Abstracts ASN Report 2019

łĹׇŁĸňŅłĸŁķłĶŅļŁĸ łŅ ŃŅłņŇĴŇĸ ĶĴŁĶĸŅņ ĵŌ ŀłĿĸĶňĿĸņ ŀĴŅľĸķ ŊļŇĻ ĿňŇĸŇļňŀіӄӊӊׇҎĿňŇĸŇļňŀ ŇĻĸŅĴŃŌҏҏђ Ҋ treatments administered by selective routes (treatment of liver cancers by administering microspheres marked with ŌŇŇŅļňŀіӌӃׇŇĻŅłňĺĻ Ĵ ĶĴŇĻĸŇĸŅ ŃĿĴĶĸķ ļŁ ĴŁ ĴŅŇĸŅŌҏє Some treatments require patients to be hospitalised for several days in specially fitted-out rooms in the nuclear medicine unit to ensure the radiation protection of the personnel, of people visiting the patients and of the environment. The radiological protection of these rooms is adapted to the nature of the radiation emitted by the radionuclides, and the contaminated urine of the patients is collected in tanks. This is particularly the case with the post- surgical treatment of certain thyroid cancers. The treatments are ŃĸŅĹłŅŀĸķ ĵŌ ĴķŀļŁļņŇĸŅļŁĺ ļłķļŁĸіӄӆӄׇŊļŇĻ ĴĶŇļʼnļŇļĸņ ʼnĴŅŌļŁĺ ĹŅłŀ ӄєӄׇ ń Ňł ӈєӈׇ ńє ĶĶłŅķļŁĺ Ňł ŇĻĸ ӅӃӄӋׇņňŅʼnĸŌ łĹ ŁňĶĿĸĴŅ ŀĸķļĶļŁĸ ňŁļŇņё ļŁ ӅӃӄӊѓ Ҋ ӉёӆӊӊׇŃĴŇļĸŁŇņ ŅĸĶĸļʼnĸķ Ĵ ŇŅĸĴŇŀĸŁŇ ĴķŀļŁļņŇĸŅļŁĺ ļłķļŁĸіӄӆӄ (with hospitalisation); Ҋ ӅӊӃׇŃĴŇļĸŁŇņ ŅĸĶĸļʼnĸķ Ĵ ŇŅĸĴŇŀĸŁŇ ĴķŀļŁļņŇĸŅļŁĺ ĿňŇĸŇļňŀіӄӊӊђ Ҋ ӇӅӉׇŃĴŇļĸŁŇņ ŅĸĶĸļʼnĸķ Ĵ ŇŅĸĴŇŀĸŁŇ ĴķŀļŁļņŇĸŅļŁĺ ŌŇŇŅļňŀіӌӃё ӅӆӃׇłĹ ŇĻĸŀ ŊļŇĻ і ŃĻĸŅĸņң ĴŁķ ӄӌӉׇŊļŇĻ ĻĸŅĴ ŃĻĸŅĸңђ Ҋ ӄӃӄׇŃĴŇļĸŁŇņ ŅĸĶĸļʼnĸķ Ĵ ŇŅĸĴŇŀĸŁŇ ĴķŀļŁļņŇĸŅļŁĺ ŅĴķļňŀіӅӅӆє łŅ ŇĻĸŅĴŃĸňŇļĶ ŃňŅŃłņĸņё ŇĻĸŅĸ ĴŅĸ ӄӈӈׇ ŁŇĸŅŁĴĿ ĴŅĺĸŇĸķ ĴķļłŇĻĸŅĴŃŌ Ҏ ņҏ ĻłņŃļŇĴĿ Ņłłŀņ ķļņŇŅļĵňŇĸķ łʼnĸŅ ӇӇׇŁňĶĿĸĴŅ ŀĸķļĶļŁĸ ňŁļŇņ Ҏņĸĸ ŅĴŃĻ ӌҏє Other treatments can be on an out-patient basis. Examples ļŁĶĿňķĸ ĴķŀļŁļņŇĸŅļŁĺ ļłķļŁĸіӄӆӄׇŇł ŇŅĸĴŇ ĻŌŃĸŅŇĻŌŅłļķļņŀё ņŇŅłŁŇļňŀіӋӌׇłŅ ņĴŀĴŅļňŀіӄӈӆׇĹłŅ ŃĴļŁĹňĿ ĵłŁĸ ŀĸŇĴņŇĴņĸņё ĴŁķ ŅĴķļňŀіӅӅӆׇĹłŅ ŃŅłņŇĴŇĸ ĶĴŁĶĸŅ ŊļŇĻ ĵłŁĸ ŀĸŇĴņŇĴņĸņє Łĸ can also treat inflammatory diseases of the joints using colloids ŀĴŅľĸķ ŊļŇĻ ŌŇŇŅļňŀіӌӃё ĸŅĵļňŀіӄӉӌё łŅ ŅĻĸŁļňŀіӄӋӉє ļŁĴĿĿŌё radioimmunotherapy can be used to treat certain lymphomas ňņļŁĺ ŌŇŇŅļňŀіӌӃׇĿĴĵĸĿĿĸķ ĴŁŇļĵłķļĸņє łŅĸ ŇĻĴŁ ӉёӈӃӃׇŃĴŇļĸŁŇņ ŊĸŅĸ ŇŅĸĴŇĸķ ŊļŇĻłňŇ ĻłņŃļŇĴĿļņĴŇļłŁ ļŁ ӅӃӄӊё ĶĻļĸĹĿŌ ŊļŇĻ ļłķļŁĸіӄӆӄׇĴŁķё Ňł Ĵ ĿĸņņĸŅ ĸŋŇĸŁŇё ĹłŅ synoviortheses or palliative treatment of metastatic pains. ג ِ׏ِ « ג ƺɀƺƏȸƬǝ ǣȇ ȇɖƬǼƺƏȸ ȅƺƳǣƬǣȇƺ ǣȇɮȒǼɮǣȇǕ ǝɖȅƏȇɀ Nuclear medicine research conducted on humans has been particularly dynamic in the last few years, with the regular introduction of protocols involving new radionuclides and vectors. Research focusing on the use of new tracers is continuing as much ļŁ ķļĴ壳ņŇļĶ ļŀĴĺļŁĺ ҎĹĿňłŅļŁĸіӄӋіĹĿňłŅłĸņŇŅĴķļłĿё ķĸʼnĸĿłŃŀĸŁŇ łĹ ŃĸŃŇļķĸņ ŀĴŅľĸķ ŊļŇĻ ĺĴĿĿļňŀіӉӋё ĶĴŅķļĴĶ ĴŃŃĿļĶĴŇļłŁņ łĹ iodine-124, exploration of pulmonary ventilation by aerosols ŀĴŅľĸķ ŊļŇĻ ĺĴĿĿļňŀіӉӋё ĸŇĶєҏ Ĵņ ļŁ ŇĻĸŅĴŃŌ ҎķĸʼnĸĿłŃŀĸŁŇ łĹ ŁĸŊ molecules marked with lutetium-177, molecules marked with copper-64, etc.). The use of new RPDs means that the radiation protection requirements associated with their use must be integrated as early as possible in the process. Indeed, given the activity levels involved, the characteristics of certain radionuclides and the preparations to produce, appropriate measures must be implemented with regard to operator exposure and environmental impact. Ӊє ŅĸņłĿňŇļłŁ ӅӃӄӊі іӃӈӌӄׇłĹ ӄӆׇ ňŁĸ ӅӃӄӊׇņĸŇŇļŁĺ ŇĻĸ ŀļŁļŀňŀ ŇĸĶĻŁļĶĴĿ ķĸņļĺŁ ŅňĿĸņ Ňł ĵĸ ŀĸŇ ĵŌ ŃŅĸŀļņĸņ ļŁ ŊĻļĶĻ ķĸʼnļĶĸņ ĸŀļŇŇļŁĺ іŅĴŌņ ĴŅĸ ňņĸķє ӊє ŅķĸŅ łĹ Ӆӆׇ ňĿŌ ӅӃӃӋׇĴŃŃŅłʼnļŁĺ ŅĸņłĿňŇļłŁ ӅӃӃӋі іӃӃӌӈׇłĹ Ӆӌׇ ĴŁňĴŅŌ ӅӃӃӋׇņĸŇŇļŁĺ ŇĻĸ ŇĸĶĻŁļĶĴĿ ŅňĿĸņ Ňł ĵĸ ŀĸŇ ĹłŅ ŇĻĸ ĸĿļŀļŁĴŇļłŁ łĹ ĸĹĹĿňĸŁŇņ and waste contaminated by radionuclides, or liable to be so contaminated owing to a nuclear activity, issued in application of the provisions of Article єׇӄӆӆӆіӄӅׇłĹ ŇĻĸ ňĵĿļĶ ĸĴĿŇĻ łķĸє ג ِ א nƏɵȒɖɎ ȸɖǼƺɀ ǔȒȸ ȇɖƬǼƺƏȸ ȅƺƳǣƬǣȇƺ ǔƏƬǣǼǣɎǣƺɀ Given the radiation protection constraints involved in the use of unsealed radioactive sources, nuclear medicine units are designed and organised so that they can receive, store, prepare and then administer unsealed radioactive sources to patients or handle them in laboratories (radioimmunology for example). Provision is also made for the collection, storage and disposal of radioactive wastes and effluents produced in the facility, particularly the radionuclides contained in patients’ urine. • !ȒȅȵǼǣƏȇƬƺ ɯǣɎǝ ³z ȸƺɀȒǼɖɎǣȒȇ א ׎׏ ٮ!(ٮג ׎ בהג Nuclear medicine units must satisfy the rules prescribed by ŅĸņłĿňŇļłŁ ӅӃӄӇі іӃӇӉӆׇłĹ Ӆӆׇ ĶŇłĵĸŅ ӅӃӄӇׇŅĸĿĴŇļʼnĸ Ňł ŇĻĸ minimum technical rules of design, operation and maintenance to be satisfied by in vivo nuclear medicine facilities. This resolution details in particular the rules for the ventilation of nuclear medicine unit premises and the rooms accommodating patients receiving, for example, treatment for thyroid cancer ŊļŇĻ ļłķļŁĸіӄӆӄє ňļķĸ łє ӆӅׇķĸŇĴļĿļŁĺ ĶĸŅŇĴļŁ ĴņŃĸĶŇņ łĹ ŇĻļņ ŅĸņłĿňŇļłŁ ŊĴņ ŃňĵĿļņĻĸķ ĵŌ ļŁ ĴŌ ӅӃӄӊׇĴŁķ ŊļĿĿ ĵĸ ňŃķĴŇĸķ in 2020. łŀŃĿļĴŁĶĸ ŊĴņ ŅĸńňļŅĸķ ĵŌ ӄׇ ňĿŌ ӅӃӄӈׇĹłŅ ŁňĶĿĸĴŅ ŀĸķļĶļŁĸ ĹĴĶļĿļŇļĸņ ĴŁķ ĵŌ ӄׇ ňĿŌ ӅӃӄӋׇĹłŅ ļŁŇĸŅŁĴĿ ŇĴŅĺĸŇĸķ ŅĴķļłŇĻĸŅĴŃŌ Ņłłŀņє łŊĸʼnĸŅё ķĸŃĴŅŇŀĸŁŇņ ĿļĶĸŁņĸķ ĵĸĹłŅĸ ӄׇ ňĿŌׇӅӃӄӈ ŊĻļĶĻ did not meet these requirements had to comply with them if they underwent major modifications. ļŁĶĸ ӄׇ ňĿŌ ӅӃӄӈё ŇĻĸ ŅĸĺļłŁĴĿ ķļʼnļņļłŁņ ŅĴķļĴŇļłŁ ŃŅłŇĸĶŇļłŁ inspectors have assessed the compliance of the facilities during inspections: ҄ łŅ ŇĻĸ ŅĴķļłŁňĶĿļķĸ ĻĴŁķĿļŁĺ Ņłłŀņё ŇĻĸ Ņłłŀņ ļŁ ŇĻĸ ŁňĶĿĸĴŅ medicine sector and the provisions for lung examinations, the data show that virtually all the departments comply with the requirements concerning the ventilation system, with the exception of the ventilation system for lung examinations which is not always independent of the system for the rooms in the nuclear medicine sector. ҄ łŅ ŇĻĸ Ņłłŀņё Ĵ ĹļŅņŇ ĶłŀŃĿļĴŁĶĸ ĴņņĸņņŀĸŁŇ ĻĴķ ĵĸĸŁ ĶĴŅŅļĸķ łňŇ ĵĸĹłŅĸ ňĿŌ ӅӃӄӋׇłŁ ŇĻĸ ĵĴņļņ łĹ ŇĻĸ ļŁņŃĸĶŇļłŁņ ĶłŁķňĶŇĸķ ĵĸŇŊĸĸŁ ӅӃӄӈׇĴŁķ ӅӃӄӊѓ ŇĻĸ ļŁņŃĸĶŇłŅņ ĴŇ ŇĻĸ Ňļŀĸ found that about half of the structures were noncompliant (independent ventilation and negative pressure). • !ȒȅȵǼǣƏȇƬƺ ɯǣɎǝ ³z ȸƺɀȒǼɖɎǣȒȇ א ׎׏ ٮ!(ٮו ׎ חד ׏ ňŅŇĻĸŅŀłŅĸё ŇĻĸ ĹĴĶļĿļŇļĸņ ĸńňļŃŃĸķ ŊļŇĻ Ĵ ņĶĴŁŁĸŅ ĶłňŃĿĸķ with a gamma-camera or a PET camera must comply with the ŃŅłʼnļņļłŁņ łĹ ŅĸņłĿňŇļłŁ ӅӃӄӊі іӃӈӌӄׇłĹ ӄӆׇ ňŁĸ ӅӃӄӊ (6) . • !ȒȅȵǼǣƏȇƬƺ ɯǣɎǝ ³z ȸƺɀȒǼɖɎǣȒȇ א ׎׎ ٮ!(ٮז ׎ דח Like all facilities producing waste and effluents contaminated by radionuclides, they must comply with the provisions of ŅĸņłĿňŇļłŁ ӅӃӃӋі іӃӃӌӈׇłĹ Ӆӌׇ ĴŁňĴŅŌ ӅӃӃӋ (7) setting the technical rules that the disposal of effluents and waste contaminated by radionuclides must meet. Premises must be dedicated to these activities, as must specific equipment for monitoring the conditions of effluent discharges (tank filling levels, leakage alarm systems, etc.). The compliance of the facilities intended to accommodate the effluents and wastes produced by nuclear medicine departments is verified regularly (see point 4.3.3.). ASN Report on the state of nuclear safety and radiation protection in France in 2019 215 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION 07