ASN Report 2018

The available data on the impact of these discharges on the public (persons outside the healthcare institution) lead to estimated doses of a few tens of microsieverts per year for the most exposed persons, notably persons working in sewage networks and wastewater treatment plants (IRSN studies, 2005 and 2014). 1.2.4  –  The environmental impact The available information concerning radiological monitoring of the environment carried out by IRSN, in particular the measurement of ambient gamma radiation, on the whole reveals no significant exposure level above the variations in the background radiation. On the other hand, radioactivity measurements in major rivers or wastewater treatment plants of large towns occasionally reveal the presence of artificial radionuclides used in nuclear medicine (e.g. iodine-131) exceeding the measurement thresholds. Furthermore, no trace of these radionuclides has ever been measured in water intended for human consumption (see chapter 1). 1.2.5  –  Significant Radiation Protection Events Significant Radiation protection Events (ESR) have been notified to ASN since 2007. These notifications provide professionals with increasingly valuable experience feedback, helping to improve radiation protection in the medical field. In 2018, ASN published a Bulletin on the safety of radiotherapy patients (No.12) concerning the risks of misidentification of the vertebral landmarks on a repositioning image, and an experience feedback sheet concerning an error in mounting an accessory on a CyberKnife® system. Following the occurrence of an exposure incident during a computed tomography examination (see section 6), a technical sheet was drawn up and widely disseminated in France and Europe. Furthermore, the incident notices are published on asn.fr . Since July 2015, radiotherapy departments can report ESRs on line. This on-line notification portal falls within the framework of the single vigilance portal created by the Ministry of Health. It was extended to cover the entire medical sector in April 2017. Since 2012, the number of ESR notifications stands at about 500 per year. In 2018, a total of 592 ESRs (Graph 1) in the medical domain were reported to ASN (+ 33 with respect to 2017, + 95 with respect to 2016). This increase is primarily due to a larger number of ESRs reported in both nuclear medicine and radiology (conventional and computed tomography). The number of ESRs reported in radiotherapy, however, has dropped since 2015. Graphs 2, 3 and 4 below illustrate the distribution of the number of ESRs in 2018 by activity category, how they have evolved since 2010, and the distribution of events by area of exposure (impact on the environment, exposure of the public, exposure of patients, exposure of medical workers), and the activity category concerned. About 80% of the notified events originate from either computed tomography (29%), radiotherapy (22%) or nuclear medicine (29%) departments. For the first time since the ESR notification system was put in place in 2007, computed tomography and nuclear medicine are the activity sectors in which the number of ESRs reported per year is the highest. The events reported in the medical sector chiefly concern the exposure of patients (56%) and foetuses in pregnant women unaware of their pregnancy (30%), the latter showing a distinct rise. Trends in the number of annual ESR notifications from 2010 to 2018 0 100 200 300 400 500 600 2018 2017 2016 2015 2014 2013 2012 2011 2010 257 435 531 553 564 534 497 559 592 Diagram 1 La sécurité du patient N°12 Bulletin à l’attention desprofessionnelsde la radiothérapie Pour une dynamique de progrès Imagerie de repositionnement : erreur de vertèbre Juin2018 Patient safety , Bulletin No. 12, 2018 ASN report on the state of nuclear safety and radiation protection in France in 2018  203 07 – MEDICAL USES OF IONISING RADIATION 07