Exposure from a Medical Treatment Source


Print View Posted on: 26 December 2024

Event Date: 21 July 2017 Event Type: Radiation Source
Event Location: Korea, Republic of, Seoul INES Rating: 3 (Final)

On July 21, 2017, at a hospital in Seoul, an incident occurred when the assigned staff member failed to follow the patient verification procedure in the I-131 therapy room. As a result, a dose of I-131 (5,550 MBq), intended for a thyroid desease patient, was mistakenly administered to another patient. The misadministrated patient had been hospitalized since July 19 for MIBG therapy and had already received a dose of I-131 (7,400 MBq). Due to the misadministration, the additional thyroid absorbed dose was estimated to be between 15.6 and 24.4 Gy.

INES Rating: 3 - Serious incident (Final) as per 23 May 2018
Release beyond authorized limits? No
Overexposure of a member of the public? Yes
Overexposure of a worker? No

Contamination spread within the facility? No
Damage to radiological barriers (incl. fuel damage) within the facility? No

Degradation of Defence In-Depth Yes

Person injured physically or casualty? No
Is there a continuing problem? No

Changsu Park
Korea Institute of Nuclear Safety (KINS)

cspark@kins.re.kr
https://www.kins.re.kr
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