Abstracts ASN Report 2019

the inspection any previously detected nonconformities had been or were being corrected, equally well in the operating theatres as in the interventional imaging departments. • xȒȸƺ ɀȵƺƬǣǔǣƬƏǼǼɵ ǣȇ Ɏǝƺ ȒȵƺȸƏɎǣȇǕ ɎǝƺƏɎȸƺɀ The medical personnel in the operating theatre has insufficient knowledge of the reference dose levels for the types of procedure performed. The theatre C-arms, due to their mobility, are more rarely connected to the centre’s archiving systems than the fixed C-arms of the interventional imaging departments. ד ِ ב ِ ב ³ǣǕȇǣǔǣƬƏȇɎ ƺɮƺȇɎɀ ȸƺǼƏɎǣȇǕ ɎȒ ǔǼɖȒȸȒɀƬȒȵɵ ٮ ǕɖǣƳƺƳ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ȵȸƏƬɎǣƬƺɀ An events recording system is in place in more than 75% of the ĻĸĴĿŇĻ ĶĴŅĸ ĶĸŁŇŅĸņ ļŁņŃĸĶŇĸķє ӅӊׇņļĺŁļĹļĶĴŁŇ ĸʼnĸŁŇņ ŊĸŅĸ ŅĸŃłŅŇĸķ ļŁ ŇĻļņ ĴŅĸĴ ļŁ ӅӃӄӌє Among these events: Ҋ ӄӆׇĶłŁĶĸŅŁĸķ łʼnĸŅĸŋŃłņňŅĸ łĹ ŃĴŇļĸŁŇņё ņłŀĸ łĹ ŊĻļĶĻ Ŀĸķ to deterministic effects such as transient hair loss (alopecia) ҎӅׇĶĴņĸņҏ łŅ ņĿļĺĻŇ ĸŅŌŇĻĸŀĴ ҎӄׇĶĴņĸҏђ Ҋ ӌׇĶłŁĶĸŅŁĸķ ĸŋŃłņňŅĸ łĹ ŀĸķļĶĴĿ ŃŅłĹĸņņļłŁĴĿņђ Ҋ ӈׇĶłŁĶĸŅŁĸķ ŃŅĸĺŁĴŁŇ ŊłŀĸŁ ĸŋŃłņĸķ ķňŅļŁĺ Ĵ ĸŋĴŀļŁі ation; these women were unaware of their pregnancy at the time of exposure. The majority of the ESRs concerning patient overexposures were due to long and complex procedures. Some of these patients had undergone several procedures to stabilise their illness. The ESRs reported for medical professionals were due to accidental overexposures: two cases occurred when stowing the ionising radiation emitting device (device powered on), in other cases it was during a surgical procedure (personnel not protected, including two pregnant staff members). One medical professional received a high level of exposure to the ĻĴŁķņ ķňŅļŁĺ ŃŅĴĶŇļĶĸņє ņ ŇĻĸ ŅĸĺňĿĴŇłŅŌ ĴŁŁňĴĿ ĸŋŃłņňŅĸ ĿļŀļŇ ŊĴņ ĸŋĶĸĸķĸķё ŇĻļņ ŊĴņ ŅĴŇĸķ ĿĸʼnĸĿ ӄׇłŁ ŇĻĸ ņĶĴĿĸє Ļĸ ĶĸŁŇŅĸ ĶłŁĶĸŅŁĸķ ŊĴņ ļŁņŃĸĶŇĸķ ļŁ ĸĴŅĿŌ ӅӃӄӌє The other cases concern dosimeter malfunctioning and intentional exposure of a dosimeter. This year there is an increase in operating theatre ESRs reported, with the number exceeding that for interventional imaging ķĸŃĴŅŇŀĸŁŇņ ҎӄӉׇłĹ ŇĻĸ Ӆӊׇ ņҏє Ļĸ ļŁņŃĸĶŇļłŁņ ļŁ ŇĻĸ ĿĴņŇ ĹĸŊ years, carried out mainly in the operating theatres, have raised radiation protection awareness among the medical professionals. ³ǣǕȇǣˡƬƏɎǣȒȇ ȸƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ ƺɮƺȇɎɀ ٢0³«٣ ǣȇ ˢɖȒȸȒɀƬȒȵɵ ٮ ǕɖǣƳƺƳ ǣȇɎƺȸɮƺȇɎǣȒȇƏǼ ȵȸƏƬɎǣƬƺɀ ي Ɏǝƺ ǣȅȵȒȸɎƏȇƬƺ Ȓǔ ɎȸƏǣȇǣȇǕ Ɏǝƺ ȵȸȒǔƺɀɀǣȒȇƏǼɀ ǣȇ Ɏǝƺ ƬȒȅȅƏȇƳ Ȓǔ Ɏǝƺ ȅƺƳǣƬƏǼ ƳƺɮǣƬƺ An ESR having caused a radiodermatitis was reported ɎȒ ³zِ XɎ ȒƬƬɖȸȸƺƳ ǔȒǼǼȒɯǣȇǕ ɎɯȒ ǔƏǣǼƺƳ ƏɎɎƺȅȵɎɀ ٫Ɏǝȸƺƺ ɯƺƺǸɀ ƏȵƏȸɎ٫ ɎȒ ǣȅȵǼƏȇɎ Ə ɎȸǣȵǼƺ ٮ ƬǝƏȅƫƺȸ ƳƺǔǣƫȸǣǼǼƏɎȒȸِ The cardiologist then referred the patient to a colleague Ȓǔ ژ Ɏǝƺ !R«È ٢«ƺǕǣȒȇƏǼ ÈȇǣɮƺȸɀǣɎɵ RȒɀȵǣɎƏǼ !ƺȇɎȸƺ٣ِ The radiodermatitis subsequently resolved itself without any complication. The analysis of this event primarily revealed a weakness in the system of induction and training of newly recruited medical professionals. A new organisation has been put in place to reinforce the training pathway of any newly recruited personnel. This formalised pathway provides more specifically for an assessment of the practitioners level of command of radiation protection rules and practices, delivery of training in occupational and patient radiation protection, along with qualification in the use of the image intensifier, registering of the training certificates, providing work procedures/instructions relative to radiation protection and the signing of a radiation protection charter. SUMMARY In the field of FGI practices, ASN considers that the important measures it has been recommending for several years are not always sufficiently implemented to improve the radiation protection of patients and professionals, particularly for surgical procedures performed in the operating theatres. The inspections frequently reveal deviations from the regulations, in the radiation protection of both patients and medical staff, and ASN is notified of events concerning interventional practitioners who have exceeded the dose limits for the extremities. The radiation protection situation is however significantly better in the departments that have been using these technologies for a long time, such as the imaging departments performing interventional cardiology and neurology activities. Extensive work to raise the awareness of all professionals is needed in order to help medical, paramedical and administrative professionals in facilities, so that they have a clearer perception of the implications, notably those professionals working in operating theatres. In ASN’s opinion, the continuous training of the professionals and the involvement of the medical physicist probably constitute the two key points to guarantee the doses delivered to patients during interventional procedures. ASN Report on the state of nuclear safety and radiation protection in France in 2019 223 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION 07