On June 24, 2011, the NRC issued a Notice of Violation to Henry Ford Macomb Hospital for a Severity Level III violation involving the failure to develop, implement, and maintain written procedures to provide high confidence that each administration is in accordance with the written directive as required by 10 CFR 35.41(a). Specifically, as of December 9, 2010, the licensee's procedure did not include steps to verify that the transfer tube assembly used at the time of the administration was the same length as the one identified in the treatment plan implementing the written directive. This resulted in four patients receiving radiation doses to areas not included within the planned treatment area.