Event Notification Report for July 08, 2026
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U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
07/07/2026 - 07/08/2026
Non-Agreement State
Event Number: 58340
Rep Org: Curium
Licensee: Curium
Region: 3
City: Noblesville State: IN
County:
License #: 13-35179-02
Agreement: N
Docket:
NRC Notified By: Cassandra Redmond
HQ OPS Officer: Adam Koziol
Licensee: Curium
Region: 3
City: Noblesville State: IN
County:
License #: 13-35179-02
Agreement: N
Docket:
NRC Notified By: Cassandra Redmond
HQ OPS Officer: Adam Koziol
Notification Date: 06/30/2026
Notification Time: 16:55 [ET]
Event Date: 06/29/2026
Event Time: 13:00 [EDT]
Last Update Date: 06/30/2026
Notification Time: 16:55 [ET]
Event Date: 06/29/2026
Event Time: 13:00 [EDT]
Last Update Date: 06/30/2026
Emergency Class: Non Emergency
10 CFR Section:
30.50(b)(1) - Unplanned Contamination
10 CFR Section:
30.50(b)(1) - Unplanned Contamination
Person (Organization):
Betancourt-Roldan, Diana (R3DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
Betancourt-Roldan, Diana (R3DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
UNPLANNED CONTAMINATION
The following information was provided by the licensee via phone and email:
"On June 29, 2026, at approximately 1300 EDT, a quality assurance (QA) technician was conditionally releasing two batches of lutetium chloride in two separate safes/pigs when one of the safes slipped from their hand during transport and fell to the ground. The 6.53 Ci glass vial shattered on the laboratory floor, spilling the contents onto the floor and the pants/shoes/socks of the QA technician. The technician notified the nearest person in the lab of the spill and together they ensured the lab was evacuated, with the QA technician remaining at the lab entrance for assistance from health physics. The other individuals exited the laboratory and performed a whole-body survey using a portal monitor. The health physics manager/radiation safety officer (RSO) was notified of the personnel and area contamination and responded to the event.
"Health physics personnel found contamination on the pants, socks, and shoes of the QA technician. The contamination levels exceeded the count rate instrument scale. Health physics did not identify contamination on the skin of the individual.
"Health physics temporarily secured the affected laboratory to prevent the spread of contamination. Health physics assessed the spill from personnel statement of events and initiated the decontamination process. As a precaution, the health physics manager/RSO designated the laboratory area as double shoe covers required. Health physics initiated decontamination efforts and were able to reduce the contamination to approximately 100 mR/hr on contact in the spill area. Health physics collected air samples of the immediate area of the spill and analyzed the filter via gamma spectroscopy to identify the nuclides. The results indicated no presence of airborne contamination.
"The director of the radiation safety office and the health physics manager communicated the incident to the NRC Region III Inspector on Monday, June 29. Curium discussed the incident and data with the Region III Inspector, and agreed to reconnect on Tuesday, June 30. On Tuesday, June 30, Curium discussed with the NRC Region III Inspector an update of the contamination and dose levels as well as further actions to remediate. Curium and the NRC agreed that the incident met the intent of the notification criteria under 10 CFR 30.50(b)(1).
"Health physics discontinued the decontamination efforts on June 30 when the dose rates and contamination levels did not decrease, indicating that the residual contamination was now fixed to the floor. Health physics measured general area exposure rates to be 4-6 mR/hr, on contact with the affected floor to be approximately 90 mR/hr, and approximately 100,000 cpm of removable contamination."
The following information was provided by the licensee via phone and email:
"On June 29, 2026, at approximately 1300 EDT, a quality assurance (QA) technician was conditionally releasing two batches of lutetium chloride in two separate safes/pigs when one of the safes slipped from their hand during transport and fell to the ground. The 6.53 Ci glass vial shattered on the laboratory floor, spilling the contents onto the floor and the pants/shoes/socks of the QA technician. The technician notified the nearest person in the lab of the spill and together they ensured the lab was evacuated, with the QA technician remaining at the lab entrance for assistance from health physics. The other individuals exited the laboratory and performed a whole-body survey using a portal monitor. The health physics manager/radiation safety officer (RSO) was notified of the personnel and area contamination and responded to the event.
"Health physics personnel found contamination on the pants, socks, and shoes of the QA technician. The contamination levels exceeded the count rate instrument scale. Health physics did not identify contamination on the skin of the individual.
"Health physics temporarily secured the affected laboratory to prevent the spread of contamination. Health physics assessed the spill from personnel statement of events and initiated the decontamination process. As a precaution, the health physics manager/RSO designated the laboratory area as double shoe covers required. Health physics initiated decontamination efforts and were able to reduce the contamination to approximately 100 mR/hr on contact in the spill area. Health physics collected air samples of the immediate area of the spill and analyzed the filter via gamma spectroscopy to identify the nuclides. The results indicated no presence of airborne contamination.
"The director of the radiation safety office and the health physics manager communicated the incident to the NRC Region III Inspector on Monday, June 29. Curium discussed the incident and data with the Region III Inspector, and agreed to reconnect on Tuesday, June 30. On Tuesday, June 30, Curium discussed with the NRC Region III Inspector an update of the contamination and dose levels as well as further actions to remediate. Curium and the NRC agreed that the incident met the intent of the notification criteria under 10 CFR 30.50(b)(1).
"Health physics discontinued the decontamination efforts on June 30 when the dose rates and contamination levels did not decrease, indicating that the residual contamination was now fixed to the floor. Health physics measured general area exposure rates to be 4-6 mR/hr, on contact with the affected floor to be approximately 90 mR/hr, and approximately 100,000 cpm of removable contamination."
Power Reactor
Event Number: 58349
Facility: Fermi
Region: 3 State: MI
Unit: [2] [] []
RX Type: [2] GE-4
NRC Notified By: Glenn West
HQ OPS Officer: Josue Ramirez
Region: 3 State: MI
Unit: [2] [] []
RX Type: [2] GE-4
NRC Notified By: Glenn West
HQ OPS Officer: Josue Ramirez
Notification Date: 07/03/2026
Notification Time: 21:50 [ET]
Event Date: 07/03/2026
Event Time: 18:27 [EDT]
Last Update Date: 07/07/2026
Notification Time: 21:50 [ET]
Event Date: 07/03/2026
Event Time: 18:27 [EDT]
Last Update Date: 07/07/2026
Emergency Class: Non Emergency
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS Actuation - Critical
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS Actuation - Critical
Person (Organization):
Betancourt-Roldan, Diana (R3DO)
Betancourt-Roldan, Diana (R3DO)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 2 | A/R | Y | 83 | Power Operation | 0 | Hot Shutdown |
EN Revision Imported Date: 7/8/2026
EN Revision Text: AUTOMATIC REACTOR SCRAM
The following information was provided by the licensee via phone and email:
"At approximately 1827 EDT on July 3, 2026, Fermi 2 experienced a lockout of bus `101' resulting in the loss of transformer `64' followed by a momentary loss of both reactor protection system (RPS) bus power sources resulting in a reactor scram. Both level `3' and level `2' isolations were received due to the reactor scram. The scram was non-complicated.
"Operations responded and stabilized the plant. Reactor water level is being maintained at normal level. The lowest water level observed was approximately 94.1 inches. Decay heat is being removed by the main steam system to the main condenser using automatic operation of the turbine bypass valve system. All control rods inserted into the core.
"Due to the reactor protection system actuation while critical, this event is being reported as a four-hour non-emergency notification per 10 CFR 50.72(b)(2)(iv)(B)."
The NRC Resident Inspector was notified.
* * * UPDATE ON 07/07/2026 AT 1122 EDT FROM SHEAY SMEAL TO ADAM KOZIOL * * *
The following information was provided by the licensee via phone and email:
"It was determined that reactor protection system (RPS) 'A' experienced a loss of power, while RPS 'B' remained energized throughout the transient. The automatic reactor scram was initiated on reactor pressure vessel (RPV) level 3 signal. Reactor core isolation cooling (RCIC) and high pressure coolant injection (HPCI) automatically initiated on an RPV level 2 signal. Primary containment and reactor isolation functions occurred as expected in response to the low reactor water level condition. Emergency diesel generators 11 and 12 automatically started and supplied their respective safety-related buses following the loss of power."
Notified R3DO (Bentancourt-Roldan).
EN Revision Text: AUTOMATIC REACTOR SCRAM
The following information was provided by the licensee via phone and email:
"At approximately 1827 EDT on July 3, 2026, Fermi 2 experienced a lockout of bus `101' resulting in the loss of transformer `64' followed by a momentary loss of both reactor protection system (RPS) bus power sources resulting in a reactor scram. Both level `3' and level `2' isolations were received due to the reactor scram. The scram was non-complicated.
"Operations responded and stabilized the plant. Reactor water level is being maintained at normal level. The lowest water level observed was approximately 94.1 inches. Decay heat is being removed by the main steam system to the main condenser using automatic operation of the turbine bypass valve system. All control rods inserted into the core.
"Due to the reactor protection system actuation while critical, this event is being reported as a four-hour non-emergency notification per 10 CFR 50.72(b)(2)(iv)(B)."
The NRC Resident Inspector was notified.
* * * UPDATE ON 07/07/2026 AT 1122 EDT FROM SHEAY SMEAL TO ADAM KOZIOL * * *
The following information was provided by the licensee via phone and email:
"It was determined that reactor protection system (RPS) 'A' experienced a loss of power, while RPS 'B' remained energized throughout the transient. The automatic reactor scram was initiated on reactor pressure vessel (RPV) level 3 signal. Reactor core isolation cooling (RCIC) and high pressure coolant injection (HPCI) automatically initiated on an RPV level 2 signal. Primary containment and reactor isolation functions occurred as expected in response to the low reactor water level condition. Emergency diesel generators 11 and 12 automatically started and supplied their respective safety-related buses following the loss of power."
Notified R3DO (Bentancourt-Roldan).
Agreement State
Event Number: 58341
Rep Org: NV Div of Rad Health
Licensee: Nevada Gold Mine LLC - Goldstrike
Region: 4
City: Carlin State: NV
County:
License #: 05-11-13549-01
Agreement: Y
Docket:
NRC Notified By: Corey Creveling
HQ OPS Officer: Christopher Prescott
Licensee: Nevada Gold Mine LLC - Goldstrike
Region: 4
City: Carlin State: NV
County:
License #: 05-11-13549-01
Agreement: Y
Docket:
NRC Notified By: Corey Creveling
HQ OPS Officer: Christopher Prescott
Notification Date: 07/01/2026
Notification Time: 08:32 [ET]
Event Date: 06/30/2026
Event Time: 00:00 [PDT]
Last Update Date: 07/01/2026
Notification Time: 08:32 [ET]
Event Date: 06/30/2026
Event Time: 00:00 [PDT]
Last Update Date: 07/01/2026
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
10 CFR Section:
Agreement State
Person (Organization):
Drake, James (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
Drake, James (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
AGREEMENT STATE REPORT - STUCK OPEN GAUGE
The following is a summary of information provided by the Nevada Division of Rad Health via phone and email:
The licensee reported a stuck open shutter on a fixed gauge. A contractor has been contacted for repair, the immediate area around the gauge has been cordoned off, and an investigation will be conducted. The radiation safety officer will coordinate service. The workers in the immediate area did not receive a dose.
Gauge Information:
Manufacturer: Ronan Engineering
Model: SA1-C5
Serial Number: 0718CG
Source: 50 mCi Cs-137
Report number: NV260004
The following is a summary of information provided by the Nevada Division of Rad Health via phone and email:
The licensee reported a stuck open shutter on a fixed gauge. A contractor has been contacted for repair, the immediate area around the gauge has been cordoned off, and an investigation will be conducted. The radiation safety officer will coordinate service. The workers in the immediate area did not receive a dose.
Gauge Information:
Manufacturer: Ronan Engineering
Model: SA1-C5
Serial Number: 0718CG
Source: 50 mCi Cs-137
Report number: NV260004
Agreement State
Event Number: 58342
Rep Org: Colorado Dept of Health
Licensee: VCA Wingate Animal Hospital
Region: 4
City: Englewood State: CO
County:
License #: GL001144
Agreement: Y
Docket:
NRC Notified By: Kathryn Kirk
HQ OPS Officer: Christopher Prescott
Licensee: VCA Wingate Animal Hospital
Region: 4
City: Englewood State: CO
County:
License #: GL001144
Agreement: Y
Docket:
NRC Notified By: Kathryn Kirk
HQ OPS Officer: Christopher Prescott
Notification Date: 07/01/2026
Notification Time: 09:19 [ET]
Event Date: 06/30/2026
Event Time: 00:00 [MDT]
Last Update Date: 07/01/2026
Notification Time: 09:19 [ET]
Event Date: 06/30/2026
Event Time: 00:00 [MDT]
Last Update Date: 07/01/2026
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
10 CFR Section:
Agreement State
Person (Organization):
Drake, James (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB, (EMAIL)
Drake, James (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB, (EMAIL)
AGREEMENT STATE REPORT - LOST EXIT SIGNS
The following is a summary of information provided by the Colorado Department of Public Health and Environment via email:
The licensee reported a lost exit sign that contained 9.21 Ci of tritium.
Manufacturer: SRB Technologies Inc
Model number: BX-10-WH
Colorado event number: CO260008
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
The following is a summary of information provided by the Colorado Department of Public Health and Environment via email:
The licensee reported a lost exit sign that contained 9.21 Ci of tritium.
Manufacturer: SRB Technologies Inc
Model number: BX-10-WH
Colorado event number: CO260008
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
Agreement State
Event Number: 58343
Rep Org: Colorado Dept of Health
Licensee: Two Rivers Convention Center
Region: 4
City: Grand Junction State: CO
County:
License #: GL001779
Agreement: Y
Docket:
NRC Notified By: Kathryn Kirk
HQ OPS Officer: Christopher Prescott
Licensee: Two Rivers Convention Center
Region: 4
City: Grand Junction State: CO
County:
License #: GL001779
Agreement: Y
Docket:
NRC Notified By: Kathryn Kirk
HQ OPS Officer: Christopher Prescott
Notification Date: 07/01/2026
Notification Time: 10:21 [ET]
Event Date: 06/18/2026
Event Time: 00:00 [MDT]
Last Update Date: 07/01/2026
Notification Time: 10:21 [ET]
Event Date: 06/18/2026
Event Time: 00:00 [MDT]
Last Update Date: 07/01/2026
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
10 CFR Section:
Agreement State
Person (Organization):
Drake, James (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB, (EMAIL) (EMAIL)
Drake, James (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB, (EMAIL) (EMAIL)
AGREEMENT STATE REPORT - LOST EXIT SIGNS
The following is a summary of information provided by the Colorado Department of Public Health and Environment via email:
The licensee reported eleven exit signs, with a total activity of 83.05 Ci of tritium, lost.
Two of the following:
Manufacturer: SRB Technologies
Model number: BX-10-GY
Activity: 9.21 Ci
Four of the following:
Manufacturer: Best Lighting Products, Inc.
Model number: SLXTU1GB10
Activity: 7.09 Ci
Three of the following:
Manufacturer: Best Lighting Products, Inc.
Model number: SLXTU1GW10
Activity: 7.09 Ci
Two of the following:
Manufacturer: Isolite Corporation
Model number: SLX60
Activity: 7.5 Ci
Colorado event number: CO260009
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
The following is a summary of information provided by the Colorado Department of Public Health and Environment via email:
The licensee reported eleven exit signs, with a total activity of 83.05 Ci of tritium, lost.
Two of the following:
Manufacturer: SRB Technologies
Model number: BX-10-GY
Activity: 9.21 Ci
Four of the following:
Manufacturer: Best Lighting Products, Inc.
Model number: SLXTU1GB10
Activity: 7.09 Ci
Three of the following:
Manufacturer: Best Lighting Products, Inc.
Model number: SLXTU1GW10
Activity: 7.09 Ci
Two of the following:
Manufacturer: Isolite Corporation
Model number: SLX60
Activity: 7.5 Ci
Colorado event number: CO260009
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
Agreement State
Event Number: 58344
Rep Org: NJ Rad Prot And Rel Prevention Pgm
Licensee: Integrity Test Lab
Region: 1
City: Pennsville State: NJ
County:
License #: 565318
Agreement: Y
Docket:
NRC Notified By: Sarah Sanderlin
HQ OPS Officer: Adam Koziol
Licensee: Integrity Test Lab
Region: 1
City: Pennsville State: NJ
County:
License #: 565318
Agreement: Y
Docket:
NRC Notified By: Sarah Sanderlin
HQ OPS Officer: Adam Koziol
Notification Date: 07/01/2026
Notification Time: 12:15 [ET]
Event Date: 05/27/2026
Event Time: 09:56 [EDT]
Last Update Date: 07/01/2026
Notification Time: 12:15 [ET]
Event Date: 05/27/2026
Event Time: 09:56 [EDT]
Last Update Date: 07/01/2026
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
10 CFR Section:
Agreement State
Person (Organization):
Dentel, Glenn (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
Dentel, Glenn (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
AGREEMENT STATE REPORT - UNRETRACTABLE SOURCE
The following is a summary of information provided by the New Jersey Department of Environmental Protection (NJDEP) via email:
On May 27, 2026, at approximately 0956 EDT, a licensee radiography crew contacted the radiation safety officer (RSO) regarding an 86.6 Ci Ir-192 source (serial number 29161P) which could not be retracted into the radiography camera (QSA D880 serial number D13840). The guide tube was likely crimped when a bar clamp attached to the guide tube became unattached and fell. The crew established a 2 mR/h barrier and secured access to the area. The RSO arrived on site around 1115 and secured the source back into the camera by 1411. The RSO received an estimated dose of 483 mR. Three additional staff received estimated doses of 120 mR, 200 mR, and 245 mR.
NJ Event Number: TBD
The following is a summary of information provided by the New Jersey Department of Environmental Protection (NJDEP) via email:
On May 27, 2026, at approximately 0956 EDT, a licensee radiography crew contacted the radiation safety officer (RSO) regarding an 86.6 Ci Ir-192 source (serial number 29161P) which could not be retracted into the radiography camera (QSA D880 serial number D13840). The guide tube was likely crimped when a bar clamp attached to the guide tube became unattached and fell. The crew established a 2 mR/h barrier and secured access to the area. The RSO arrived on site around 1115 and secured the source back into the camera by 1411. The RSO received an estimated dose of 483 mR. Three additional staff received estimated doses of 120 mR, 200 mR, and 245 mR.
NJ Event Number: TBD
Agreement State
Event Number: 58346
Rep Org: PA Bureau of Radiation Protection
Licensee: Allegheny Health Network
Region: 1
City: Pittsburgh State: PA
County:
License #: PA-1659
Agreement: Y
Docket:
NRC Notified By: John Chippo
HQ OPS Officer: Adam Koziol
Licensee: Allegheny Health Network
Region: 1
City: Pittsburgh State: PA
County:
License #: PA-1659
Agreement: Y
Docket:
NRC Notified By: John Chippo
HQ OPS Officer: Adam Koziol
Notification Date: 07/01/2026
Notification Time: 15:36 [ET]
Event Date: 06/29/2026
Event Time: 15:45 [EDT]
Last Update Date: 07/01/2026
Notification Time: 15:36 [ET]
Event Date: 06/29/2026
Event Time: 15:45 [EDT]
Last Update Date: 07/01/2026
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
10 CFR Section:
Agreement State
Person (Organization):
Dentel, Glenn (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
Allen, Logan (NMSS)
Dentel, Glenn (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
Allen, Logan (NMSS)
AGREEMENT STATE REPORT - MEDICAL EVENT
The following information was provided by the Pennsylvania Bureau of Radiation Protection (the Department) via email:
"On June 30, 2026, the licensee notified the Department of a medical event that occurred on June 29, 2026, at approximately 1545 EDT.
"A patient was being treated with high dose rate (HDR) Ir-192 to a 5 cc area using a vaginal cuff with vaginal cylinder. The original treatment was 600 cGy per fraction, 5 fractions, and this was her 2nd treatment. The applicator was installed but while waiting for the authorized user (AU), the patient started coughing. A nurse checked the patient, and it seemed like everything was fine. When the AU arrived, they informed them of the coughing and they asked some questions. The nurse said everything looked okay, so they went ahead with treatment without the AU checking for themselves. The treatment was delivered. When the AU went to pull the cylinder out, it was removed with no resistance which indicated it was further out of the patient than intended. The AU reinserted the cylinder to the area they thought it should have been located for the treatment and noted that when removing the cylinder after treatment it was 5-6 cm further out of the patient than it should have been. They suspect it moved when the patient coughed before treatment, but it could have moved during treatment. They performed an initial dose estimate and found that when the cylinder moved 5 cm the source did not provide any dose to the intended tissue and delivered all 600 cGy (600 rem) to the vaginal mucosa/vaginal wall. This area should have received 4 percent of the dose if the treatment was delivered as intended (24 cGy). This is reportable under 35.3045(a)(1)(i)(C) and 35.3045(a)(1)(iii).
"The AU does not expect any adverse effects. The patient and referring physician have been notified. The Department will perform a reactive inspection."
Pennsylvania Event Report ID Number: PA260009
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.
The following information was provided by the Pennsylvania Bureau of Radiation Protection (the Department) via email:
"On June 30, 2026, the licensee notified the Department of a medical event that occurred on June 29, 2026, at approximately 1545 EDT.
"A patient was being treated with high dose rate (HDR) Ir-192 to a 5 cc area using a vaginal cuff with vaginal cylinder. The original treatment was 600 cGy per fraction, 5 fractions, and this was her 2nd treatment. The applicator was installed but while waiting for the authorized user (AU), the patient started coughing. A nurse checked the patient, and it seemed like everything was fine. When the AU arrived, they informed them of the coughing and they asked some questions. The nurse said everything looked okay, so they went ahead with treatment without the AU checking for themselves. The treatment was delivered. When the AU went to pull the cylinder out, it was removed with no resistance which indicated it was further out of the patient than intended. The AU reinserted the cylinder to the area they thought it should have been located for the treatment and noted that when removing the cylinder after treatment it was 5-6 cm further out of the patient than it should have been. They suspect it moved when the patient coughed before treatment, but it could have moved during treatment. They performed an initial dose estimate and found that when the cylinder moved 5 cm the source did not provide any dose to the intended tissue and delivered all 600 cGy (600 rem) to the vaginal mucosa/vaginal wall. This area should have received 4 percent of the dose if the treatment was delivered as intended (24 cGy). This is reportable under 35.3045(a)(1)(i)(C) and 35.3045(a)(1)(iii).
"The AU does not expect any adverse effects. The patient and referring physician have been notified. The Department will perform a reactive inspection."
Pennsylvania Event Report ID Number: PA260009
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
Event Number: 58348
Rep Org: Virginia Rad Materials Program
Licensee: Dickenson-Russell Contura, LLC
Region: 1
City: McClure State: VA
County:
License #: 1625
Agreement: Y
Docket:
NRC Notified By: Sheila Nelson
HQ OPS Officer: Adam Koziol
Licensee: Dickenson-Russell Contura, LLC
Region: 1
City: McClure State: VA
County:
License #: 1625
Agreement: Y
Docket:
NRC Notified By: Sheila Nelson
HQ OPS Officer: Adam Koziol
Notification Date: 07/01/2026
Notification Time: 18:42 [ET]
Event Date: 07/01/2026
Event Time: 00:00 [EDT]
Last Update Date: 07/02/2026
Notification Time: 18:42 [ET]
Event Date: 07/01/2026
Event Time: 00:00 [EDT]
Last Update Date: 07/02/2026
Emergency Class: Non Emergency
10 CFR Section:
Agreement State
10 CFR Section:
Agreement State
Person (Organization):
Dentel, Glenn (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB, (EMAIL) (EMAIL)
Dentel, Glenn (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
ILTAB, (EMAIL) (EMAIL)
AGREEMENT STATE REPORT - LOST SOURCE
The following information was received from the Virginia Radioactive Materials Program (VRMP) via email:
"On July 1, 2026, the licensee discovered and reported a lost generally licensed Cs-137 fixed gauge source with a current activity of 12.1 mCi. Source model number CDC.P4 with serial number MT563, gauge model Berthold LB7440. The gauge containing the source was reported to be locked out in the shielded position. It is believed the gauge was disposed of in scrap metal during demolition work conducted the week prior to July 1. The licensee has conducted a thorough search, including their site and visits to potential scrap metal facilities they use, but the source/gauge was not located. There is no indication of any exposures associated with this incident thus far.
"The source meets the reporting requirement of immediately after it becomes known. The licensee plans to continue searching for the source and will contact the agency if found. The licensee has been instructed to file a written report with the VRMP within 30 days."
* * * UPDATE ON 07/02/2026 AT 1035 EDT FROM SHEILA NELSON TO CHRISTOPHER PRESCOTT * * *
The following information was provided by the Virginia Radioactive Materials Program (VRMP) via email:
"The licensee has located the gauge/source. It has been locked in a secure storage building on their site since the demolition work occurred. The radiation safety officer has confirmed the gauge is still appropriately locked out in the shielded position and there have been no exposures to anyone."
Notified R1DO (Dentel), NMSS Events Notifications (Email), and ILTAB (Email).
Virginia Event Number: VA260003
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
The following information was received from the Virginia Radioactive Materials Program (VRMP) via email:
"On July 1, 2026, the licensee discovered and reported a lost generally licensed Cs-137 fixed gauge source with a current activity of 12.1 mCi. Source model number CDC.P4 with serial number MT563, gauge model Berthold LB7440. The gauge containing the source was reported to be locked out in the shielded position. It is believed the gauge was disposed of in scrap metal during demolition work conducted the week prior to July 1. The licensee has conducted a thorough search, including their site and visits to potential scrap metal facilities they use, but the source/gauge was not located. There is no indication of any exposures associated with this incident thus far.
"The source meets the reporting requirement of immediately after it becomes known. The licensee plans to continue searching for the source and will contact the agency if found. The licensee has been instructed to file a written report with the VRMP within 30 days."
* * * UPDATE ON 07/02/2026 AT 1035 EDT FROM SHEILA NELSON TO CHRISTOPHER PRESCOTT * * *
The following information was provided by the Virginia Radioactive Materials Program (VRMP) via email:
"The licensee has located the gauge/source. It has been locked in a secure storage building on their site since the demolition work occurred. The radiation safety officer has confirmed the gauge is still appropriately locked out in the shielded position and there have been no exposures to anyone."
Notified R1DO (Dentel), NMSS Events Notifications (Email), and ILTAB (Email).
Virginia Event Number: VA260003
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
Page Last Reviewed/Updated July 08, 2026, 05:03 am EDT