Abstracts ASN Report 2019

ASN ASSESSMENTS PER LICENSEE AND BY AREA OF ACTIVITY the management of priorities. It does nevertheless give the project team a level of visibility that is appropriate for the issues and enables the subjects to be addressed with a high standard of technical proficiency. As regards taking organisational and human aspects into account, ASN considers that Andra’s organisation, which is based on outsourcing, could present weaknesses. ³z ټ ɀ ƏɀɀƺɀɀȅƺȇɎɀ Ȓǔ Ɏǝƺ ȒɎǝƺȸ ǼǣƬƺȇɀƺƺɀ Əȸƺ ȵȸƺɀƺȇɎƺƳ ǣȇ Ɏǝƺ «ƺǕǣȒȇƏǼ…ɮƺȸɮǣƺɯ ȵƏȸɎ ƏȇƳ ǣȇ Ɏǝƺ ɮƏȸǣȒɖɀ ƬǝƏȵɎƺȸɀ Ȓǔ Ɏǝǣɀ ȸƺȵȒȸɎِ ASN ASSESSMENTS BY AREA OF ACTIVITY THE MEDICAL SECTOR Xȇ ȸƏƳǣȒɎǝƺȸƏȵɵ , the safety fundamentals are in place (equipment verifications, medical staff training, quality and risk management policy). The quality initiatives are making progress. The prospective risk analyses however remain relatively theoretical and are insufficiently deployed prior to organisational or technical changes. ASN is reducing its inspection frequencies, but given the diversity of situations encountered, the centres displaying vulnerabilities or particular risks will continue to be subject to particular scrutiny and more frequent monitoring in 2020. With regard to treatment safety, the situation in ƫȸƏƬǝɵɎǝƺȸƏȵɵ is comparable with that of external-beam radiotherapy. The radiation protection of medical staff and the management of high-activity sealed sources are considered satisfactory on the whole. This level must however be maintained through continuous training. In the current context, increased attention must be given to securing access to these sources, to prevent any unauthorised access. Xȇ ȇɖƬǼƺƏȸ ȅƺƳǣƬǣȇƺ , the radiation protection of patients and medical staff is satisfactory. 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 goodmanagement 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. In the area of ǔǼɖȒȸȒɀƬȒȵɵ ٮ ǕɖǣƳƺƳ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ȵȸƏƬɎǣƬƺɀ , ASN considers that the measures it has been recommending for several years to improve the radiation protection of patients and professionals have still not been sufficiently implemented, particularly for surgical procedures performed in operating theatres. The inspections frequently reveal deviations from the regulations, as much in the radiation protection of patients as in that of medical staff, and ASN is regularly notified of events concerning interventional practitioners who have exceeded the dose limits for the extremities. The radiation protection situation is however significantly better in the departments that have been using these technologies for a long time, such as the imaging departments performing interventional cardiology and neurology activities. Substantial awareness-raising in all the professionals is necessary to help the medical, paramedical and administrative staff of the medical centres gain a better perception of the risks, particularly for the professionals working in operating theatres. In ASN’s opinion, the continuous training of the medical staff and the involvement of the medical physicist probably constitute the two key points to guarantee control of the doses delivered to patients during interventional procedures. The growing number of diagnostic examinations performed using !Á ɀƬƏȇȇƺȸɀ –computed tomography scanners– contributes very substantially to the collective dose received by the public, as medical imaging is the leading source of artificial exposure of the population to ionising radiation. The medical justification of these procedures is still not sufficiently operational, due to the highly insufficient training of the prescribing physicians, not to mention the lack of availability of other diagnostic methods –Magnetic resonance imaging (MRI), ultrasonography. In July 2018, ASN published a second plan of action for controlling ionising radiation doses delivered to persons duringmedical imaging. This plan aims to reinforce the application of justification of the procedures and optimisation of the ionising radiation doses delivered to the patients. 14 ASN Report on the state of nuclear safety and radiation protection in France in 2019