Abstracts ASN Report 2019

ڲ٫ת Nuclear-based medical activities 1. Internal Targeted Radiotherapy (ITR) aims to administer a RadioPharmaceutical Drug (RPD) emitting ionising radiation which will deliver a high dose to a target organ for curative or remedial purposes. 2. An RPD (RadioPharmaceutical Drug) is a drug containing one or more radionuclides. RPDs can be used for diagnostic (scintigraphy) or therapeutic (internal targeted radiotherapy) purposes. ׏ِ׏ Áǝƺ ƳǣǔǔƺȸƺȇɎ ƏƬɎǣɮǣɎɵ ƬƏɎƺǕȒȸǣƺɀ The nuclear-based therapeutic medical activities, particularly those dedicated to the treatment of cancer, include external-beam radiotherapy, brachytherapy and internal targeted radiotherapy (1) . The nuclear-based diagnostic medical activities include computed tomography, conventional radiology, dental radiology and diagnostic nuclear medicine. Interventional practices using ionising radiation (fluoroscopy- guided interventional practices) group together different techniques used primarily for invasive medical or surgical procedures for diagnostic, preventive and/or therapeutic purposes. These different activities and the techniques used are presented ļŁ ņĸĶŇļłŁņ ӅׇŇł ӊє ׏ِ א 0ɴȵȒɀɖȸƺ ɀǣɎɖƏɎǣȒȇɀ ǣȇ Ɏǝƺ ȅƺƳǣƬƏǼ ɀƺƬɎȒȸ ׏ِ א ِ׏ 0ɴȵȒɀɖȸƺ Ȓǔ ǝƺƏǼɎǝ ȵȸȒǔƺɀɀǣȒȇƏǼɀ The risks for health professionals arising from the use of ionising radiation are firstly the risks of external exposure generated by the medical devices (devices containing radioactive sources, X-ray generators or particle accelerators) or by sealed and unsealed sources –particularly after administering RadioPharmaceutical Drugs (RPDs) (2) . When using unsealed sources, the risk of contamination must also be taken into consideration in the risk assessment (in nuclear medicine and in the biology laboratory). ĶĶłŅķļŁĺ Ňł ŇĻĸ ķĴŇĴ ĶłĿĿĸĶŇĸķ ļŁ ӅӃӄӋׇĵŌ ŇĻĸ ŁņŇļŇňŇĸ ĹłŅ ĴķļĴŇļłŁ ŅłŇĸĶŇļłŁ ĴŁķ ňĶĿĸĴŅ ĴĹĸŇŌ Ҏ ҏё ӅӅӄёӋӊӈׇŃĸłŃĿĸ working in the areas of medical and veterinary activities were subject to dosimetric monitoring of their exposure. The average ĴŁŁňĴĿ ķłņĸ ļņ Ӄєӆׇŀ ʼn ҎŀļĿĿļņļĸʼnĸŅŇҏє Ļļņ ķłņĸ ļņ ņŇĴĵĿĸ ŊļŇĻ respect to 2017. Radiology activities (radiodiagnosis and interventional radiology) represent the largest proportion (40%) of exposed medical personnel and the lowest average annual ķłņĸ ŊļŇĻ ӃєӅׇŀ ʼnє ňĶĿĸĴŅ ŀĸķļĶļŁĸ ŅĸŃŅĸņĸŁŇņ ӆՌ łĹ ŇĻĸ headcount but the average annual whole-body dose in nuclear ŀĸķļĶļŁĸ ŃĸŅņłŁŁĸĿ ļņ ӃєӋׇŀ ʼnє ӄӈёӌӅӅׇŀĸķļĶĴĿ ŃĸŅņłŁŁĸĿ ҎӊՌҏ were subject to dosimetry of the extremities. The average dose to ŇĻĸ ĸŋŇŅĸŀļŇļĸņ ļņ ӉєӅӅׇŀ ʼnё ŊĻļĶĻ ļņ ņŇĴĵĿĸ ŊļŇĻ ŅĸņŃĸĶŇ Ňł ӅӃӄӊє ׏ِ א ِ א 0ɴȵȒɀɖȸƺ Ȓǔ ȵƏɎǣƺȇɎɀ The patient’s exposure situation differs depending on whether diagnostic or therapeutic medical applications are being considered. In the first case, it is necessary to optimise the exposure to ionising radiation in order to deliver the minimum dose required to obtain the appropriate diagnostic information or to perform the planned interventional procedure; in the second case, it is necessary to deliver the highest possible dose needed to destroy the tumoral cells while at the same time preserving the healthy neighbouring tissues to the best possible extent. Whatever the case however, control of the doses delivered during imaging examinations and treatments is a vital requirement that depends not only on the skills of the patient radiation protection professionals but also on the procedures for optimising and maintaining equipment performance. Controlling doses in medical imaging remains a priority for ASN which, following on from the first plan initiated in 2011, published Ĵ ŁĸŊ łŃļŁļłŁ łŁ ӅӇׇ ňĿŌ ӅӃӄӋё ĴĿłŁĺ ŊļŇĻ Ĵ ņĸĶłŁķ ŃĿĴŁё ļŁ łŅķĸŅ to continue promoting a culture of radiation protection with the professionals (see chapter 1). ׏ِ א ِ ב 0ɴȵȒɀɖȸƺ Ȓǔ Ɏǝƺ ȵɖƫǼǣƬ With the exception of incident situations, the potential impact of medical applications of ionising radiation is likely to concern: Ҋ members of the public who are close to facilities that emit ionising radiation but do not have the required protection; Ҋ persons close to patients having received a nuclear medicine treatment or examination, involving in particular radionuclides such as iodine-131, or brachytherapy using iodine-125; Ҋ the specific professional categories likely to be exposed to effluents or wastes produced by nuclear medicine departments. The available data on the impact of these discharges on the public (persons outside the health care institution) lead to estimated doses of a few tens of microsieverts per year for the most exposed persons, notably persons working in sewage networks ĴŁķ ŊĴņŇĸŊĴŇĸŅ ŇŅĸĴŇŀĸŁŇ ŃĿĴŁŇņ Ҏ ņŇňķļĸņё ӅӃӃӈׇĴŁķ ӅӃӄӇҏє CHAPTER 07 For more than a century now, medicine has made use of ionising radiation produced either by electric generators or by radionuclides in sealed or unsealed sources for both diagnostic and therapeutic purposes. The benefits and usefulness of these techniques have long been proven, but they nevertheless contribute significantly to the exposure of the population to ionising radiation. They effectively represent the second source of exposure for the population (behind exposure to natural ionising radiation) and the leading source of artificial exposure (see chapter 1). Medical uses of ionising radiation 200 ASN Report on the state of nuclear safety and radiation protection in France in 2019