ASN Report 2018

half the facilities, and an intervention protocol and reflex action sheet for work in the event of a leak in a tank are available in about one third of the facilities. Nonetheless, more than 40% of the departments have no such documents available. 4.3.4  –  Significant events in nuclear medicine Seventy-two percent of the inspected departments have a system for recording adverse events which have been analysed and reported to ASN. One hundred and seventy-one ESRs were reported in 2018, representing an increase of 15% with respect to 2017. It is probable that the opening of the ASN on-line notification portal in 2017 and the efforts of the SFMN to encourage the reporting of events contributed to this increase. As in the preceding years, most of the notified events (66%) concerned patients, of which 65% had undergone a procedure for diagnostic purposes. The majority of the reported events have no expected clinical consequences. • Significant events concerning patients (113 ESRs, or 66% of the reported ESRs) The majority of the ESRs reported in nuclear medicine and concerning patients are linked to errors in administering an RPD to a patient (interchanging of syringes or of patients), to dose errors (adult dose injected into a child, injection of a higher or lower activity than that prescribed, etc.) or to errors during the preparation of the medication (interchanging of bottles). Twenty-nine extravasations (6) were reported, with no expected clinical consequences. One reported event was linked to the administration of microspheres of yttrium-90 in part of a healthy organ (kidney) after movement of the microcatheter for an interventional CT procedure. Due to the possible consequences, the patient will be subject to medical monitoring. • Significant events concerning workers (13 ESRs, i.e. 8% of the notified ESRs) Thirteen events concerning workers were reported in 2018, three of which concerned projections of radiopharmaceuticals or effluents, two result from needle injuries when removing needles from syringes, and two concerned internal contaminations. None of the doses received by these workers exceeded the regulatory exposure limits. 6. The extravasation of a radiopharmaceutical, administered by a peripheral intravenous device, is an abnormal passage of the substance outside the catheterised vessel (passage through tissue). Its consequences in terms of lesions caused on neighbouring tissues depend primarily on the volume and the energy level of the extravasated radiopharmaceutical (diagnostic or therapeutic procedure). • Significant events concerning the public (19 ESRs, i.e. 11% of the notified ESRs) All these events concerned exposure of the foetus in women unaware of their pregnancy. The doses received had no consequences for the child (ICRP, 2007). • Significant radiation protection events concerning radioactive sources, waste and effluents (19 ESRs, i.e. 11% of the notified ESRs) Most of these ESR were associated with the loss of radioactive sources (old sources or cobalt rod), the dispersion of radionuclides (leaks of radioactive effluents from pipes or tanks or discharge of effluents before radioactive decay) or the transfer of waste to an inappropriate disposal route. • Other events (7 ESRs, i.e. 4% of the notified ESRs) The other events concerned, for example, forgetting to close a door after a radiopharmaceutical drug delivery, contamination of an enclosure interior due to the explosion of a medication bottle during preparation by heating, or forgetting to retrieve a radiopharmaceutical drug syringe in a syringe shield after cancelling an examination (in the electroencephalogram video- surveillance room during an epileptic fit). SUMMARY The radiation protection of patients and workers in nuclear medicine is duly taken into account. The training efforts must be maintained in this sector as well. Moreover, the coordination of prevention measures when outside companies intervene (for machine maintenance, upkeep of the premises, etc.) must be improved. One of the radiation protection challenges is also to ensure good management of radioactive effluents, which is all the more important given that therapies administering high activities to patients are going to increase in number, leading to an increase in the discharged radioactivity. 220  ASN report on the state of nuclear safety and radiation protection in France in 2018 07 – MEDICAL USES OF IONISING RADIATION