Event Notification Report for April 18, 2022

EN Revision Imported Date: 5/17/2022

EN Revision Text: AGREEMENT STATE REPORT - GROUNDWATER CONTAINING URANIUM IDENTIFIED DURING EXCAVATION

The following was received from the Utah Department of Environmental Quality via email:

"On April 18, 2022, Licensee personnel reported a strong fuel smell coming from a recent excavation associated with a new facility under construction. The excavations for sumps extended into the groundwater and were not included on the conditionally approved plans. The smell triggered an investigation where groundwater samples were collected for both chemical and radiological analysis. One sample indicated a concentration of 12,000 pCi/L of uranium (preliminary findings). The presence of uranium in the groundwater was unanticipated. Subsequently, the Division of Waste Management and Radiation Control has communicated to the licensee to characterize the nature and extent of the contamination. The Division is waiting for additional information from the licensee."

Event Report ID No.: UT220003

* * * UPDATE AT 1612 EDT ON MAY 16, 2022, FROM JALYNN KNUDSEN TO BRIAN P. SMITH * * *

The following update was received from the Utah Department of Environmental Quality (the agency) via email:

"On April 18, 2022, [Licensee] personnel reported a strong fuel smell coming from a recent excavation associated with a new facility under construction. The [Licensee] did not anticipate encountering groundwater at the depth of excavation. Upon encountering the groundwater and observing a hydrocarbon odor, the Licensee collected groundwater samples for both organic and radiological analysis. The preliminary screening of one sample indicated a potentially high concentration of uranium. The preliminary result of the analysis was reported to the agency with the intent to conduct additional confirmatory work. The Licensee contends that the initial high concentrations were in error due to improper analytical methodology. These results were presented to the agency prior to confirmation. Results of further investigation by the Licensee indicate that the contaminant was thorium, not uranium, and that all radionuclides were below detection limits.

"The agency collected confirmatory samples for analysis and is awaiting results of both organic and radiological analysis.

"The Licensee is preparing an investigation plan to fully characterize the nature and extent of the contamination."

Event Report ID No.: UT220003 (updated)

Notified R4DO (Gepford) and NMSS Events Notification (email).

AGREEMENT STATE REPORT - PATIENT UNDERDOSE

The following was received from the Pennsylvania Bureau of Radiation Protection by e-mail:

"On April 18, 2022, a patient underwent a Y-90 SIR-Sphere treatment. The prescribed dosage was 7.07 milliCuries, however only 5.27 milliCuries was able to be delivered, or 74.5 percent. The apparent cause is that the blood vessel the catheter was placed in had a complicated vasculature which inhibited the flow of the spheres. No harm is expected to the patient. The referring physician and the patient have been informed."

Event Report ID Number: PA220014

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.

AGREEMENT STATE REPORT - PATIENT UNDERDOSE

The following was received from the Ohio Bureau of Radiation Protection by e-mail:

"On 4/18/22, a patient was scheduled to receive 120 Gy to the right hepatic lobe of the liver [involving Y-90 TheraSpheres], however only 94.2 Gy was delivered, resulting in an underdose of 21.5 percent. The [authorized user] notified the [Radiation Safety Officer] on 4/19/22. Stasis was not reached and at this time no cause was identified."

Item Number: OH220006

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.