Abstracts ASN Report 2019

implementation of the optimisation principle. Close collaboration between the operator and medical physicist and the regular presence of the latter would allow, among other things, the equipment to be better used, with the application of protocols adapted to the procedures performed, recording of the delivered doses and the evaluation in the light of dosimetric reference levels to be defined locally. When medical centres use outside companies proposing medical physics services, it is observed that few centres embrace the optimisation approach. These observations were noted in particular in the operating theatres, where the optimisation approach is rarely put in place. • Xȇ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ǣȅƏǕǣȇǕ ƳƺȵƏȸɎȅƺȇɎɀ ƏȇƳ ǣȇ ȒȵƺȸƏɎǣȇǕ ɎǝƺƏɎȸƺɀ The observed shortcomings concern firstly a lack of training of medical professionals in patient radiation protection, and secondly, deficiencies in application of the principle of procedure optimisation, as much in the adjustment of the devices and the protocols used as in the practices. ASN observes that although doses are recorded, they are rarely analysed (34% for operating theatres, 62% for interventional imaging departments). Patient monitoring in cases where the exposure threshold is exceeded (skin exposure threshold) defined by the HAS (8) is not very satisfactory, particularly in the operating ŇĻĸĴŇŅĸņ ҎӈӈՌ ĹłŅ łŃĸŅĴŇļŁĺ ŇĻĸĴŇŅĸņ ĴŁķ ӊӋՌ ĹłŅ ļŁŇĸŅʼnĸŁŇļłŁĴĿ imaging departments). Reference levels for the most common examinations are being developed locally more and more often. This approach also enables, among other things, alert levels to be set to trigger appropriate medical monitoring of the patient according to the dose levels received. The patient dose archiving and analysis systems currently being deployed facilitate the development of 8. Improving patient monitoring in interventional radiology and fluoroscopy-guided procedures –reducing the risk of deterministic effects– HAS. local reference levels and alert levels per machine and per type of procedure. These systems are an asset for determining the doses previously received by the patient and for monitoring the patient. The third-party quality controls of the medical devices are generally carried out at the right frequency and on the day of (ǣƏǕȇȒɀɎǣƬ ȸƺǔƺȸƺȇƬƺ ǼƺɮƺǼɀ ي ȒȵɎǣȅǣɀƏɎǣȒȇ ɎȒȒǼɀ ÁǝȸȒɖǕǝ ȸƺɀȒǼɖɎǣȒȇ א ׎׏ ٮ!(ٮח ׎ ژוהה Ȓǔ ׏ ژז ȵȸǣǼ א ׎׏ ח ً ASN updated the Diagnostic Reference Levels (DRL) used by the medical professionals in medical imaging procedures. The DRLs are not dose limit values; they enable the professionals to assess their practices through comparison with these reference values with a view to optimising the ionising radiation doses delivered to the patients while still preserving image quality to achieve the desired clinical objective. These levels are defined for the most common procedures but also for those involving the highest exposures and must be updated regularly to take account of changes in practices and technologies. This resolution requires the party responsible for the nuclear activity to carry out dosimetric evaluations in the adult and in paediatrics. The ASN resolution also introduces for the first time DRLs for certain FGI procedures, along with the notion of diagnostic guide value, which is lower than the DRL, as a second optimisation reference. ٹ Áǝƺ ɎǝƺƏɎȸƺ Ȓǔ ƺȸȸȒȸɀ ٺ ً Ȓȸ ǝȒɯ ƳȒ ɵȒɖ ƬȸƺƏɎƺ Ə ȵȸƏƬɎǣƬƏǼ ɯȒȸǸɀǝȒȵ ǔȒȸ ȸƏǣɀǣȇǕ ȸƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ ƏɯƏȸƺȇƺɀɀ ǣȇ Ɏǝƺ ȒȵƺȸƏɎǣȇǕ ɎǝƺƏɎȸƺّ The FGI procedures carried out in operating theatres are constantly increasing, as much in the number of procedures as in the medical indications. More and more surgeons and physicians from different disciplines can apply them. If, for the patient, the dose risk associated with a single procedures may be low, the same cannot be said for the medical professional. The reason for this is that the professionals perform procedures that repeatedly expose them to ionising radiation. This can lead to significant exposure levels though the cumulative effect of the doses in the course of their professional life. Awareness of the radiological risk is an increasing necessity, especially in the operating theatre where the radiation protection culture is still poorly developed. Practical and operational aids must therefore be used to better mobilise the professionals with regard to radiation protection. That is the aim of this document applied to the operating theatre. Produced in collaboration with the Lariboisière Hospital ٢¨ɖƫǼǣƬ RƺƏǼɎǝ ³ƺȸɮǣƬƺ ٫ ¨Əȸǣɀ RȒɀȵǣɎƏǼɀ٣ً ǣɎ Əǣȅɀ ɎȒ Ǖǣɮƺ Ɏǝƺ medical professionals in charge of worker and patient radiation protection the information they need to set up practical and collegial workshops on radiation protection. The concept of the “theatre of errors” is to propose a “game of errors” based on work situations. The practical workshop enables operating theatre professionals to embrace good worker and patient radiation protection practices through a simulation in real operating theatre situations. The participants must view and identify the errors intentionally slipped into the operating theatre simulation. The aim of the final debriefing is to correct errors and reiterate the good practices. The tool provides the rules, the methodology and the steps for carrying out a simulation with a multidisciplinary team. This document echoes one of the recommendations of the GPMED working group on the FGIs in the operating theatre: broad awareness-raising Ȓǔ ژ ȅƺƳǣƬƏǼ ȵȸȒǔƺɀɀǣȒȇƏǼɀ ɯǣɎǝ ƏƬɎǣɮƺً ȵȸƏǕȅƏɎǣƬ ɎƺƏƬǝǣȇǕ approaches that are adapted to professional practices ƏȇƳ ژ ƬȒȇɀɎȸƏǣȇɎɀِ 222 ASN Report on the state of nuclear safety and radiation protection in France in 2019 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION