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Event Detail - Abnormal Occurrence Print ITEMNO 950291 AO_NO: NRC 95-04 DATE: 03/14/1995 TITLE: MEDICAL BRACHYTHERAPY MISADMINISTRATION AT THE UNIVERSITY OF VIRGINIA, IN CHARLOT NAME: University of Virginia Medical Cent CITY: Charlottesville STATE: VA Nature and Probable Consequences: NRC Action: A patient was prescribed a manual brachytherapy NRC conducted a special inspection on March 23-24, procedure using cesium-137 (Cs-137) sources loaded in 1995, to review the circumstances surrounding the an applicator, for a total gynecological treatment dose of misadministration. The inspection report was issued on 3000 centigray (cGy) (3000 rad). May 2, 1995. Enforcement action will be taken as appropriate. Cause: Other Agency Action: The licensee's staff involved in the brachytherapy procedure were not familiar with handling of the applicator that contained the Cs-137 sources. Also, because of anatomic characteristics of the patient, the physician had difficulty inserting the source carrier into the applicator. Licensee Action: Criteria: The licensee provided training for its staff, involved in The following information pertaining to this event is also brachytherapy procedures, concerning the precautions being reported in the Federal Register. Appendix A (see which must be taken when handling an applicator such as Event Type 3 in Table A-1) of this report notes that a the one used in the subject procedure. Also, emphasis therapeutic exposure to any part of the body not was placed on the need to be more attentive during the scheduled to receive radiation can be considered an AO. source insertion process in order to account for all ITEMNO 950645 AO_NO: NRC 95-05 DATE: 05/09/1995 TITLE: MEDICAL THERAPEUTIC RADIOPHARMACEUTICAL MISADMINISTRATION OF IODINE-131 AT MASS NAME: Massachusetts General Hospital CITY: Boston STATE: MA Nature and Probable Consequences: NRC Action: A patient was prescribed a 296 megabecquerel (MBq) (8 NRC performed an inspection on May 12, 1995, to learn millicurie [mCi]) dosage of iodine-131 (I-131) for about the event and determined that it constituted a hyperthyroidism; however, a dosage of 1106.3 MBq (29.9 misadministration as defined in 10 CFR 35.2. NRC mCi) was administered. determined that this was an isolated violation of the licensee's Quality Management Program and issued a Cause: Other Agency Action: The licensee stated that this event occurred because of a human error. The technologist involved in this procedure inadvertently switched the labeled lids on the vial shields containing the I-131 dosages prescribed for different patients. Additionally, the technician failed to check for Licensee Action: Criteria: The licensee instituted a procedure for checking the vial The following information pertaining to this event is also label before giving a dose. In addition, the licensee is being reported concurrently in the Federal Register. obtaining a second dose calibrator which will be used in Appendix A (see Event Type 5 [a] in Table A-1) of this the out-patient dosing room of the Thyroid Clinic. Each report notes that administering a therapeutic dose of a dose will be re-assayed immediately before the I-131 is radiopharmaceutical differing from the prescribed dose by administered to the patient rather than relying on the more than 10 percent and the actual dose is greater than ITEMNO 950755 AO_NO: NRC 95-06 DATE: 05/09/1995 TITLE: MULTIPLE MEDICAL BRACHYTHERAPY MISADMINISTRATIONS AT MADIGAN ARMY MEDICAL CEN NAME: Madigan Army Medical Center CITY: Fort Lewis STATE: WA Nature and Probable Consequences: NRC Action: Four patients were prescribed brachytherapy procedures, NRC initiated an inspection on June 6, 1995, to review using iridium-192 seeds of different source strengths, and the circumstances associated with the misadministrations received doses other than those prescribed because of and to review the licensee's corrective actions. (As of the the same computer input error. (The same computer input date of this report, the inspection is ongoing.) An NRC error could cause either underdoses or overdoses medical consultant will review each case in order to Cause: Other Agency Action: Based upon NRC's initial review of the misadministrations, it appears that the probable causes of the treatment errors were failures to: (1) independently review or check the data input to the computerized treatment planning system, and (2) perform an Licensee Action: Criteria: The physics staff at MAMC promptly corrected the data The following information pertaining to this event is also entered into the computer treatment planning computer, being reported concurrently in the Federal Register. recalculated the doses received by the patients, and took Appendix A (see Event Type 5[d] in Table A-1) of this steps to ensure that appropriate data will be used for report notes that administering a therapeutic dose from a future treatment plans. sealed source such that the treatment dose differs from the prescribed dose by more than 10 percent and the ITEMNO 950290 AO_NO: AS 95-02 DATE: 03/14/1995 TITLE: MEDICAL BRACHYTHERAPY MISADMINISTRATION BY MOBILE TECHNOLOGY, INC., AT IRVINE ME NAME: Irvine Medical Center CITY: Irvine STATE: CA Nature and Probable Consequences: NRC Action: A patient was prescribed a brachytherapy treatment to the left lung using a high dose rate (HDR) remote afterloading unit. However, because of an error the patient received 800 centigray (800 rad) to the right lung. Cause: Other Agency Action: A chest x-ray showing that the HDR remote afterloading The State Agency requested that the licensee take the unit's positioning catheter was erroneously placed in the above corrective actions. right lung was not reviewed by either the pulmonologist or the radiation oncologist. This event is considered closed for the purpose of this report. Licensee Action: Criteria: The licensee took the following actions to prevent Appendix A (see Event Type 3 in Table A-1) of this report recurrence: (1) real-time fluoroscopy will be used at the notes that a therapeutic exposure to any part of the body time of the bronchoscopy; (2) a guide wire will be utilized not scheduled to receive radiation can be considered an within all bronchial catheters at the time of the AO. bronchoscopy; (3) a chest x-ray will be obtained and reviewed by the participating physicians immediately ITEMNO 950451 AO_NO: AS 95-03 DATE: 04/06/1995 TITLE: OVEREXPOSURE OF PERSONNEL AT GWINNETT MEDICAL CENTER IN LAWRENCEVILLE, GEORGI NAME: Gwinnett Medical Center CITY: Lawrenceville STATE: GA Nature and Probable Consequences: NRC Action: Licensee personnel involved in a brachytherapy treatment using iridium-192 seeds received exposures above minimum as a result of handling what they assumed was a dummy source. The personnel included physicists, physicians, technologists and nursing staff. One of the Cause: Other Agency Action: The licensee stated that the overexposures occurred The Department of Natural Resources of the State of because: (1) the hospital procedures were not followed Georgia investigated the incident. The corrective and when ordering the radioactive material; (2) the personnel preventative actions submitted by the licensee will be handling the iridium-192 seeds assumed that they were reviewed during the next inspection by the Department. dummy sources; (3) the physicist who primarily handled Enforcement action will be taken as appropriate. Licensee Action: Criteria: The licensee addressed the issues involving the incident, Appendix A (see For All Licensees, Criterion No. 1) of this and either has or will implement corrective actions to report notes that exposure of the feet, ankles, hands or prevent recurrence. Exposure dose calculations have forearms of any individual to 375 rem or more of radiation been made by a certified health physicist. The personnel can be considered an AO. training and accreditation program has been modified. Physicist A and Physicist B have received inservice ITEMNO 950065 AO_NO: AS 95-04 DATE: 07/28/1994 TITLE: MEDICAL BRACHYTHERAPY MISADMINISTRATION AT SOUTHWEST TEXAS METHODIST HOSPITA NAME: Southwest Texas Methodist Hospit CITY: San Antonio STATE: TX Nature and Probable Consequences: NRC Action: Two patients were prescribed brachytherapy procedures using manual loading for prostate treatment. One prescribed to receive a dose of 160 gray (Gy) (16,000 rad) of iodine-125 and the other was prescribed a dose of 115 Gy (11,500 rad) of palladium-103. However, Cause: Other Agency Action: The licensee was unable to determine how the The State Agency investigated the incident and reviewed misidentification occurred. the new procedures of prostate implants. No violations were cited. This event is considered closed for the purpose of this Licensee Action: Criteria: The Radiation Safety Committee immediately Appendix A (see Event Type 5[d] in Table A-1) of this implemented new procedures for ordering, receiving, report notes that administering a therapeutic dose from a loading, sterilizing, and implanting prostate implants. sealed source such that the treatment dose differs from the prescribed dose by more than 10 percent and the event (regardless of health effects) affects two or more patients at the same facility can be considered an AO ITEMNO 960191 AO_NO: AS 95-01 DATE: 05/23/1993 TITLE: MEDICAL TELETHERAPY MISADMINISTRATION AT AN "UNSPECIFIED LICENSEE" IN NEW YORK, N NAME: Unspecified Licensee CITY: New York STATE: NY Nature and Probable Consequences: NRC Action: A patient was prescribed a total dose to the right superclavicular area and spine of 2400 centigray (cGy) (2400 rad) using cobalt-60 teletherapy equipment. During simulation, the technologist erroneously placed the preparatory tattoo marking the treatment area on the Cause: Other Agency Action: The misadministration occurred because the licensee Acting under authority granted by the State Agency, the staff marked the wrong treatment area on the patient New York City Bureau of Radiological Health investigated during a simulation in preparation for treatment. the misadministration and submitted its investigative reports to NRC. The reports contained information about the licensee's actions to prevent recurrence.
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