NRC to examine radiation treatment program at Veterans Affairs

The Nuclear Regulatory Commission said on Tuesday it was conducting a special inspection of a radiation therapy program at the Veterans Affairs Medical Center in Philadelphia after officials there discovered that dozens of prostate cancer patients had received lower-than-prescribed radiation doses.

"We will take a look at what happened and why," said Viktoria Mitlyng, a spokeswoman at NRC's Region III office in Lisle, Ill.

The special inspection was triggered after VA inspectors found 55 out of 112 prostate cancer patients treated at the facility between February 2002 and June 2008 had received radiation doses less than 80 percent of what was prescribed. The patients all were receiving brachytherapy in which tiny radioactive rods containing iodine-125, sometimes called seeds, are implanted in the prostate to treat cancer.

The first case of underdosing was discovered in May after a physicist at the Philadelphia medical center suspected that a patient in the brachytherapy program likely had received an insufficient dose of radiation, said Dale Warman, a medical center spokesman.

Medical center officials immediately notified the National Health Physics Program, which provides regulatory oversight for radiation safety throughout the Veterans Affairs medical system, and began their own administrative review of the cancer treatment program, Warman said. NHPP confirmed the underdosing and notified NRC on May 18.

A single event of underdosing does not trigger an NRC special inspection, said Mitlyng. But it did prompt officials in the National Health Physics Program to review other patient records at the Philadelphia medical center to determine if there were other cases of underdosing. An initial review of 20 records led officials to review all 112 brachytherapy procedures that had taken place since the program's inception in 2002, Warman said.

The medical center has examined all 112 patients, 55 of whom were found to have received incorrect radiation doses. Each patient has been assigned a physician and is receiving follow-up care, Warman said. The medical center suspended its prostate cancer treatment program in June.

In response to the findings of the National Health Physics Program, NRC Region III, which oversees the Veterans Affairs radioactive materials license, in July began a "reactive inspection" into the high number of medical events reported.

Based on that initial inspection, NRC launched the more extensive special inspection to broadly examine the medical center's radiation treatment program, the training and qualifications of personnel involved in the program, how medical center officials responded to the discovery, and their plan to address the problem, said Mitlyng.

In addition, NRC will look at any other Veterans Affairs facilities that use the same equipment and materials, she said. The agency also will ask an independent medical body to examine a sample of the 55 cases of underdosing to determine the health effects on patients.