Abstracts ASN Report 2019

• !ǝƏȸƏƬɎƺȸǣɀɎǣƬɀ Ȓǔ Ɏǝƺ ǣȇɀȵƺƬɎƺƳ ƬƺȇɎȸƺɀ ƏȇƳ ƳƺȵƏȸɎȅƺȇɎɀ ļŇĻļŁ ŇĻĸņĸ ӄӌӌׇļŁņŃĸĶŇĸķ ĶĸŁŇŅĸņё ӆӅӅׇķĸŃĴŅŇŀĸŁŇņ ŊĸŅĸ ŉļņļŇĸķ ҎӄӌӇׇłŃĸŅĴŇļŁĺ ŇĻĸĴŇŅĸ ķĸŃĴŅŇŀĸŁŇņё ӄӅӋׇļŁŇĸŅŉĸŁŇļłŁĴĿ ļŀĴĺļŁĺ ķĸŃĴŅŇŀĸŁŇņ ĶłŀŃŅļņļŁĺ ӈӆׇĶĴŅķļłĿłĺŌ ҂ĶłŅłŁĴŅŌ ĴŁĺļłĺŅĴŃĻŌ ķĸŃĴŅŇŀĸŁŇņё ӆӌׇĶĴŅķļłĿłĺŌ҂ ŅĻŌŇĻŀłĿłĺŌ ķĸŃĴŅŇŀĸŁŇņё ӆӇׇŉĴņĶňĿĴŅ and osetoarticular interventional radiology departments and ӅׇŁĸňŅłŅĴķļłĿłĺŌ ķĸŃĴŅŇŀĸŁŇņҏѓ ҄ łĹ ŇĻĸ ӄӌӇׇłŃĸŅĴŇļŁĺ ŇĻĸĴŇŅĸ ķĸŃĴŅŇŀĸŁŇņё ӄӋӄׇĻĴķ ĴŇ ĿĸĴņŇ łŁĸ ŀłĵļĿĸ іĴŅŀё ӄӃׇĻĴķ Ĺļŋĸķ іĴŅŀņ ĴŁķ ӆׇĻĴķ ŀłĵļĿĸ ņĶĴŁŁĸŅņђ ҄ łĹ ŇĻĸ ӄӅӋׇļŁŇĸŅŉĸŁŇļłŁĴĿ ļŀĴĺļŁĺ ķĸŃĴŅŇŀĸŁŇņё ӄӃӊׇĻĴķ ĴŇ ĿĸĴņŇ łŁ Ĺļŋĸķ іĴŅŀё ӄӆׇĻĴķ ŀłĵļĿĸ іĴŅŀņ ĴŁķ ӋׇĻĴķ Ĺļŋĸķ ņĶĴŁŁĸŅņє ł ņňŀŀĴŅļņĸё ļŁ ŀłŅĸ ŇĻĴŁ ӋӃՌ łĹ ŇĻĸ ļŁņŃĸĶŇĸķ ļŁŇĸŅŉĸŁŇļłŁĴĿ imaging departments, the procedures are carried out using fixed C-arms, whereas in the operating theatres the physicians mainly ňņĸ ŀłĵļĿĸ іĴŅŀņ ҎӌӆՌҏ Ňł ĺňļķĸ ŇĻĸļŅ ņňŅĺļĶĴĿ ŃŅłĶĸķňŅĸņє Ň ļņ also observed that evermore efficient medical devices are installed in the operating theatres. These are mobile CT scanners or fixed C-arms in the “hybrid” rooms, which combine the characteristics of a conventional surgical room with those of an interventional imaging room; the combination enables the surgeon to perform ѢŀļŁļіļŁŉĴņļŉĸѣ ņňŅĺĸŅŌ ŊļŇĻ Ӆ ĴŁķ ӆ ļŀĴĺļŁĺє ļŋĸķ scanners coupled to fixed C-arms are also beginning to be installed in health care centres. ד ِ ב ِ׏ «ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ Ȓǔ ȅƺƳǣƬƏǼ ȵȸȒǔƺɀɀǣȒȇƏǼɀ • Xȇ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ǣȅƏǕǣȇǕ ƳƺȵƏȸɎȅƺȇɎɀ ƏȇƳ ǣȇ ȒȵƺȸƏɎǣȇǕ ɎǝƺƏɎȸƺɀ Occupational radiation protection seems to be taken into account ĸĹĹĸĶŇļŉĸĿŌё ŊļŇĻ ŇĻĸ ĴŃŃłļŁŇŀĸŁŇ łĹ ĴŁ і ҎļŁ ĴĵłňŇ ӌӉՌ łĹ ŇĻĸ ķĸŃĴŅŇŀĸŁŇņ ļŁņŃĸĶŇĸķҏё ĴŁķ ŅĴķļłĿłĺļĶĴĿ ōłŁļŁĺ łĹ ŇĻĸ ĹĴĶļĿļŇļĸņ ҎŀłŅĸ ŇĻĴŁ ӋӈՌ łĹ ŇĻĸ ķĸŃĴŅŇŀĸŁŇņ ļŁņŃĸĶŇĸķҏє However, the lack of training of the medical professionals in occupational radiation protection (refresher training for all the personnel provided in only about 20% of the departments inspected), especially practitioners working in operating theatres, is a recurrent inspection finding. The occupational radiation protection training of the medical and paramedical professionals who use machines with fixed C-arms in dedicated rooms also remains low, even if they are on the whole better trained. Although collective radiation protection equipment is available for the interventional imaging departments, it is still too rarely present in the operating theatres. A substantial improvement is expected in the coordination of prevention measures with the outside contractors working in the interventional imaging departments and operating theatres, where ASN observes that few prevention plans are signed with all the service providers (only 26% of the inspected centres have a document signed by all the outside contractors formalising the coordination of prevention measures). • xȒȸƺ ɀȵƺƬǣǔǣƬƏǼǼɵ ǣȇ Ɏǝƺ ȒȵƺȸƏɎǣȇǕ ɎǝƺƏɎȸƺɀ In 73% of the inspected sites the operating theatre professionals have dosimetric monitoring devices that are appropriate for worker exposure and in sufficient quantity. This is still insufficient, but nevertheless a distinct improvement compared ŊļŇĻ ӅӃӄӋє The lack of appropriate dosimetric monitoring for certain fluoroscopy-guided procedures, particularly at the extremities, and the absence of medical monitoring of the practitioners, make it difficult to assess the radiation protection situation of these professionals in the operating theatres. ASN nevertheless observes improvements in the departments having been inspected previously. There are still organisational difficulties for the RPE-Os who do not always have the means or the necessary authority to perform ŇĻĸļŅ ķňŇļĸņ ļŁ ĹňĿĿє ňŅŇĻĸŅŀłŅĸё ŇĻĸ Ňļŀĸ ĴĿĿłĶĴŇĸķ Ňł ŇĻĸļŅ ķňŇļĸņ is not always appropriate, particularly in some centres which rely on the RPE-O to ensure patient radiation protection. ASN notes that the RPE-Os analyse the dosimetric results in order to detect incorrect practices and remedy them, above all in the interventional imaging departments. In operating theatres in the private sector, dosimetric monitoring, medical monitoring and, where applicable, employee monitoring, represent a recurrent difficulty. • «ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ ɎƺƬǝȇǣƬƏǼ ɮƺȸǣǔǣƬƏɎǣȒȇɀ Radiation protection external technical verifications were carried łňŇ ļŁ ӋӈՌ łĹ ŇĻĸ ļŁŇĸŅŉĸŁŇļłŁĴĿ ļŀĴĺļŁĺ ķĸŃĴŅŇŀĸŁŇņ ĴŁķ ĴĵłňŇ 74% of the operating theatres. In both cases, the nonconformities observed previously had either been or were being corrected in just 66% of the inspected facilities when the inspection took place. There is room for progress in meeting the required verification frequencies, but an improvement is nevertheless noted. ד ِ ב ِ « א ƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ Ȓǔ ȵƏɎǣƺȇɎɀ The findings established on completion of the inspections in ӅӃӄӌ ŊļŇĻ ŅĸĺĴŅķ Ňł ŃĴŇļĸŁŇ ŅĴķļĴŇļłŁ ŃŅłŇĸĶŇļłŁ ĶłŁĹļŅŀ ŇĻĸ observations made over the last few years (see Graph 14). ASN thus still observes low involvement of medical physicists in ŇĻĸ ķĸŃĴŅŇŀĸŁŇņ ŃŅĴĶŇļĶļŁĺ ŃŅłĶĸķňŅĸņё ĴŁķ ņĻłŅŇĶłŀļŁĺņ in the description of the medical physics organisation in the POPMs (the duties and times of presence of the medical physicist according to the activities are not specified). This slows down IǼɖȒȸȒɀƬȒȵɵ ٮ ǕɖǣƳƺƳ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ȵȸƏƬɎǣƬƺɀ ǣȇ Ɏǝƺ ȒȵƺȸƏɎǣȇǕ ɎǝƺƏɎȸƺ ي Ɏǝƺ ȸƺƬȒȅȅƺȇƳƏɎǣȒȇɀ Ȓǔ Ɏǝƺ ƳɮǣɀȒȸɵ !ȒȅȅǣɎɎƺƺ ǔȒȸ «ƏƳǣƏɎǣȒȇ ¨ȸȒɎƺƬɎǣȒȇ ǣȇ xƺƳǣƬƏǼ ƏȇƳ IȒȸƺȇɀǣƬ ȵȵǼǣƬƏɎǣȒȇɀ Ȓǔ XȒȇǣɀǣȇǕ «ƏƳǣƏɎǣȒȇ ٢J¨x0(٣ Fluoroscopy-Guided Interventional (FGI) practices in the operating theatres are in full expansion, in both the diversity of the procedures and the number of specialist areas concerned and the medical devices used. If radiation protection in FGI procedures performed on fixed X-ray equipment has significantly improved in the last decade, ASN inspections highlight shortcomings in procedures performed in the operating theatre. The radiation exposure risks for each patient are usually low. On the other hand, occupational exposure risks are increasing due to the large number of procedures carried out. The risks are primarily linked to a poor culture in the basic rules of radiation protection. Significant progress remains to be made in surgical procedures. In 2019, with a view to improving radiation protection during FGI procedures in operating theatres, a working group of the GPMED of ASN put forward א ׎ ژ ȸƺƬȒȅȅƺȇƳƏɎǣȒȇɀ ƫƏɀƺƳ Ȓȇ ژג Ɏǝƺȅƺɀ ي ཛྷ quality and risk management; ཛྷ the responsibilities of each player; ཛྷ radiation protection training; ཛྷ the radiation protection tools to develop. ASN Report on the state of nuclear safety and radiation protection in France in 2019 221 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION 07