Abstracts ASN Report 2019

ב ِ א ÁƺƬǝȇǣƬƏǼ ȸɖǼƺɀ ƏȵȵǼǣƬƏƫǼƺ ɎȒ ƫȸƏƬǝɵɎǝƺȸƏȵɵ installations The rules for radioactive source management in brachytherapy are comparable to those defined for all sealed sources, regardless of their use. • nȒɯ (Ȓɀƺ «ٮ ƏɎƺ ƫȸƏƬǝɵɎǝƺȸƏȵɵ In cases where permanent implant techniques are used (seeds łĹ ļłķļŁĸіӄӅӈׇļŁ ŃĴŅŇļĶňĿĴŅ ĹłŅ ŇŅĸĴŇļŁĺ ŃŅłņŇĴŇĸ ĶĴŁĶĸŅҏё ŇĻĸ applications are carried out in the operating theatre with ultrasonography monitoring, and do not require hospitalisation in a room with radiation protection. • ¨ɖǼɀƺƳ (Ȓɀƺ «ٮ ƏɎƺ ƫȸƏƬǝɵɎǝƺȸƏȵɵ Ļļņ ŇĸĶĻŁļńňĸ ňņĸņ ņłňŅĶĸ ĴĹŇĸŅĿłĴķĸŅņ ҎĺĸŁĸŅĴĿĿŌ ӄӋєӈ ń łĹ ļŅļķļňŀіӄӌӅҏє Ļĸ ŇŅĸĴŇŀĸŁŇ ŇĴľĸņ ŃĿĴĶĸ ļŁ ĻłņŃļŇĴĿ Ņłłŀņ ŊļŇĻ radiological protection appropriate for the maximum activity of the radioactive source used. • RǣǕǝ (Ȓɀƺ «ٮ ƏɎƺ ƫȸƏƬǝɵɎǝƺȸƏȵɵ ņ ŇĻĸ ŀĴŋļŀňŀ ĴĶŇļʼnļŇŌ ňņĸķ ļņ ĻļĺĻ ҎӆӊӃ ń łĹ ļŅļķļňŀіӄӌӅׇłŅ ӌӄ ń łĹ ĶłĵĴĿŇіӉӃҏё ļŅŅĴķļĴŇļłŁ ĶĴŁ łŁĿŌ ĵĸ ĶĴŅŅļĸķ łňŇ ļŁ Ĵ room with a configuration comparable to that of an external- beam radiotherapy room. ב ِ ב «ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ ɀǣɎɖƏɎǣȒȇ ǣȇ ƫȸƏƬǝɵɎǝƺȸƏȵɵ In the same way as for external-beam radiotherapy, the safety of brachytherapy treatments has been a priority area of ASN oversight since 2007. In addition, because high-activity radioactive sources are used, the questions of the management of these sources and of potential emergency situations associated with their use must also be taken into account. Ł ӅӃӄӌё Ĵņ ļŁ ӅӃӄӋё ӅӄׇĶĸŁŇŅĸņ ŃŅĴĶŇļņļŁĺ ĵŅĴĶĻŌŇĻĸŅĴŃŌ ŊĸŅĸ inspected, meaning that two thirds of the centres have been inspected over the last two years. ב ِ ב ِ׏ «ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ Ȓǔ ȅƺƳǣƬƏǼ ȵȸȒǔƺɀɀǣȒȇƏǼɀ The occupational radiation protection measures deployed ļŁ ӅӃӄӌׇĵŌ ŇĻĸ ĵŅĴĶĻŌŇĻĸŅĴŃŌ ķĸŃĴŅŇŀĸŁŇņ ŊĸŅĸ ĶłŁņļķĸŅĸķ satisfactory on the whole. Nevertheless, improvements can still be made in the additional training to cope with emergency situations. In slightly more than half of the centres inspected, no simulated situation exercises were held (high activity source jammed, for example), or there is no procedure covering this situation. ASN considers that efforts must still be made to reinforce the radiation protection training of medical professionals when high activity sources are held. ב ِ ב ِ « א ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ Ȓǔ ȵƏɎǣƺȇɎɀ As with external-beam radiotherapy, the radiation protection of brachytherapy patients is assessed from the inspections concerning the implementation of the treatment quality and safety management system. The presence of medical physicists in sufficient numbers for ŇĻĸ ĴĶŇļʼnļŇŌ ļņ łĵņĸŅʼnĸķ ļŁ ŁĸĴŅĿŌ ӌӃՌ łĹ ŇĻĸ ĶĸŁŇŅĸņ ļŁņŃĸĶŇĸķє A medical physics organisation plan is also available in about ӌӃՌ łĹ ŇĻĸ ĶĸŁŇŅĸņє • Áǝƺ ɎȸƺƏɎȅƺȇɎ ȷɖƏǼǣɎɵ ƏȇƳ ɀƏǔƺɎɵ ȅƏȇƏǕƺȅƺȇɎ ɀɵɀɎƺȅ Ļĸ ńňĴĿļŇĴŇļʼnĸ ŅĸņňĿŇ łĹ ŇĻĸ ļŁņŃĸĶŇļłŁņ ĶĴŅŅļĸķ łňŇ ļŁ ӅӃӄӌׇĻĴņ shown that the majority of brachytherapy departments inspected have deployed the quality management system, with the support of the external-beam radiotherapy departments. They nevertheless present the same shortcomings with regard to the prospective risks analysis and no improvement has been seen in this area ĶłŀŃĴŅĸķ ŊļŇĻ ӅӃӄӋє The effectiveness of corrective actions put in place following adverse events is found to be insufficient in about 57% of the ĶĸŁŇŅĸņ ļŁņŃĸĶŇĸķ ļŁ ӅӃӄӌё Ĵņ ļŁ ӅӃӄӋё ŊĻļĶĻ ĿĸĴʼnĸņ ĶłŁņļķĸŅĴĵĿĸ room for improvement given that the situation has not changed. The prior validation of HDR brachytherapy treatments is formalised in just 52% of the cases, which is still insufficient given the risks associated with the use of high-activity sources. ĸŅĸ ĴĺĴļŁё ŇĻĸ ņļŇňĴŇļłŁ ĻĴņ ŁłŇ ĶĻĴŁĺĸķ ŊļŇĻ ŅĸņŃĸĶŇ Ňł ӅӃӄӋє Maintenance and quality controls – The majority of the centres have an inventory of the medical devices and a register for recording maintenance operations and quality controls. In the absence of an ANSM decision defining the baseline requirements for the GRAPH 7 Breakdown, by ASN regional division, of the number of brachytherapy centres, and more precisely, high dose-rate brachytherapy centres and the number of new licenses or license renewals up to date in 2019 Strasbourg Division Paris Division Orléans Division Nantes Division Marseille Division Lyon Division Lille Division Dijon Division Châlons-en- Champagne Division Caen Division Bordeaux Division 0 2 4 6 8 10 12 14 16 Licensed centres High-dose rate centres Authorisations 210 ASN Report on the state of nuclear safety and radiation protection in France in 2019 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION