Abstracts ASN Report 2019

׮٫ ڲ Fluoroscopy-guided interventional practices ד ِ׏ ɮƺȸɮǣƺɯ Ȓǔ Ɏǝƺ ɎƺƬǝȇǣȷɖƺɀ ƏȇƳ Ɏǝƺ ƺȷɖǣȵȅƺȇɎ ĿňłŅłņĶłŃŌіĺňļķĸķ ļŁŇĸŅŉĸŁŇļłŁĴĿ ŃŅĴĶŇļĶĸņ ĺŅłňŃ Ѣ all the imaging techniques using ionising radiation to perform invasive medical or surgical procedures for diagnostic, preventive and/or therapeutic purposes, and surgical and medical procedures using ionising radiation for the purpose of guidance or verification ”. • Áǝƺ ƺȷɖǣȵȅƺȇɎ The equipment items used are either fixed C-arm devices installed in the interventional imaging departments in which vascular specialities (neuroradiology, cardiology, etc.) are carried out, or mobile C-arm radiology devices used chiefly in operating theatres in several surgical specialities, such as gastroenterology, orthopaedics and urology. The detectors present on the devices with C-arms are image intensifiers or flat panel detectors. These devices employ techniques that use fluoroscopy and dynamic radiography (called “photofluorography”, or “cineradiography”) intended to produce high-resolution spatial images. After injecting a contrast agent, practitioners can also use the subtraction method to obtain images. Surgeons have recently started to use CT scanners, sometimes mobile, in the operating theatre. This type of equipment helps the practitioner perform the procedure by providing multi-plane images allowing virtual navigation. These scanners however are not equipped with the latest dose reduction technologies. The personnel most often work in the immediate proximity of the patient and are also exposed to higher dose levels than in other interventional practices. In these conditions, given the exposure risks for both the operator and the patient, practices must be optimised to reduce doses and ensure the radiation protection of operators and patients alike. • Áǝƺ ǝƺƏǼɎǝ ƬƏȸƺ ƬƺȇɎȸƺɀ On the basis of the codes of the common classification of medical procedures and the activity data reported by the health care centres to the Agency for Information on Hospital Care Ҏ ҏё ӌӃӆׇĶĸŁŇŅĸņ ŃĸŅĹłŅŀļŁĺ ĹĿňłŅłņĶłŃŌіĺňļķĸķ ļŁŇĸŅŉĸŁŇļłŁĴĿ practices involving risks (with regard to radiation protection) in one or more disciplines have been inventoried. The distribution of the number of centres by category of fluoroscopy-guided interventional practice is shown in Graph 12. Ł ӅӃӄӌё ŇĻĸ ŅĸĺļłŁĴĿ ķļŉļņļłŁņ ņĸŁŇ ņłŀĸ ӆӌӃׇĴĶľŁłŊі ledgements of notification of fluoroscopy-guided interventional procedures. ד ِ א ÁƺƬǝȇǣƬƏǼ ȸɖǼƺɀ ǔȒȸ Ɏǝƺ ǔǣɎɎǣȇǕ ȒɖɎ Ȓǔ ȅƺƳǣƬƏǼ ȸȒȒȅɀ The rooms in which fluoroscopy-guided intervention procedures are carried out, operating theatres and interventional imaging rooms must be organised in accordance with the provisions of ŅĸņłĿňŇļłŁ ӅӃӄӊі іӃӈӌӄׇłĹ ӄӆ ňŁĸ ӅӃӄӊׇŀĸŁŇļłŁĸķ ļŁ point 4.2. ĸŊ ĶĸŁŇŅĸņ ĴŅĸ ļŁ ĶłŀŃĿļĴŁĶĸ ŊļŇĻ ŇĻļņ ŅĸņłĿňŇļłŁ ĵĸĶĴňņĸ ŇĻĸ signalling and safety systems are often absent; as for the technical reports, of those that do actually exist, many are incomplete. ASN has noted that the interventional radiology departments comply with this resolution to a greater extent than the operating theatres. ד ِ ב «ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ ɀǣɎɖƏɎǣȒȇ ǣȇ ǔǼɖȒȸȒɀƬȒȵɵ ٮ ǕɖǣƳƺƳ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ȵȸƏƬɎǣƬƺɀ łŅ ņĸŉĸŅĴĿ ŌĸĴŅņ ŁłŊё ņļĺŁļĹļĶĴŁŇ ŅĴķļĴŇļłŁ ŃŅłŇĸĶŇļłŁ ĸŉĸŁŇņ have been regularly reported to ASN in the area of fluoroscopy- guided interventional practices. Although these events represent just a small proportion of all the medical events reported to ASN, they most often have serious consequences with the occurrence of tissue damage (radiodermatitis, necrosis) in patients having undergone particularly long and complex interventional procedures. In addition to these events, which underline the major radiation exposure risks for the patients, are those concerning professionals, whose exposure can lead to the exceeding of regulatory limits, particularly at the extremities (fingers). On account of the radiation exposure risks, ASN carries łňŇ Ĵ ĿĴŅĺĸ ŁňŀĵĸŅ łĹ ļŁņŃĸĶŇļłŁņ ļŁ ŇĻļņ ņĸĶŇłŅє Ł ӅӃӄӌё ӄӌӌׇķĸŃĴŅŇŀĸŁŇņ ŊĸŅĸ ļŁņŃĸĶŇĸķє Ļĸņĸ ļŁņŃĸĶŇļłŁņ ŊĸŅĸ ĶĴŅŅļĸķ out in interventional imaging departments (rooms dedicated to interventional vascular and osteoarticular radiology, to neuroradiology and to cardiology) and surgical departments (operating theatre) performing fluoroscopy-guided interventional ŃŅłĶĸķňŅĸņє ӉӃՌ łĹ ŇĻĸ ļŁņŃĸĶŇļłŁņ ļŁ ӅӃӄӌׇŊĸŅĸ ĶĴŅŅļĸķ łňŇ ļŁ operating theatre departments. ¨ȸȒǔƺɀɀǣȒȇƏǼ ɀƺȅǣȇƏȸɀ ǣȇ Ɏǝƺ ƏȸƺƏ Ȓǔ ˢɖȒȸȒɀƬȒȵɵ ٮ ǕɖǣƳƺƳ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ȵȸƏƬɎǣƬƺɀ In view of the increase in the risks associated ɯǣɎǝ ژ Ɏǝƺ ژ ɖɀƺ ژ Ȓǔ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ǣȅƏǕǣȇǕ ȵȸȒƬƺƳɖȸƺɀً ³z ژ ȒȸǕƏȇǣɀƺƳ ɀƺɮƺȸƏǼ ȸƺǕǣȒȇƏǼ ȵȸȒǔƺɀɀǣȒȇƏǼ ɀƺȅǣȇƏȸɀ ǣȇ א ׎׏ ژח ٢ǣȇ nǣǼǼƺً nɵȒȇً ƏȇƳ zƏȇƬɵ٣ ǣȇ ȒȸƳƺȸ ɎȒ ȸƏǣɀƺ the awareness of all the medical players and to stimulate interchanges between practitioners regarding their experience, good practices and difficulties. These seminars allowed the dissemination Ȓǔ ژ ɯǣƳƺ ٮ ȸƏȇǕǣȇǕ ǣȇǔȒȸȅƏɎǣȒȇً ǔȸȒȅ ȸƺǕɖǼƏɎȒȸɵ ȇƺɯɀ to the presentation of innovative cutting-edge ɎƺƬǝȇǣȷɖƺɀ ژ ƏȵȵǼǣƺƳ Ȓȇ ȅɖǼɎǣȅȒƳƏǼ ȵǼƏɎǔȒȸȅɀ ƏȇƳ ƬȒȇƬƺȸȇǣȇǕ Ɏǝƺ ژ ȸƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ Ȓǔ ȅƺƳǣƬƏǼ ɀɎƏǔǔ and patients alike. The strong participation of representatives of all the medical centres of the regions concerned and the great diversity of medical professionals ȸƺȵȸƺɀƺȇɎƺƳ ٫ɀɖȸǕƺȒȇɀً ȸƏƳǣȒǼȒǕǣɀɎɀً ȵǝɵɀǣƬǣɀɎɀً «¨0 ٮ ɀً ȸƏƳǣȒǕȸƏȵǝƺȸɀً ǝƺƏǼɎǝ ƺɴƺƬɖɎǣɮƺɀً ƺɎƬِ٫ ɎƺɀɎǣǔǣƺƳ ɎȒ Ɏǝƺ interest the medical sphere holds for the control and improvement of radiation protection in fluoroscopy-guided interventional practices. The discussions arising from these seminars highlighted the specific nature of the risks associated with these medical practices, due firstly to continuous innovation and secondly to updating of the regulations. Consideration of organisational and human factors and the mobilisation of professionals in a collective work effort are success factors to drive progress in radiation protection. ASN Report on the state of nuclear safety and radiation protection in France in 2019 219 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION 07