Abstracts ASN Report 2019

is a medical procedure in its own right, like all other imaging pro- cedures, and cannot be reduced to a simple remote interpretation of images. Teleradiology therefore fits into the general health care organisation governed by the Public Health Code and obeys the rules of professional ethics in effect. Ļĸ ŇĸĿĸŅĴķļłĿłĺŌ ĻĴŅŇĸŅ ŃňĵĿļņĻĸķ ĵŌ ŇĻĸ ŅĸŁĶĻ ŅłĹĸņņļłŁĴĿ łňŁĶļĿ łĹ ĴķļłĿłĺŌ Ҏ Ӈҏ ŊĴņ ňŃķĴŇĸķ ļŁ ӅӃӄӋє Ļļņ ŇĻļŅķ version (10) updates the Charter in the light of practices and the regulations in force, particularly with regard to personal health ķĴŇĴ ĴŁķ ŇĻĸ ŅĸĶłŀŀĸŁķĴŇļłŁņ łĹ ŇĻĸ Ҏ ŅĸŁĶĻ ĴŇļłŁĴĿ Commission for Data Protection and Liberties). It details the organisation of the two parts of teleradiology (telediagnosis and tele-expertise). In addition, a guide to good practices concerning the quality and safety of teleimaging procedures (11) was published ļŁ ĴŌ ӅӃӄӌׇĵŌ ŇĻĸ ŅĸŁĶĻ ĴŇļłŁĴĿ ňŇĻłŅļŇŌ ĹłŅ ĸĴĿŇĻ Ҏ ҏє It enables the HAS to make important clarifications concerning the proper use of “medical imaging examinations with remote interpretation”. It has the particularity of also addressing nuclear telemedicine, deployed with the aim of providing uniform coverage of the country. This guide does not consider either mammography, which cannot be done by teleradiology because it necessitates clinical examination of the patient, including palpation, or tele-ultrasonography. ה ِ׏ِ ( א ƺȇɎƏǼ ȸƏƳǣȒƳǣƏǕȇȒɀǣɀ • XȇɎȸƏ ٮ ȒȸƏǼ ȸƏƳǣȒǕȸƏȵǝɵ Intra-oral radiography generators, which are usually mounted on an articulated arm, are used to take localised planar images of the teeth (the radiological detector is placed in the patient’s mouth). They operate with low voltage and current and a very short exposure time, of about a few hundredths of a second. This technique is most often associated with digital systems for processing and filing the radiographic images. • ¨ƏȇȒȸƏȅǣƬ ƳƺȇɎƏǼ ȸƏƳǣȒǕȸƏȵǝɵ Panoramic radiography (orthopantomography) gives a single picture showing both jaws in full, by rotating the radiation generating tube around the patient’s head for a few seconds. • !Ȓȇƺ ٮ ƫƺƏȅ ƬȒȅȵɖɎƺƳ ɎȒȅȒǕȸƏȵǝɵ Cone-beam computed tomography (3D) is developing very rapidly in all areas of dental radiology, due to the exceptional quality of ŇĻĸ ļŀĴĺĸņ ŃŅłķňĶĸķ ҎņŃĴŇļĴĿ ŅĸņłĿňŇļłŁ łĹ ĴĵłňŇ ӄӃӃׇŀļĶŅłŁņҏє 10. sites.google.com/site/g4radiologie/vie-professionnelle/teleradiologie/guides-et-recommandations 11. has-sante.fr/jcms/c_2971634/fr/teleimagerie-guide-de-bonnes-pratiques The trade-off for this better diagnostic performance is that these devices deliver significantly higher doses than in conventional dental radiology. • ¨ȒȸɎƏƫǼƺ æ ٮ ȸƏɵ ǕƺȇƺȸƏɎǣȇǕ ƳƺɮǣƬƺɀ ASN and the Dental Radiation Protection Commission (CRD) ŃňĵĿļņĻĸķ ĴŁ ļŁĹłŅŀĴŇļłŁ ŁłŇļĶĸ ļŁ ĴŌ ӅӃӄӉׇŅĸļŇĸŅĴŇļŁĺ ŇĻĸ ŅňĿĸņ associated with the possession and utilisation of portable X-ray generating devices. “ The performance of radiological examinations outside a room fitted out for that purpose must remain the exception and be justified by vital medical needs, limited to intraoperative examinations or for patients who cannot be moved. Routine radiology practice in a dental surgery equipped with a compliant facility shall not be carried out using mobile or portable devices .” This position is supported by Heads of the European Radiological protection Competent Authorities (HERCA), for which the use of such devices should be reserved for incapacitated patients, for forensic medicine and military field operations (HERCA Position Statement on Use of Handheld Portable Dental X-ray Equipment, June 2014). ה ِ א ÁƺƬǝȇǣƬƏǼ ǼƏɵȒɖɎ ȸɖǼƺɀ ǔȒȸ ȅƺƳǣƬƏǼ ƏȇƳ ƳƺȇɎƏǼ ȸƏƳǣȒƳǣƏǕȇȒɀǣɀ ǔƏƬǣǼǣɎǣƺɀ • «ƏƳǣȒǼȒǕɵ ǣȇɀɎƏǼǼƏɎǣȒȇɀ A conventional radiological facility usually comprises a generator (high-voltage unit, X-ray tube), associated with a support (the stand) for moving the tube, a control unit and an examination table or chair. Mobile facilities, but which are often used in the same given room, such as the X-ray generators used in operating theatres, are to be considered as fixed facilities. Radiological facilities must be fitted out in accordance with the ŃŅłʼnļņļłŁņ łĹ ŇĻĸ ŁĸŊ ŇĸĶĻŁļĶĴĿ ŅĸņłĿňŇļłŁ ӅӃӄӊі іӃӈӌӄׇłĹ ӄӆׇ ňŁĸ ӅӃӄӊׇҎņĸĸ ŃłļŁŇ ӇєӅҏє Ļļņ ķĸĶļņļłŁ ĴŃŃĿļĸņ Ňł ĴĿĿ ŀĸķļĶĴĿ radiology facilities, including computed tomography and dental radiology. It does not however apply to X-ray generators that are used exclusively for bedside radiography. A technical report demonstrating conformity of the facility with the requirements of the ASN resolution is to be drawn up by the person or entity responsible for the nuclear activity. Áǝƺ ȸƺɀȒǼɖɎǣȒȇ ȸƺǼƏɎǣɮƺ ɎȒ ȷɖƏǼǣɎɵ ƏɀɀɖȸƏȇƬƺ ǣȇ ȅƺƳǣƬƏǼ ǣȅƏǕǣȇǕ ƺȇɎƺȸƺƳ ǣȇɎȒ ƺǔǔƺƬɎ Ȓȇ ׏ ژ hɖǼɵ א ׎׏ ח In France, medical applications represent the primary source of artificial exposure of the public to ionising radiation. This medical exposure is increasing, mainly due to the increased number of examinations using computed tomography (CT) scanners. In order to control the doses delivered to patients undergoing medical imaging examinations, and thereby contribute to enhanced safety for the patients, ASN has defined new quality assurance requirements in medical imaging. ASN resolution א ׎׏ ٮ!(ٮח ׎ הה ׎ ژ Ȓǔ ׏ ژד hƏȇɖƏȸɵ א ׎׏ ژח ƏȵȵǼǣƺɀ ɎȒ ƬȒȅȵɖɎƺƳ tomography, FGI practices, diagnostic nuclear medicine and conventional and dental radiology. The main objective of this resolution is to control the doses delivered to patients undergoing medical imaging examinations. The person/entity responsible for its application is the person/entity responsible for the nuclear activity. The resolution defines the quality assurance system, formalises the work station training and qualification processes, sets out two fundamental principles of radiation protection, namely the justification for the procedures and the optimisation of doses, describes the steps of the experience feedback process by reinforcing the recording and analysis of events that could lead to accidental or unintentional exposure of persons during a medical imaging procedure. This resolution is applicable in accordance with a “graded” approach, proportionate to the radiological risk for the exposed persons. ASN Report on the state of nuclear safety and radiation protection in France in 2019 225 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION 07