a patient that [the dose] was 24-hours old. The RSO reported that she had learned of the incident today and that the dose was administered to the intended patient. The activity of the dose originally is unknown at this time.

"The licensee will be investigating the event further to determine the details of what happened.

"[The ODEQ] will update this notice with more information as [the ODEQ] receives it."

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.

PART 21 REPORT - POTENTIAL DEVIATION OF PRESSURE TRANSMITTERS DUE TO TEMPERATURE RISE

The following information was received from Emerson Rosemount Nuclear Instruments, Inc. via fax:

"Rosemount Nuclear Instruments, Inc. (RNII) is providing an interim evaluation report on the treatment of temperature rise due to electronics self-heating in qualified life thermal aging calculations on Model 1153 and 1154 [inclusive of 1153 Series B, 1153 Series D, 1154, and 1154 Series H] pressure transmitters. The evaluation is being conducted to determine if modifications to the currently specified qualified life are warranted.

"Qualification programs for 1153 and 1154 pressure transmitters were structured to comply with the requirements of IEEE standard 323-1974 which requires aging to establish a qualified life prior to design basis event testing. Thermal aging is considered a significant aging mechanism; therefore, accelerated thermal aging was conducted on type test specimens as described in RNII qualification reports D8300040 and D8700096. These reports document the thermal aging basis for all 1153 and 1154 models identified in section 1.0. In both type test programs, temperature rise due to electronics self-heating was present during thermal aging and was consistent with expected in service normal operating conditions.

"These evaluations are expected to be complete by February 28, 2020.

"If there are any questions, or you require additional information related to this issue, please contact Nathan Schukei (952) 949-5213 or Paul Schmeling (952) 949-5359."

There are currently no known affected customers.

* * * UPDATE ON 2/26/20 AT 1454 EST FROM JEFF CHIVERS TO KERBY SCALES * * *

The following is a summary of the information provided by the vendor via fax:

"Rosemount Nuclear Instrument Inc. (RNII) analysis of both 1150 series and 3150 series included electronics thermal imaging to characterize the thermal distribution on electronic assemblies, as well as direct in situ temperature measurements of qualified life limiting components. Specifically, temperature measurements were taken on limiting components to quantify actual temperature rise for both the original qualification accelerated aging conditions as well as for normal operating conditions.

"The analysis demonstrates that temperature rise due to electronics self-heating on limiting components is application dependent. As a result, the calculated qualified life will be application dependent. In many application conditions, the originally established qualified life calculations will remain conservative with respect to the updated calculations (i.e. the updated qualified life will be longer than the originally established qualified life). In applications where the originally established qualified life calculations may not be conservative (i.e. the updated qualified life will be shorter than the originally established qualified life), RNII believes there is no impact to the safety function of either the 1150 series or 3150 series pressure transmitters due to any difference in calculated qualified life because long term aging information obtained from the limiting component supplier, supported by RNII independent internal testing, demonstrates insignificant change over time in the electrical parameters of the limiting components for the temperatures and operating conditions in question.

"To provide a more accurate model to account for electronics temperature rise in Arrhenius calculations, RNII is revising our temperature inputs into the Arrhenius accelerated aging calculation methodology for both 1150 series and 3150 series pressure transmitters. This revised methodology will be provided separately to end users.

"RNII does not believe this issue presents a risk to the safety function of the 1150 and 3150 series pressure transmitters. RNII recommends end users evaluate the significance of this notice to their specific pressure transmitter applications. If there are any questions, please contact our Technical Support Engineers at 952-949-5200 (RNll.lnfo@emerson.com) or Nathan Schukel at 952-949-5213."

Notified R1DO (Ferdas), R2DO (Davis), R3DO (Orth), R4DO (Kozal), and Part 21/50.55 Reactors, Part 21 Materials, NMSS _Events via e-mail.