Event Notification Report for March 17, 2022
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
03/16/2022 - 03/17/2022
EVENT NUMBERS
55806
55806
Agreement State
Event Number: 55806
Rep Org: New York State Dept. of Health
Licensee: Northwell Health Imaging
Region: 1
City: Lake Success State: NY
County:
License #: 5255
Agreement: Y
Docket:
NRC Notified By: Daniel Samson
HQ OPS Officer: Howie Crouch
Licensee: Northwell Health Imaging
Region: 1
City: Lake Success State: NY
County:
License #: 5255
Agreement: Y
Docket:
NRC Notified By: Daniel Samson
HQ OPS Officer: Howie Crouch
Notification Date: 03/29/2022
Notification Time: 09:34 [ET]
Event Date: 03/17/2022
Event Time: 00:00 [EDT]
Last Update Date: 04/21/2022
Notification Time: 09:34 [ET]
Event Date: 03/17/2022
Event Time: 00:00 [EDT]
Last Update Date: 04/21/2022
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
10 CFR Section:
Agreement State
Person (Organization):
Werkheiser, Dave (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB, (EMAIL)
CNSC (Canada), - (Email)
Werkheiser, Dave (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB, (EMAIL)
CNSC (Canada), - (Email)
EN Revision Imported Date: 4/22/2022
EN Revision Text: AGREEMENT STATE REPORT - LOST GD-153 and CO-57 SOURCES
The following information was received from the state of New York (NYSDOH) via fax:
"Four transmission/reference/calibration sources were shipped out in two separate shipments via [a common carrier] to Eckert & Ziegler on 3/17/2022 under two-day shipping and have been listed as 'delayed' since 3/18/2022. Upon contacting [the common carrier], an incident (No. C-61803614) was opened to attempt to locate the sources as [the common carrier] was unable to locate the two shipments. The licensee formally reported the sources as missing to NYSDOH on 3/28/2022.
"The Gd-153 source, (1.27 mCi as of 3/17/22), is deemed a reportable quantity under 20.2201 (a)(1)(ii), as greater than 10 times the Appendix C to Part 20 value (10 microCi), but less than 1000 times. The three other sources (Cobalt-57) fall below the values in Appendix C of 10 CFR 20 and are not reportable under 10 CFR 20.2201.
"The licensee is continuing to contact [the common carrier] regarding these sources and keeping NYSDOH updated on the status. NYS is consistently monitoring this situation under Incident No. 1389:
Device Manufacturer: Eckart & Zeigler
Device Model: TBD
Device S/N: S5-864
Source Manufacturer: Eckart & Zeigler
Source Model: TBD
Source S/N: S5-864
Isotope: Gd-153
Activity: 1.27 millicuries on 3/17/2022 (10 mCi assayed on 4/1/2020)
* * * UPDATE ON 04/21/22 AT 1216 EDT FROM DANIEL SAMSON TO TOM HERRITY * * *
The following information was received from the state of New York (NYSDOH) via fax:
"Updated Event description:
"The previously reported Gd-153 source (1.27 mCi on 3/17/22) was recovered on Friday, April 1, 2022. The Gd-153 source was successfully delivered to the intended recipient (Eckert & Ziegler) without any signs of tampering, opening, or modification. All sources in question were accounted for by the NY state medical licensee and Eckert & Ziegler. This event is attributed to a logistical error in transporting these packages by the common courier.
"As previously reported, the Gd-153 source was deemed a reportable quantity under 20.2201(a)(1)(ii) (1.27 mCi as of 3/17/22), as greater than 10 times the Appendix C to Part 20 Value, but less than 1000 times (10 micro-Ci). The 3 other sources (Cobalt-57) fell below the values in Appendix C of 10 CFR 20 and are not reportable under 10 CFR 20.2201. All other Cobalt-57 sources were also recovered without any signs of tampering, opening, or modification, and were all accounted for by the NY state medical licensee and Eckert & Ziegler on 4/1/2022.
"NYS opened Incident No.1389 to track this event. As of today, Incident No.1389 has been closed.
Device Manufacturer: Eckert & Ziegler
Device Model: HEGL-0133
Device S/N: S5-864
Source Manufacturer: Eckert & Ziegler
Source Model: HEGL-0133
Source S/N: S5-864
Isotope: Gd-153
Activity: 1.27 milliCuries on 3/17/2022 (10 mCi assayed on 4/1/2020)"
Event Report ID No.: Update to NYDOH - 22-02
Notified R1DO (Dentel), NMSS Events Notification, ILTAB, CNSC (Canada) via 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
EN Revision Text: AGREEMENT STATE REPORT - LOST GD-153 and CO-57 SOURCES
The following information was received from the state of New York (NYSDOH) via fax:
"Four transmission/reference/calibration sources were shipped out in two separate shipments via [a common carrier] to Eckert & Ziegler on 3/17/2022 under two-day shipping and have been listed as 'delayed' since 3/18/2022. Upon contacting [the common carrier], an incident (No. C-61803614) was opened to attempt to locate the sources as [the common carrier] was unable to locate the two shipments. The licensee formally reported the sources as missing to NYSDOH on 3/28/2022.
"The Gd-153 source, (1.27 mCi as of 3/17/22), is deemed a reportable quantity under 20.2201 (a)(1)(ii), as greater than 10 times the Appendix C to Part 20 value (10 microCi), but less than 1000 times. The three other sources (Cobalt-57) fall below the values in Appendix C of 10 CFR 20 and are not reportable under 10 CFR 20.2201.
"The licensee is continuing to contact [the common carrier] regarding these sources and keeping NYSDOH updated on the status. NYS is consistently monitoring this situation under Incident No. 1389:
Device Manufacturer: Eckart & Zeigler
Device Model: TBD
Device S/N: S5-864
Source Manufacturer: Eckart & Zeigler
Source Model: TBD
Source S/N: S5-864
Isotope: Gd-153
Activity: 1.27 millicuries on 3/17/2022 (10 mCi assayed on 4/1/2020)
* * * UPDATE ON 04/21/22 AT 1216 EDT FROM DANIEL SAMSON TO TOM HERRITY * * *
The following information was received from the state of New York (NYSDOH) via fax:
"Updated Event description:
"The previously reported Gd-153 source (1.27 mCi on 3/17/22) was recovered on Friday, April 1, 2022. The Gd-153 source was successfully delivered to the intended recipient (Eckert & Ziegler) without any signs of tampering, opening, or modification. All sources in question were accounted for by the NY state medical licensee and Eckert & Ziegler. This event is attributed to a logistical error in transporting these packages by the common courier.
"As previously reported, the Gd-153 source was deemed a reportable quantity under 20.2201(a)(1)(ii) (1.27 mCi as of 3/17/22), as greater than 10 times the Appendix C to Part 20 Value, but less than 1000 times (10 micro-Ci). The 3 other sources (Cobalt-57) fell below the values in Appendix C of 10 CFR 20 and are not reportable under 10 CFR 20.2201. All other Cobalt-57 sources were also recovered without any signs of tampering, opening, or modification, and were all accounted for by the NY state medical licensee and Eckert & Ziegler on 4/1/2022.
"NYS opened Incident No.1389 to track this event. As of today, Incident No.1389 has been closed.
Device Manufacturer: Eckert & Ziegler
Device Model: HEGL-0133
Device S/N: S5-864
Source Manufacturer: Eckert & Ziegler
Source Model: HEGL-0133
Source S/N: S5-864
Isotope: Gd-153
Activity: 1.27 milliCuries on 3/17/2022 (10 mCi assayed on 4/1/2020)"
Event Report ID No.: Update to NYDOH - 22-02
Notified R1DO (Dentel), NMSS Events Notification, ILTAB, CNSC (Canada) via 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