Abstracts ASN Report 2019

א ِ׏ِ ה XȇɎȸƏȒȵƺȸƏɎǣɮƺ ȸƏƳǣȒɎǝƺȸƏȵɵ Intraoperative radiotherapy combines surgery and radiotherapy, which are carried out at the same time in an operating theatre. The dose of radiation is delivered to the tumour bed during surgical intervention. Ł ĴŅĶĻ ӅӃӄӄё ŇĻĸ ŅĸŁĶĻ ĴŇļłŁĴĿ ĴŁĶĸŅ ŁņŇļŇňŇĸ Ҏ Ĵҏ launched a call for proposals to support the installation of intraoperative radiotherapy equipment for the treatment of breast cancer patients. Ł ŃŅļĿ ӅӃӄӉё ŇĻĸ ŅĸŁĶĻ ĴŇļłŁĴĿ ňŇĻłŅļŇŌ ĹłŅ ĸĴĿŇĻ Ҏ ҏ published the results of the assessment of this practice. According to the HAS, current knowledge is insufficient to demonstrate the benefits of intraoperative radiotherapy in the adjuvant treatment of breast cancer compared with standard external-beam radiotherapy. The HAS concludes that at present, the elements necessary to propose that it be covered by the health insurance scheme are not yet established and considers that the clinical and medico-economic studies must be continued in order to acquire clinical data over the longer term. At the end of this assessment, the HAS does however recommend continuing the assessment of intraoperative radiotherapy for clinical research purposes. Intraoperative radiotherapy has been one of the techniques used Ňł ŇŅĸĴŇ ņŀĴĿĿ ĶĴŁĶĸŅņ łĹ ŇĻĸ ĵŅĸĴņŇ ĹłŅ ӇׇŌĸĴŅņ ŁłŊђ ļŇ ļņ ķĸʼnĸĿłŃļŁĺ little, but its assessment is continuing. א ِ׏ِ ו RƏƳȸȒȇ ɎǝƺȸƏȵɵ Hadron therapy is a treatment technique based on the use of beams of charged particles –protons and carbon nuclei– whose particular physical properties ensure highly localised dose distribution during treatment. Compared with existing techniques, the dose delivered around the tumour to irradiate is lower, therefore the volume of healthy tissue irradiated is drastically reduced. Hadron therapy allows the specific treatment of certain tumours. In June 2016, the INCa published a report on proton therapy treatment indications and possibilities. Hadron therapy with protons is currently used in three centres ļŁ ŅĴŁĶĸѓ Ҋ in the Curie Institute of Orsay (equipment modified in 2016); Ҋ in the Antoine-Lacassagne Centre in Nice (new equipment installed in 2016); Ҋ ļŁ ŇĻĸ ŅĴŁŬłļņі ĴĶĿĸņņĸ ĸŁŇŅĸ Ҏ ŃŅłĽĸĶŇҏ ļŁ ĴĸŁ ҎĶłŀŀļņņļłŁĸķ ļŁ ӅӃӄӋҏє According to its advocates, hadron therapy with carbon nuclei is more suited to the treatment of the most radiation-resistant tumours and could result in several hundred additional cancer cases being cured each year. The claimed biological advantage is purportedly due to the very high ionisation of these particles at the end of their path, combined with a lesser effect on the tissues they pass through before reaching the target volume. א ِ א ÁƺƬǝȇǣƬƏǼ ȸɖǼƺɀ ƏȵȵǼǣƬƏƫǼƺ ɎȒ ƺɴɎƺȸȇƏǼ ٮ ƫƺƏȅ ȸƏƳǣȒɎǝƺȸƏȵɵ ǣȇɀɎƏǼǼƏɎǣȒȇɀ The devices must be installed in rooms specially designed to guarantee radiation protection of the staff, turning them into ʼnĸŅļŇĴĵĿĸ ĵňŁľĸŅņ ҎŊĴĿĿ ŇĻļĶľŁĸņņ ĶĴŁ ʼnĴŅŌ ĹŅłŀ ӄׇŀĸŇŅĸ Ňł ӅєӈׇŀĸŇŅĸņ łĹ łŅķļŁĴŅŌ ĶłŁĶŅĸŇĸҏє ŅĴķļłŇĻĸŅĴŃŌ ļŁņŇĴĿĿĴŇļłŁ comprises a treatment room including a technical area containing the treatment device, a control station outside the room and, for some accelerators, auxiliary technical premises. The protection of the premises, in particular the treatment room, must be determined in order to respect the annual exposure limits for the workers and/or the public around the premises. A specific study must be carried out for each installation by the machine supplier, together with the medical physicist and the Radiation Protection Expert-Officer (RPE-O). This study defines the thicknesses and nature of the various protections required, which are determined according to the conditions of use of the device, the characteristics of the radiation beam and the use of the adjacent rooms, including those vertically above and below the treatment room. This study should be included in the file presented to support the application for a license to use a radiotherapy installation, which is examined by ASN. In addition, a set of safety systems informs the operator of the machine operating status (exposure in progress or not) and switches off the beam in an emergency or if the door to the irradiation room is opened. א ِ ב «ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ ɀǣɎɖƏɎǣȒȇ ǣȇ ƺɴɎƺȸȇƏǼ ٮ ƫƺƏȅ ȸƏƳǣȒɎǝƺȸƏȵɵ The safety of radiotherapy treatments has been a priority area of ASN oversight since 2007. An inspection programme was defined ĹłŅ ŇĻĸ ӅӃӄӉіӅӃӄӌׇŃĸŅļłķё ĴŁķ ļŇņ ĵŅłĴķ ĿļŁĸņ ŊĸŅĸ ĶłŀŀňŁļĶĴŇĸķ to all the radiotherapy departments in early 2016. The inspections focus on the ability of the centres to deploy a risk management approach and, depending on the situation found by the inspectors, they also address the management of skills, the implementation of new techniques or practices and the command of the equipment. ASN has continued its graded approach to inspection: Ҋ by reducing, in the light of the progress made in the control of treatment safety, the average frequency of inspection, which ņļŁĶĸ ӅӃӄӉׇĻĴņ ĵĸĸŁ ŅĸķňĶĸķ Ňł łŁĶĸ ĸʼnĸŅŌ ŇĻŅĸĸ ŌĸĴŅņ ҎļŁņŇĸĴķ of the previous two-yearly frequency); Ҋ by maintaining a higher frequency for the centres displaying vulnerabilities or risks, especially certain centres having required tightened inspections (Lucien Neuwirth Cancerology ŁņŇļŇňŇĸ ļŁ ĴļŁŇі ŅļĸņŇіĸŁі ĴŅĸōё ŇĻĸ ĸňŃĿļĸŅņ ŅļʼnĴŇĸ łņŃļŇĴĿ in Paris) and the continuation of the tightened monitoring of ŇĻĸ ŅļʼnĴŇĸ ĴķļłŇĻĸŅĴŃŌ ĸŁŇŅĸ łĹ ĸŇōё ŅĸŁĴŀĸķ ŇĻĸ ŅļʼnĴŇĸ ŁņŇļŇňŇĸ łĹ ĴķļłŇĻĸŅĴŃŌ łĹ ĸŇō ķňŅļŁĺ ӅӃӄӌё ĹłĿĿłŊļŁĺ Ĵ change of ownership. ļŁņŃĸĶŇĸķ ӊӆׇĶĸŁŇŅĸņ ļŁ ӅӃӄӌё ŅĸŃŅĸņĸŁŇļŁĺ ӇӅՌ łĹ ŇĻĸ ŁĴŇļłŁĴĿ ŇłŇĴĿє Ł ӅӃӄӋё ļŇ ļŁņŃĸĶŇĸķ ӊӌׇĶĸŁŇŅĸņё łŅ ӇӈՌ łĹ ŇĻĸ ŁĴŇļłŁĴĿ ŇłŇĴĿє Ł ŇŊł ŌĸĴŅņё ĴĵłňŇ ŇŊłіŇĻļŅķņ łĹ ŇĻĸ ŅĸŁĶĻ radiotherapy centres have been inspected, some of them twice. א ِ ב ِ׏ «ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ Ȓǔ ƺɴɎƺȸȇƏǼ ٮ ƫƺƏȅ ȸƏƳǣȒɎǝƺȸƏȵɵ ȵȸȒǔƺɀɀǣȒȇƏǼɀ When the radiotherapy facilities are correctly designed, the radiation risks for the medical staff are limited due to the protection provided by the walls of the irradiation room. Ļĸ ŅĸņňĿŇņ łĹ ŇĻĸ ļŁņŃĸĶŇļłŁņ ĶĴŅŅļĸķ łňŇ ļŁ ӅӃӄӌׇŅĸʼnĸĴĿ Łł ŀĴĽłŅ problems in this sector: Ҋ The effective designation of Radiation Protection Expert- Officers (RPE-Os) was confirmed in the majority of the centres inspected. Ҋ The radiation protection technical controls were carried out ļŁ ĴĵłňŇ ӌӃՌ łĹ ŇĻĸ ĶĸŁŇŅĸņ ļŁņŃĸĶŇĸķ ĴŁķ ŊĸŅĸ ņĴŇļņĹĴĶŇłŅŌє 206 ASN Report on the state of nuclear safety and radiation protection in France in 2019 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION