Abstracts ASN Report 2019

׬٫ ڲ Brachytherapy Brachytherapy allows specific or complementary treatment of cancerous tumours. This technique consists in implanting radionuclides, exclusively in the form of sealed sources, either in contact with or inside the solid tumours to be treated. Ļĸ ŀĴļŁ ŅĴķļłŁňĶĿļķĸņ ňņĸķ ļŁ ĵŅĴĶĻŌŇĻĸŅĴŃŌ ĴŅĸ ļŅļķļňŀіӄӌӅׇĴŁķ iodine-125. Brachytherapy uses three techniques (detailed below), depending on the indications. ļŋŇŌіŇŊł ĵŅĴĶĻŌŇĻĸŅĴŃŌ ĶĸŁŇŅĸņ ĴŅĸ ĿļĶĸŁņĸķ ĵŌ ё ĴŁķ ӇӌׇłĹ ŇĻĸŀ ňņĸ ŇĻĸ ļĺĻ łņĸі ĴŇĸ Ҏ ҏ ŇĸĶĻŁļńňĸє ļņņňĸķ ӆӄׇĿļĶĸŁņĸņ ļŁ ӅӃӄӌє Ļĸ ŀĴĽłŅļŇŌ łĹ ŇĻĸŀ ĶłŁĶĸŅŁĸķ ŇĻĸ ňŃķĴŇļŁĺ łĹ ĴŁ ĸŋļņŇļŁĺ license. ב ِ׏ (ƺɀƬȸǣȵɎǣȒȇ Ȓǔ Ɏǝƺ ɎƺƬǝȇǣȷɖƺɀ ב ِ׏ِ׏ nȒɯ (Ȓɀƺ «ٮ ƏɎƺ ٢n(«٣ ƫȸƏƬǝɵɎǝƺȸƏȵɵ Ҋ ķĸĿļʼnĸŅņ ķłņĸ ŅĴŇĸņ łĹ ĵĸŇŊĸĸŁ ӃєӇׇĴŁķ Ӆׇ ŌѼĻ ҎĺŅĴŌņѼĻłňŅҏђ Ҋ ĵŌ ŀĸĴŁņ łĹ ŃĸŅŀĴŁĸŁŇĿŌ ļŀŃĿĴŁŇĸķ ļłķļŁĸіӄӅӈׇņĸĸķņ łŅ ŇĸŀŃłŅĴŅļĿŌ ļŀŃĿĴŁŇĸķ ĶĴĸņļňŀіӄӆӊׇņĸĸķņє Indications: Ҋ Treatment of prostate cancers. Permanent implantation in the patient’s prostate gland of seeds with a unit activity of between ӄӃׇĴŁķ ӆӃׇ ń ҎŀĸĺĴĵĸĶńňĸŅĸĿņҏє ŇŅĸĴŇŀĸŁŇ ŅĸńňļŅĸņ ĴĵłňŇ łŁĸ ĻňŁķŅĸķ ņĸĸķņё ŅĸŃŅĸņĸŁŇļŁĺ Ĵ ŇłŇĴĿ ĴĶŇļʼnļŇŌ łĹ ӄׇŇł Ӆׇ ń (gigabecquerels). Ҋ Treatment of certain eye tumours by temporary implants łĹ ļłķļŁĸіӄӅӈׇŃĿĴĶĸķ ļŁ Ĵ ņļĿļĶłŁĸ ļŁņĸŅŇ ҎӋׇŇł ӅӇׇĺŅĴļŁņ ŃĸŅ ķļņľҏё ĸŁĶĿłņĸķ ļŁ Ĵ ĺłĿķіŇļŇĴŁļňŀ ŃĿĴńňĸє Ļĸ ņĸĸķ ņļōĸ ļņ the same as for prostate treatment, but the activity is higher ҎĴĵłňŇ ӅӃӃׇ ń ŃĸŅ ĺŅĴļŁҏє Ļĸ ļŀŃĿĴŁŇņ ĴŅĸ ŃňŇ ļŁ ŃĿĴĶĸ ļŁ ŇĻĸ operating theatre under general anaesthetic and the treatment ĿĴņŇņ ĹŅłŀ ӄєӈׇķĴŌņ Ňł łŁĸ Ŋĸĸľё ŊļŇĻ ĻłņŃļŇĴĿļņĴŇļłŁ łĹ ŇĻĸ patient. Ҋ Treatment of tumours of the endometrium or the uterine cervix by brachytherapy with caesium-137. The treatment is delivered ļŁ Ĵ ņĻļĸĿķĸķ ĻłņŃļŇĴĿ Ņłłŀ ňņļŁĺ Ĵ ĶĴĸņļňŀіӄӆӊׇĴĹŇĸŅĿłĴķĸŅ ҎĴĶŇļʼnļŇŌ łĹ ĴĵłňŇ ӋєӅׇ ńҏє Ļĸ ŇŅĸĴŇŀĸŁŇ ļŁʼnłĿʼnĸņ ӅׇŇł ӈׇķĴŌņ of hospitalisation. This technique is used very little, pulsed dose-rate brachytherapy being the preferred treatment. ב ِ׏ِ א ¨ɖǼɀƺƳ (Ȓɀƺ «ٮ ƏɎƺ ٢¨(«٣ ƫȸƏƬǝɵɎǝƺȸƏȵɵ Ҋ ķĸĿļʼnĸŅņ ķłņĸ ŅĴŇĸņ łĹ ĵĸŇŊĸĸŁ ӅׇĴŁķ ӄӅׇ ŌѼĻђ Ҋ ňņļŁĺ ņłňŅĶĸņ łĹ ļŅļķļňŀіӄӌӅׇŊļŇĻ Ĵ ŀĴŋļŀňŀ ĴĶŇļʼnļŇŌ łĹ ӄӋєӈׇ ń ĴŁķ ĴŃŃĿļĸķ ňņļŁĺ Ĵ ņŃĸĶļĹļĶ ĴĹŇĸŅіĿłĴķĸŅє Indications: mainly gynaecological cancers, more occasionally bronchus or oesophageal cancer, and exceptionally breast and prostate cancers. This technique requires patient hospitalisation for several days in a room with radiological protection appropriate to the maximum activity of the radioactive source used. It is based on the use of a single radioactive source which moves in steps, and stops in predetermined positions for predetermined times. Ļĸ ķłņĸņ ĴŅĸ ķĸĿļʼnĸŅĸķ ļŁ ņĸńňĸŁĶĸņ łĹ ӈׇŇł ӅӃׇŀļŁňŇĸņё ņłŀĸŇļŀĸņ ĸʼnĸŁ ӈӃׇŀļŁňŇĸņё ĸʼnĸŅŌ ĻłňŅ ĹłŅ ŇĻĸ ķňŅĴŇļłŁ łĹ ŇĻĸ ŃĿĴŁŁĸķ treatment, hence the name pulsed dose-rate brachytherapy. Pulsed dose-rate brachytherapy offers a number of advantages with regard to radiation protection: Ҋ no handling of sources; Ҋ no continuous irradiation, which enables the patient to receive medical care without irradiating the staff or having to interrupt the treatment. However, it is necessary to make provision for accident situations related to the operation of the source after-loader and to the high dose-rate delivered by the sources used. ב ِ׏ِ ב RǣǕǝ (Ȓɀƺ «ٮ ƏɎƺ ٢R(«٣ ƫȸƏƬǝɵɎǝƺȸƏȵɵ Ҋ ķĸĿļʼnĸŅņ ķłņĸіŅĴŇĸņ ļŁ ĸŋĶĸņņ łĹ ӄӅׇ ŌѼĻђ Ҋ ňņļŁĺ ņłňŅĶĸņ łĹ ļŅļķļňŀіӄӌӅׇŊļŇĻ Ĵ ŀĴŋļŀňŀ ĴĶŇļʼnļŇŌ łĹ 370 GBq and implemented with a specific afterloader (some ĴĹŇĸŅĿłĴķĸŅņ ňņĸ Ĵ ĻļĺĻіĴĶŇļʼnļŇŌ ĶłĵĴĿŇіӉӃׇņłňŅĶĸҏє This technique does not require the patient to be hospitalised in a room with radiological protection; it is performed on an out- patient basis in a room with a configuration comparable to that of an external-beam radiotherapy room. The treatment is performed with an afterloader containing the source and involves one or more sessions lasting a few minutes, spread over several days. Indications: mainly gynaecological cancers, occasionally the treatment of prostate and bronchus cancers, and exceptionally ear, nose and throat cancers. This technique is also indicated in the treatment of keloid scars. ٹ áȸȒȇǕ ٮ ɀǣƳƺ ٺ ƺȸȸȒȸɀً Ɏǝƺ ȇƺƺƳ ɎȒ ȸƺȅƏǣȇ ƏɎɎƺȇɎǣɮƺ ɎǝȸȒɖǕǝȒɖɎ Ɏǝƺ ȸƏƳǣȒɎǝƺȸƏȵɵ ȵƏɎǝɯƏɵ Ȓǔ Ɏǝƺ ȵƏɎǣƺȇɎ So-called “wrong side” (or laterality) errors are frequent causes of ESRs reported to ASN and most often rated ǼƺɮƺǼ ژאژ Ȓȇ Ɏǝƺ ³z ٮ ³I«…ɀƬƏǼƺِ ³zً ǣȇ ƬȒǼǼƏƫȒȸƏɎǣȒȇ with the professionals, published a Radiotherapy Patient Safety bulletin on this subject (Bulletin No. 6) in 2014. ³ǣȇƬƺ Ɏǝƺȇً ȒɖɎ Ȓǔ Ə ɎȒɎƏǼ Ȓǔ ژחא ƺɮƺȇɎɀ ȸƏɎƺƳ ǼƺɮƺǼ ژא ƏȇƳ ɎɯȒ ژ ƺɮƺȇɎɀ ȸƏɎƺƳ ǼƺɮƺǼ ڷא Ȓɮƺȸ Ɏǝƺ א ׎׏ אٮג ׎׏ ژח ȵƺȸǣȒƳً ٹژח ɯȸȒȇǕ ɀǣƳƺ ٺ ƺȸȸȒȸɀ ǝƏɮƺ ƫƺƺȇ ȸƺȵȒȸɎƺƳً ژא Ȓǔ Ɏǝƺȅ ǣȇ אژ ׎׏ ח ِ These errors can occur at various stages from the beginning to the end of a patient’s radiotherapy treatment pathway: ཛྷ when preparing the medical prescription, whether handwritten or computerised, by failing to consult Ɏǝƺ ژ ƳȒƬɖȅƺȇɎɀ Ȓǔ Ɏǝƺ ȅƺƳǣƬƏǼ ǔǣǼƺ ٢ɀɖȸǕǣƬƏǼ Ȓȸ ƏȇƏɎȒȅɵٖ pathology report) to check the laterality; ཛྷ during imaging, due to an error or lack of left/right position indications on the images; ཛྷ during dosimetric planning; ཛྷ when defining the patient positioning references; ཛྷ when carrying out one or more radiotherapy sessions. To prevent these errors, it is vital to ensure traceability of all the paired organs in all the documents throughout the patients’ treatment pathway. Any doubt must be lifted by a collegial review of the radiotherapy file. Lastly, the active participation of the patient or the person accompanying them is key to preventing this type of error. ASN Report on the state of nuclear safety and radiation protection in France in 2019 209 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION 07