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NRC CAL – NOV (SL III)

EA-07-313 · CAL · Severity SLIII · Issued 2008-03-31 · Materials Licensees

Action

EA Number
EA-07-313
Licensee
NOV (SL III)
Category
Materials Licensees
Action type
CAL
Severity level
SLIII
Date issued
2008-03-31

Description

On March 31, 2008, a Notice of Violation was issued for a Severity Level III problem. The violations involved the failure to instruct an Authorized Medical Physicist, a supervised individual, in the licensee's written directive procedures with respect to the use of byproduct material and failure to develop, implement and maintain written directive procedures to provide high confidence that each administration was in accordance with the written directive. Specifically, the licensee did not verify before treatment that the treatment plan was properly input into the high dose rate remote afterloader unit and did not verify, after treatment, that the step size, a treatment parameter used for the treatments, was in agreement with the treatment plan. A medical event occurred during the licensee's administration of three treatment fractions to a patient. As a result, portions of the treatment site received a total dose that differed from the prescribed dose by more than 20 percent.

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