Abstracts ASN Report 2019

Áǝƺ ɀƺƬȒȇƳ ȵǼƏȇ Ȓǔ ƏƬɎǣȒȇ ǔȒȸ ƬȒȇɎȸȒǼǼǣȇǕ Ɏǝƺ ƳȒɀƺɀ Ȓǔ ǣȒȇǣɀǣȇǕ ȸƏƳǣƏɎǣȒȇ ƳƺǼǣɮƺȸƺƳ ɎȒ ȵƺȸɀȒȇɀ ǣȇ ȅƺƳǣƬƏǼ ǣȅƏǕǣȇǕ In France, exposure for medical purposes represents the primary source of artificial exposure of the public to ionising radiation. This exposure is rising, mainly owing to the increasing number of computed tomography examinations. Imaging examinations have proven their benefits for both diagnosis and treatment. The issue at stake however is to avoid examinations that are not really necessary or that offer no real benefit for the patients and the results of which could be obtained by other available, non-irradiating techniques. Controlling the doses delivered to patients for diagnostic or therapeutic purposes leads to measures to ensure that the principles of justification and optimisation are embraced in the exercise of medical practices that use ionising radiation. ASN’s second action plan, published in July 2018, aims at continuing to promote a culture of radiation protection in medical professionals with the reinforcing of skills and the harmonising of practices in an updated regulatory framework. The actions target several areas: increasing accountability and awareness in the medical professionals, training, new practices and techniques, ƏȇƳ Ɏǝƺ ƺȷɖǣȵȅƺȇɎِ Áǝƺɵ ǝǣȇǕƺ Ȓȇ ژו Ɏǝƺȅƺɀ ي 0ȇǝƏȇƬǣȇǕ ƏƬƬȒɖȇɎƏƫǣǼǣɎɵً ƏɯƏȸƺȇƺɀɀً ȷɖƏǼǣɎɵ Theme 1. Heighten the awareness of physicians making referrals for examinations and provide updated guides to good practices in examination referral in order to improve the individual justification of medical imaging procedures. Áǝƺȅƺ א ِ (ژ ƺɎƏǣǼ Ɏǝƺ ȸȒǼƺɀ Ȓǔ ƏǼǼ Ɏǝƺ ǝƺƏǼɎǝ ȵȸȒǔƺɀɀǣȒȇƏǼɀ involved in the procedure justification process and dose optimisation. Áǝƺȅƺ ב ِ ژ ¨ɖɎ ǣȇ ȵǼƏƬƺ ƏȇƏǼɵɀƺɀ Ȓǔ ȵȸȒǔƺɀɀǣȒȇƏǼ ȵȸƏƬɎǣƬƺɀ (clinical audits) relating to the justification of procedures and dose optimisation. Áǝƺȅƺ ג ِ ژ ƳƏȵɎ ƏȇƳ ȸƺǣȇǔȒȸƬƺ Ɏǝƺ ǼƺǕƏǼ ƏȇƳ ƺƬȒȇȒȅǣƬ framework relative to the justification of medical radiological imaging procedures and dose optimisation. ÁȸƏǣȇǣȇǕ Áǝƺȅƺ ד ِ ژ ¨ɖɎ ǣȇ ȵǼƏƬƺ Ə ɀɵɀɎƺȅ Ȓǔ ǣȇǣɎǣƏǼ ƏȇƳ ƬȒȇɎǣȇɖȒɖɀ training of medical professionals in the radiation protection of persons exposed for medical purposes. zƺɯ ȵȸƏƬɎǣƬƺɀ ƏȇƳ ɎƺƬǝȇǣȷɖƺɀ Áǝƺȅƺ ה ِ ژ ¨ɖɎ ǣȇ ȵǼƏƬƺ Ə ȇƺɯ ɀɵɀɎƺȅ ǔȒȸ ƏƬƬȒȅȵƏȇɵǣȇǕ the implementation of new procedures and new techniques “involving risks”. 0ȷɖǣȵȅƺȇɎ Áǝƺȅƺ ו ِ ژ 0ȇƏƫǼƺ Ɏǝƺ ȵȸȒǔƺɀɀǣȒȇƏǼɀ ɎȒ ǝƏɮƺ Ɏǝƺ ȅȒɀɎ suitable equipment for performing the “justified” procedures and optimising doses. Two ASN resolutions were published under this plan ǣȇ א ׎׏ يח ȸƺɀȒǼɖɎǣȒȇ א ׎׏ ٮ!(ٮח ׎ הה ׎ ژ Ȓǔ ׏ ژד hƏȇɖƏȸɵ אژ ׎׏ ח setting the quality assurance requirements for medical imaging procedures that use ionising radiation ƏȇƳ ȸƺɀȒǼɖɎǣȒȇ א ׎׏ ٮ!(ٮח ׎ ژחהה Ȓǔ ׏׏ ژ hɖȇƺ א ׎׏ ژח ɯǝǣƬǝ ƏȅƺȇƳɀ ȸƺɀȒǼɖɎǣȒȇ א ׎׏ ٮ!(ٮו ׎ ژדזד Ȓǔ ׏ ژג xƏȸƬǝ אژ ׎׏ ו relative to the continuous training of medical professionals in the radiation protection of people exposed to ionising radiation for medical purposes. Lastly, to coincide with the International day of ȸƏƳǣȒǼȒǕɵ Ȓȇ ژז zȒɮƺȅƫƺȸ א ׎׏ ח ً Ȓȇ Ɏǝƺ ǣȇǣɎǣƏɎǣɮƺ Ȓǔ Ɏǝƺ European association Heads of European Radiological protection Competent Authorities (HERCA), a campaign ɯƏɀ ǼƏɖȇƬǝƺƳ ǣȇ ׏ ژח 0ɖȸȒȵƺƏȇ ƬȒɖȇɎȸǣƺɀ ɎȒ ȅƏǸƺ health professionals more aware of the appropriate use of medical imaging examinations. This event provided ASN with the opportunity to publish a census of French institutional and associative initiatives fostering the justification and the relevance of imaging examinations using ionising radiation, divided into three broad categories: recommendations for health professionals, guidance documents for communicating with patients, and awareness-raising campaigns. The notion of justification effectively converges with the notion of relevance. The aim of justifying each examination is to ensure that the patient derives benefit from the examination that outweighs the risks inherent to exposure to ionising radiation. The medical notion of relevance means endeavouring to perform “the right procedure for the right patient at the right time”, taking into account the benefit-risk trade-off. TABLE 5 Total number of procedures and associated collective effective dose for each imaging method (rounded values) in France in 2012 IMAGING METHOD PROCEDURES TOTAL COLLECTIVE EFFECTIVE DOSE: 102,198 Sv NUMBER ۏ ۏ Conventional radiology (dentistry excluded) 44,175,500 54.0 17.7 Dental radiology 27,616,000 33.8 0.2 Computed tomography 8,484,000 10.4 71.2 Diagnostic interventional radiology 377,000 0.5 3.1 Nuclear medicine 1,103,000 1.3 7.8 Total 81,755,500 100.0 100.0 Source: IRSN 2014. ASN Report on the state of nuclear safety and radiation protection in France in 2019 113 ׎׏ ٲ NUCLEAR ACTIVITIES: IONISING RADIATION AND HEALTH AND ENVIRONMENTAL RISKS 01