Abstracts ASN Report 2019

quality controls of brachytherapy devices, the quality controls implemented result from the past practices and are based on the recommendations of the manufacturers or medical professionals. Maintenance of the HDR and PDR afterloaders is ensured by the manufacturers. More specifically, the manufacturers perform the afterloader operating verifications when the sources are replaced. The brachytherapy units rely on these verifications to guarantee correct operation of the devices. The source activity is verified at each delivery and source removal verifications are also carried out. ב ِ ב ِ ב xƏȇƏǕƺȅƺȇɎ Ȓǔ ɀȒɖȸƬƺɀ Management of the brachytherapy sources is satisfactory. All the centres inspected record the tracking of source movements, transmit the source inventory to IRSN and store the sources waiting to be loaded or collected in a suitable place. The organisation in place enables the category of each source or batch of sources to be identified in 53% of the centres inspected. ӋӃՌ łĹ ŇĻĸ ĶĸŁŇŅĸņ ķļķ ŁłŇ ķĸĿļʼnĸŅ ŇĻĸ ĴňŇĻłŅļņĴŇļłŁņ ŇĻĴŇ ĴňŇĻłŅļņĸ people to have access to the high activity sources, therefore progress is still to be made. Areas for improvement have also been identified regarding the safeguarding of access to the high activity sources, given ŇĻĴŇ łŁĿŌ ӆӋՌ łĹ ŇĻĸ ĶĸŁŇŅĸņ ļŁņŃĸĶŇĸķ ļŁ ӅӃӄӌׇĻĴʼnĸ ŃňŇ ļŁ ŃĿĴĶĸ appropriate measures to prevent unauthorised access to these sources. ASN will remain attentive to the progress to be made and ŇĻļņ ļŁņŃĸĶŇļłŁ ŇĻĸŀĸ ņĻĴĿĿ ĵĸ Ĵ ŃŅļłŅļŇŌ ļŁ ӅӃӅӃׇĹłŅ ŇĻĸ ĶĸŁŇŅĸņ holding high-activity sealed sources. ב ِ ב ِ ג 0ȅƺȸǕƺȇƬɵ ɀǣɎɖƏɎǣȒȇɀ ƏȇƳ ȅƏȇƏǕƺȅƺȇɎ Ȓǔ ȅƏǼǔɖȇƬɎǣȒȇɀ Two events involving the jamming of the source in a PDR ĴŃŃĿļĶĴŇłŅ ŊĸŅĸ ŅĸŃłŅŇĸķ ļŁ ӅӃӄӌє ĻĸŌ ķļķ ŁłŇ ĿĸĴķ Ňł łʼnĸŅі exposure of either the personnel or the patients. Describing these events aims to draw attention to the need to comply with the technical conditions of use of these devices and give a reminder of the obligations concerning training in emergency situation management and conducting exercises. ב ِ ב ِ ד ³ǣǕȇǣǔǣƬƏȇɎ ƺɮƺȇɎɀ ǣȇ ƫȸƏƬǝɵɎǝƺȸƏȵɵ Ł ӅӃӄӌё ӄӈׇ ņ ŊĸŅĸ ŅĸŃłŅŇĸķ ļŁ ĵŅĴĶĻŌŇĻĸŅĴŃŌё łŁĸ łĹ ŊĻļĶĻ was rated level 2. This event concerned a prostate cancer treated by brachytherapy with permanent implants. In addition to the two source jamming events described above, there was one case of interruption of a PDR brachytherapy treatment when the patient removed the treatment material herself. It was decided to stop the treatment. The analysis of these events underlines that the control of risks in brachytherapy must be based on appropriate quality controls and the implementation of organisational measures to better manage the informing of the patient, the sources and emergency situations. ³ȒɖȸƬƺ ǴƏȅȅǣȇǕ ي ƬȒȅȵǼɵ ɯǣɎǝ Ɏǝƺ ƬȒȇƳǣɎǣȒȇɀ Ȓǔ ɖɀƺ Ȓǔ Ɏǝƺ ƳƺɮǣƬƺɀ ƏȇƳ ȵȸȒɮǣƳƺ ɎȸƏǣȇǣȇǕ ǣȇ ƺȅƺȸǕƺȇƬɵ ɀǣɎɖƏɎǣȒȇ ȅƏȇƏǕƺȅƺȇɎ Two significant radiation protection events involving sources becoming jammed due to equipment faults ɯƺȸƺ ژ ȸƺȵȒȸɎƺƳ ɎȒ ³z ǣȇ א ׎׏ ח ِ Áǝƺɵ ȒƬƬɖȸȸƺƳ ƳɖȸǣȇǕ ¨ɖǼɀƺƳ (Ȓɀƺ «ٮ ƏɎƺ ٢¨(«٣ ژ ɎȸƺƏɎȅƺȇɎ Ȓǔ ǕɵȇƏƺƬȒǼȒǕǣƬƏǼ ƬƏȇƬƺȸɀِ In the first case reported, the source was subject ɎȒ ژ ǔȸǣƬɎǣȒȇ ǣȇɀǣƳƺ Ɏǝƺ ƏǔɎƺȸǼȒƏƳƺȸً ƬƏɖɀǣȇǕ Ɏǝƺ ɀȒɖȸƬƺ ɎȒ ژ ȸƺɎȸƏƬɎ ɎȒ Ɏǝƺ ɀɎȒȸƏǕƺ ȵȒɀǣɎǣȒȇ ɯǝƺȸƺ ǣɎ ǴƏȅȅƺƳِ This means there were no consequences in terms of dose to the tumour to treat or to healthy organs. It was nevertheless necessary to reschedule the treatment and change the equipment. The friction of the source inside the incriminated afterloader was caused by obsolescence of the equipment used beyond the maximum time recommended by the manufacturer, which is normally ژב ɵƺƏȸɀِ «ƺ ٮ ɖɀƏƫǼƺ ƺȷɖǣȵȅƺȇɎ Ȓǔ Ɏǝǣɀ Ɏɵȵƺ ǝƏɀ ɎȒ ɖȇƳƺȸǕȒ numerous sterilisation cycles which can cause wearing of the surfaces and materials, therefore it is assigned a service life that must not be exceeded. In the second case, shortly after the start of the last pulse ٫ǣȇ Ɏǝƺ ȅǣƳƳǼƺ Ȓǔ Ɏǝƺ ȇǣǕǝɎ٫ Ɏǝƺ ƳƺɮǣƬƺ ƺȅǣɎɎƺƳ Əȇ ƏǼƏȸȅ while the source was blocked in the treatment position. The duty personnel were unsettled by contradictory information indicated by the device, with a red light prohibiting access to the treatment room, and the “treatment interrupted” light remaining on. Illumination of the “treatment interrupted” light normally means ɎǝƏɎ ژ Ɏǝƺ ɀȒɖȸƬƺ ǣɀ ȸƺɎȸƏƬɎƺƳ ǣȇɎȒ Ɏǝƺ ƳƺɮǣƬƺً ɯǝǣƬǝ ɯƏɀ ȇȒɎ ژ Ɏǝƺ ƬƏɀƺِ Áǝƺ ƳɖɎɵ ȵƺȸɀȒȇȇƺǼ ɯƺȸƺ ƏƫǼƺ ɎȒ ȵƺȸǔȒȸȅ emergency withdrawal of the treatment equipment ٢Ɏǝƺ ژ ƏǔɎƺȸǼȒƏƳƺȸً Ɏǝƺ ɀȒɖȸƬƺ ƏȇƳ Ɏǝƺ ɀǝƺƏɎǝ٣ ǔȸȒȅ Ɏǝƺ ژ ȵƏɎǣƺȇɎ ƏȇƳ ȵǼƏƬƺ ǣɎ ǣȇ Ɏǝƺ ƬȒȇɎƏǣȇƺȸ ȵȸȒɮǣƳƺƳ ǔȒȸ ɎǝƏɎ ژ ȵɖȸȵȒɀƺِ XɎ ɎɖȸȇƺƳ ȒɖɎ ɎǝƏɎ ǣɎ ɯƏɀ ȇȒɎ Ɏǝƺ ȸǣǕǝɎ container and consequently its cover could not be closed. The intervention of the treatment device manufacturer allowed the recovery and disposal of the incriminated source. This event formed the subject of an incident notice ƫƺƬƏɖɀƺ ǣɎ ɯƏɀ ȸƏɎƺƳ ǼƺɮƺǼ ׏ ژ Ȓȇ Ɏǝƺ XȇɎƺȸȇƏɎǣȒȇƏǼ zɖƬǼƺƏȸ ƏȇƳ «ƏƳǣȒǼȒǕǣƬƏǼ 0ɮƺȇɎ ³ƬƏǼƺ ٢Xz0³٣ً ǣȇ ɮǣƺɯ Ȓǔ ژ Ɏǝƺ noncompliance with certain in-house procedures when Ɏǝƺ ƳɖɎɵ ȵƺȸɀȒȇȇƺǼ ǣȇɎƺȸɮƺȇƺƳِ RȒɯƺɮƺȸً Ɏǝƺȸƺ ɯƺȸƺ ژ ȇȒ dosimetric consequences for the patient or the personnel of the centre. SUMMARY With regard to health care safety, the brachytherapy situation is comparable to that of external-beam radiotherapy. Occupational radiation protection and the management of high-activity sealed sources are considered satisfactory on the whole, but the standard must nevertheless be maintained through continuous training actions. In the current context, increased attention must be devoted to safeguarding access to prevent unauthorised access to these sources. ASN Report on the state of nuclear safety and radiation protection in France in 2019 211 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION 07