Event Notification Report for March 08, 2023
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
03/07/2023 - 03/08/2023
Agreement State
Event Number: 56383
Rep Org: Texas Dept of State Health Services
Licensee: Citizens Medical Center
Region: 4
City: Victoria State: TX
County:
License #: L 00283
Agreement: Y
Docket:
NRC Notified By: Chris Moore
HQ OPS Officer: Adam Koziol
Notification Date: 02/28/2023
Notification Time: 07:02 [ET]
Event Date: 02/27/2023
Event Time: 00:00 [CST]
Last Update Date: 02/28/2023
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
Person (Organization):
Vossmar, Patricia (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
Event Text
AGREEMENT STATE REPORT - STUCK SOURCE
The following information was provided by the Texas Department of State Health Services (the Agency) via email:
"On February 27, 2023, the Agency was sent a reciprocity notice that a service company was going to work in a hospital to repair a Elekta model 136146 Flexitron high dose rate remote afterloader unit (HDR) containing 10 Ci of Ir-192. The report indicated the source was stuck. The Agency contacted the hospital and determined that the source became stuck outside the HDR unit during the conduct of a dwell position accuracy check using the source position check ruler. This was conducted as a daily Quality Assurance (QA) check. The QA device transfer tube for the test was connected upside down, the connector was inverted, by error, which allowed the source to travel outside the tube and get stuck outside the vault below the ruler. The source could not be retrieved. There is no report of excess exposure to hospital staff and no medical procedure was being conducted. The unit was repaired and a report was issued by the service technician to determine if there is a design issue with the test equipment. Additional details will be sent in accordance with SA 300."
Texas Incident Number: I-9994
Texas NMED Number: TX23007
Agreement State
Event Number: 56391
Rep Org: Louisiana Radiation Protection Div
Licensee: Boise Packaging and Newsprint, LLC
Region: 4
City: DeRidder State: LA
County:
License #: LA-28736-L01
Agreement: Y
Docket:
NRC Notified By: James Pate
HQ OPS Officer: John Russell
Notification Date: 03/07/2023
Notification Time: 14:38 [ET]
Event Date: 03/07/2023
Event Time: 09:54 [CST]
Last Update Date: 03/07/2023
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
Person (Organization):
Gepford, Heather (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
Event Text
AGREEMENT STATE REPORT - SOURCE SHUTTER MALFUNCTION
The following information was received from the Louisiana Radiation Protection Division (the Department) via email:
"On March 7, 2023, Boise Packaging and Newsprint, LLC notified the Department that there was an equipment malfunction. The pivot pin connecting the shutter handle rusted out and failed. The fixed gauge was an Ohmart Model SHRM-B serial number 1301/1830. The source was 80 mCi of Cs-137. A third party licensee was contacted to come out and fix the Ohmart gauge."
Louisiana Report ID: LA20230003