Abstracts ASN Report 2019

׏ِ א ِ ג Áǝƺ ƺȇɮǣȸȒȇȅƺȇɎƏǼ ǣȅȵƏƬɎ The available information concerning radiological monitoring of the environment carried out by IRSN, in particular the measurement of ambient gamma radiation, on the whole reveals no significant exposure level above the variations in the background radiation. On the other hand, radioactivity measurements in major rivers or wastewater treatment plants of large towns occasionally reveal the presence of artificial radionuclides used in nuclear medicine (e.g. iodine-131) exceeding the measurement thresholds. However, no trace of these radionuclides has been measured in water intended for human consumption (see chapter 1). ׏ِ א ِ ד ³ǣǕȇǣǔǣƬƏȇɎ ȸƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ ƺɮƺȇɎɀ Significant Radiation protection Events (ESR) have been reported to ASN since 2007. These notifications provide professionals with increasingly valuable experience feedback, helping to ļŀŃŅłʼnĸ ŅĴķļĴŇļłŁ ŃŅłŇĸĶŇļłŁ ļŁ ŇĻĸ ŀĸķļĶĴĿ ĹļĸĿķє Ł ӅӃӄӌё ASN published two Patient safety bulletins entitled “Experience ĸĸķĵĴĶľ ļŁ łŇĻĸŅ łňŁŇŅļĸņѣ Ҏ ŃŅļĿҏ ĴŁķ Ѣ ĴľļŁĺ ŅłŃĸŅ ņĸ łĹ łŀŃňŇĸķ łŀłĺŅĴŃĻŌ ĶĴŁŁĸŅ ňŁĶŇļłŁņѣё ĴŁķ ĴŁ ĸŋŃĸŅļĸŁĶĸ feedback sheet “Mapping the sensitive functions and alarms of computed tomography scanners”. The latter two documents were produced further to the occurrence of an exposure incident ķňŅļŁĺ Ĵ ĶłŀŃňŇĸķ ŇłŀłĺŅĴŃĻŌ ĸŋĴŀļŁĴŇļłŁ ļŁ ӅӃӄӋׇĴŁķ ĻĴʼnĸ ĵĸĸŁ ŊļķĸĿŌ ķļņņĸŀļŁĴŇĸķ ļŁ ŅĴŁĶĸ ĴŁķ ňŅłŃĸє Ł ĴķķļŇļłŁ Ňł this, the incident notices are published on asn.fr . Since July 2015, radiotherapy departments can report significant radiation protection events on line. This on-line notification portal falls within the framework of the single vigilance portal created by the Ministry of Health. It was extended to cover the entire medical sector in April 2017. Ł ӅӃӄӌё ŇĻĸ ŁňŀĵĸŅ łĹ ņ ļŁ ŇĻĸ ŀĸķļĶĴĿ ĹļĸĿķ ŅĸŃłŅŇĸķ Ňł ŇłŇĴĿĿĸķ ӉӄӊׇҎ ŅĴŃĻ ӄҏё Ĵ ĹļĺňŅĸ ŇĻĴŇ ĻĴņ ĵĸĸŁ Ĵĵłʼnĸ ӈӃӃׇņļŁĶĸ 2012, with the exception of 2016. This overall stability in the total ŁňŀĵĸŅ łĹ ŅĸŃłŅŇĸķ ĸʼnĸŁŇņ ŊļŇĻ ŅĸņŃĸĶŇ Ňł ӅӃӄӋׇĶłŁĶĸŅŁņ ĴĿĿ ŇĻĸ activities. The drop in the number significant events reported in radiotherapy has stabilised and the figure is equivalent to ŇĻĴŇ łĹ ӅӃӄӋє ŅĴŃĻņ Ӆё ӆׇĴŁķ ӇׇļĿĿňņŇŅĴŇĸ ŇĻĸ ķļņŇŅļĵňŇļłŁ łĹ ŇĻĸ ŁňŀĵĸŅ łĹ ņ ļŁ ӅӃӄӌׇĵŌ ĴĶŇļʼnļŇŌ ĶĴŇĸĺłŅŌё ĻłŊ ŇĻĸŌ ĻĴʼnĸ ĸʼnłĿʼnĸķ ņļŁĶĸׇӅӃӄӃё and the distribution of events by area of exposure (impact on the environment, exposure of the public, exposure of patients, exposure of medical workers), and by activity category concerned. The reported events originate mainly from computed tomography (30%), radiotherapy (24%) and nuclear medicine (24%) departments. ňŅŇĻĸŅŀłŅĸё ŇĻĸ ĸʼnĸŁŇņ ĶĻļĸĹĿŌ ĶłŁĶĸŅŁ ĸŋŃłņňŅĸ łĹ ŃĴŇļĸŁŇņ ҎӈӌՌҏ ĴŁķ ĹłĸŇňņĸņ ļŁ ŃŅĸĺŁĴŁŇ ŊłŀĸŁ ňŁĴŊĴŅĸ łĹ ŇĻĸļŅ ŃŅĸĺŁĴŁĶŌ ҎӆӄՌҏё Ĵņ ļŁ ӅӃӄӋє Ł ŇĻĸ ĿļĺĻŇ łĹ ŇĻĸ ĸʼnĸŁŇņ ŅĸŃłŅŇĸķ Ňł ļŁ ӅӃӄӌё ŇĻĸ ŀłņŇ significant findings from the radiation protection aspect are: Ҋ for the medical professionals: fluoroscopy-guided interventional practices (external exposure of operators, and their hands in particular) with cases where dose limits are exceeded, and nuclear medicine (contamination of workers, external exposure); Ҋ for the patients: ҄ fluoroscopy-guided interventional practices, with determin- istic effects observed in some patients having undergone long and complex procedures; ҄ radiotherapy, with overdoses linked in particular to target errors and wrong-side errors; ҄ nuclear medicine, with radiopharmaceutical drug adminis- tration errors; Ҋ for the public and the environment: nuclear medicine, with losses of sources, leaks from radioactive effluent pipes and containment structures. ĸŇĴļĿĸķ ļŁĹłŅŀĴŇļłŁ ŃĸŅ ĶĴŇĸĺłŅŌ ļņ ŃŅłʼnļķĸķ ļŁ ņĸĶŇļłŁņ ӅׇŇł Ӊє ׏ِ א ِ ה Áǝƺ ȸǣɀǸɀ ƏȇƳ Ɏǝƺ ȒɮƺȸɀǣǕǝɎ ȵȸǣȒȸǣɎǣƺɀ In order to establish its oversight priorities, ASN has classified the nuclear-based medical activities according to the risks for the patients, the personnel, the public and the environment. This classification takes particular account of the doses delivered or administered to the patients, the conditions of use of ionising radiation sources by the medical professionals, the possible impact on the environment, the significant events reported to ASN and the radiation protection situation in the institutions exercising these activities. On the basis of this classification, ASN considers that its oversight must focus in priority on external-beam radiotherapy, brachytherapy, nuclear medicine and fluoroscopy-guided interventional practices. GRAPH 1 ÁȸƺȇƳɀ ǣȇ Ɏǝƺ ȇɖȅƫƺȸ Ȓǔ ƏȇȇɖƏǼ 0³« ȇȒɎǣǔǣƬƏɎǣȒȇɀ ǔȸȒȅ א ׎׏׎ ژ ɎȒ א ׎׏ ח 0 130 260 390 520 650 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 257 435 531 553 564 534 497 559 592 617 ASN Report on the state of nuclear safety and radiation protection in France in 2019 201 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION 07