Poster Poster Program Radiopharmaceuticals, Theranostics, and Nuclear Medicine

A Comprehensive Yearly Review of U.S. NRC Event Notification Reports

Abstract
Purpose

To evaluate 2024 NRC medical‑related Event Notification Reports and identify recurring incident patterns as well as isotope‑specific trends from January through December. By characterizing common failure modes and operational vulnerabilities, this analysis aims to support quality‑management improvements and guide targeted strategies to reduce future occurrences.

Methods

All NRC Event Notification Reports from January–December 2024 were compiled into a structured database (N = 1,240). Reports were classified as medical or non‑medical, with only medical events included in the final evaluation dataset. Two supplemental datasets were generated: an incident‑category dataset (N = 89) and an isotope‑incident dataset (N = 84) derived from monthly tabulations. Events were categorized by facility type, radionuclide, incident mechanism, and regulatory significance. Quantitative analyses were performed using Python and Excel to generate frequency distributions, temporal trends, and graphical summaries. Root‑cause patterns were classified and evaluated across human‑factor, procedural, and equipment‑related contributors.

Results

A total of 89 medical‑related incidents were identified across 10 incident categories. Underexposure was the most frequent type of event, followed by contamination, lost source, and retraction events when ranking the incidents based on their occurrence throughout the year. Monthly totals remained stable, indicating a consistent baseline for reportable occurrences. The isotope‑specific dataset contained 84 events total, with 5 events of unidentified isotope. Y‑90 accounted for 42 incidents, representing the largest proportion of radionuclide‑related reports.

Conclusion

The 2024 data reveal persistent patterns in underexposure, contamination, and lost‑source incidents, along with a disproportionate number of Y‑90–related events. The concentration of Y‑90 events suggests workflow‑specific vulnerabilities in radiopharmaceutical handling and verification. These findings highlight opportunities to strengthen verification protocols, source‑tracking practices, and radiopharmaceutical procedures. The development of targeted quality‑control interventions may reduce recurrence and enhance institutional safety performance. Organizations that address lessons learned from these events have an opportunity to strengthen their quality management programs

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