ASN Report 2018

Andra Andra is the sole licensee of a radioactivewastedisposal BNI in France. ASN considers that the licensee’s organisational and technical resources are appropriate for operation of the existing centres and that the operation of these centres is satisfactory. Over the past ten years, ASN has found a significant improvement in the approval and monitoring activities for packages of Low and Intermediate Level, Short-Lived Waste (LLW / ILW-SL). ASN hopes to see a ramp-up of the system with regard to waste packaged for the planned future facilities. ASN considers that the design of Cigéo has on the whole reached satisfactory technological maturity at the Safety Options Dossier (DOS) stage. Some of the safety options, more particularly concerning the possible disposal of bituminised waste and management of the fire risk, nonetheless need to be supplemented for the purposes of the creation authorisation application. From the Andra organisation viewpoint, the fact of becoming the licensee of a facility of the scale and complexity of Cigéo is a real challenge. With regard to Low Level, Long-Lived Waste (LLW-LL), the National Radioactive Materials and Waste Management Plan (PNGMDR) has set out the steps for defining and designing disposal solutions. ASN notes that the definition of the design options is behind schedule. ASN’s assessments of the other licensees are presented in the Regional Overview part and in the various chapters of this report. ASN ASSESSMENTS PER FIELD OF ACTIVITY THE MEDICAL FIELD In 2018, ASNconsiders that the state of radiation protection in themedical field remained stable, with the professionals on thewhole giving satisfactory consideration to radiation protection, with the exception of fluoroscopy-guided interventional practices. In external radiotherapy , the improvement in treatment safety, which has been underway for several years, continued. It is however still faced with signif icant technological changes, with potential risks arising when the organisational and human factors are not correctly managed. These technological changes require risk assessments, but the professionals do not as yet have complete expertise in the relevant methodology. After a marked rise in the number of Significant Radiation Protection Events (ESR) in this field of activity, ASN has observed that the numbers have fallen over the past three years. The reasons for this drop must be identified. With regard to health care safety, the brachytherapy situation is comparable to that of external radiotherapy. The radiation protection of workers and the management of High-Level Sealed Sources (SSHA) are considered to be on the whole satisfactory, although this level must be maintained by means of a continuous training effort. In the current context, greater attention must be given to increased SSHA access security, to prevent unauthorised access to these sources. The radiation protection of patients and professionals in nuclear medicine is dealt with satisfactorily. Also in this sector, training efforts must be maintained. In addition, the coordination of preventive measures during work by outside contractors (for equipment maintenance, cleaning of the premises, etc.) must be improved. One of the issues of radiation protection is also good management of radioactive effluents; this is all the more important as internal targeted radiotherapy treatments, which require the administration of high activity levels to the patients, will undoubtedly become more widespread, resulting in an increased level of discharged radioactivity. In the field of fluoroscopy-guided interventional practices , ASN considers that the important measures it has been recommending in recent years are not always sufficiently followed in order to improve the radiation protection of patients and professionals during interventional practices, notably for surgery in the operating theatres. The inspections frequently reveal deviations from the regulations, concerning the radiation protection of both patients and medical staff, and ASN is regularly notified of events concerning interventional surgeons who have exceeded the dose limits for the extremities. The state of radiation protection is however far better in the units which have been using these technologies for a long time, for example in imaging units where interventional cardiology and neurology activities are carried out. Extensive work to raise the awareness of all professionals is needed in order to help medical, paramedical and administrative professionals in facilities, so that they have a clearer perception of the implications, notably those professionals working in operating theatres. For ASN, continuous training of professionals and intervention by the medical physicist are certainly the two key points for guaranteeing management of the doses delivered to the patients during interventional procedures. The growing number of diagnostic examinations using computed tomography is contributing to a high collective dose level, with medical imaging being the leading source of the population’s artificial exposure to ionising radiation. The medical justification for these procedures is as yet insufficiently operational, owing to the insufficient training of the prescribing physicians, or even the lack of availability of other diagnostic means (MRI, ultrasonography). In July 2018, ASN published the second action plan for the management of ionising radiation doses delivered to persons undergoing medical imaging. This plan aims 12  ASN report on the state of nuclear safety and radiation protection in France in 2018