ASN Report 2018

or contradiction of a diagnosis, to determine a therapeutic orientation or to guide a remote examination. The data transmissions are protected and preserve medical secrecy and image quality. Teleradiology involves many responsibilities which must be specified in the agreement binding the practitioner performing the procedure to the teleradiologist. The teleradiology procedure is a medical procedure in its own right, like all other imaging procedures, and cannot be reduced to a simple interpretation of images. Teleradiology therefore fits into the general healthcare organisation governed by the Public Health Code and obeys the rules of professional ethics in effect (Teleradiology Charter). 6.1.2  –  Dental radiodiagnosis • Intra-oral radiography Intra-oral radiography generators, which are usually mounted on an articulated arm, are used to take localised planar images of the teeth (the radiological detector is placed in the patient’s mouth). They operate with low voltage and current and a very short exposure time, of about a few hundredths of a second. This technique is most often associated with digital systems for processing and filing the radiographic images. • Panoramic dental radiography Panoramic radiography (orthopantomography) gives a single picture showing both jaws in full, by rotating the radiation generating tube around the patient’s head for a few seconds. • Cone-beam computed tomography Cone-beam computed tomography (3D) is developing very rapidly in all areas of dental radiology, due to the exceptional quality of the images produced (spatial resolution of about 100 microns). The trade-off for this better diagnostic performance is that these devices deliver significantly higher doses than in conventional dental radiology. • Portable X-ray generating devices ASN and the Dental Radiation Protection Commission (CRD) published an information notice in May 2016 reiterating the rules associated with the possession and utilisation of portable X-ray generating devices. “ The performance of radiological examinations outside a room fitted out for that purpose must remain the exception and be justified by vital medical needs, limited to intraoperative examinations or for patients who cannot be moved. Routine radiology practice in a dental surgery equipped with a compliant facility shall not be carried out using mobile or portable devices ”. This position is supported by HERCA (Heads of the European Radiological protection Competent Authorities), for which the use of such devices should be reserved for incapacitated patients, for forensic medicine and military field operations (HERCA Position Statement on use of handheld portable dental X-ray equipment , June 2014). 6.2  ̶  Technical rules for fitting out radiology and tomography installations • Radiology installations A conventional radiological facility usually comprises a generator (high-voltage unit, X-ray tube), associated with a support (the stand) for moving the tube, a control unit and an examination table or chair. Mobile facilities, but which are often used in the same given room, such as the X-ray generators used in operating theatres, are to be considered as fixed facilities. Radiological facilities must be fitted out in accordance with the provisions of the new ASN technical resolution 2017-DC- 0591 of 13 June 2017 (see point 4.2). This decision applies to all medical radiology facilities, including computed tomography and dental radiology. It does not however apply to X-ray generators that are used exclusively for bedside radiography. A technical report demonstrating conformity of the facility with the requirements of the ASN resolution is to be drawn up by the person or entity responsible for the nuclear activity. Distribution of the number of scanners by geographical area covered by ASN and the number of licences examined in 2018 0 50 100 150 200 250 Strasbourg Division Paris Division Orléans Division Nantes Division Marseille Division Lyon Division Lille Division Dijon Division Châlons-en- Champagne Division Caen Division Bordeaux Division Authorised centres Scanners Authorisations Diagram 15 226  ASN report on the state of nuclear safety and radiation protection in France in 2018 07 – MEDICAL USES OF IONISING RADIATION