Abstracts ASN Report 2019

ה ِ ב Áǝƺ ȸƏƳǣƏɎǣȒȇ ȵȸȒɎƺƬɎǣȒȇ ɀǣɎɖƏɎǣȒȇ ي ɀȵȒɎǼǣǕǝɎ Ȓȇ Ɏǝƺ !Á ɀƬƏȇȇƺȸ łŅĸ ŇĻĴŁ ӌӃӃׇĹĴĶļĿļŇļĸņ Ńłņņĸņņ ӄёӅӇӈׇ ņĶĴŁŁĸŅņ ĴŁķ ĴŅĸ ĶłʼnĸŅĸķ ĵŌ ĴŁ ĿļĶĸŁņĸє ŅĴŃĻ ӄӈׇņĻłŊņ ŇĻĸ ķļņŇŅļĵňŇļłŁ łĹ ņĶĴŁŁĸŅņ ĵŌ ĺĸłĺŅĴŃĻļĶĴĿ ōłŁĸ ĶłʼnĸŅĸķ ĵŌ ŇĻĸ ŅĸĺļłŁĴĿ ķļʼnļņļłŁņё ĴŁķ ŇĻĸ ķļņŇŅļĵňŇļłŁ łĹ ŇĻĸ ӅӌӆׇĿļĶĸŁņĸņ ĸŋĴŀļŁĸķ ļŁ ӅӃӄӌє Ł Ĵ ŅĸŃłŅŇ ŃňĵĿļņĻĸķ ļŁ ĸŃŇĸŀĵĸŅ ӅӃӄӋё ŁłŇĸņ ŇĻĴŇ ŇĻĸ average age of the installed pool of CT scanners is higher in the public sector than in the private sector. Ļĸ ŅĸĺļłŁĴĿ ķļʼnļņļłŁņ ĶĴŅŅļĸķ łňŇ ӆӋׇļŁņŃĸĶŇļłŁņ ļŁ ӅӃӄӌє They focused specifically on sites with CT scanners used to examine patients arriving in the emergency department (whether the scanner is dedicated solely to that use or not). Ļĸņĸ ļŁņŃĸĶŇļłŁņ ĶłŁĶĸŅŁĸķ ӄӈׇĻĸĴĿŇĻ ĶĴŅĸ ĶĸŁŇŅĸņђ ŇĻĸŌ ŊĸŅĸ ĵĴņĸķ łŁ ŅĸņłĿňŇļłŁ ӅӃӄӌі іӃӉӉӃׇłĹ ӄӈׇ ĴŁňĴŅŌ ӅӃӄӌׇŅĸĿĴŇļʼnĸ to quality assurance in medical imaging. The majority of the inspected centres are in the public sector ҎӄӇׇłňŇ łĹ ӄӈҏє ŁĿŌ ӅׇłĹ ŇĻĸŀ ĻĴķ Ĵ ņĶĴŁŁĸŅ ķĸķļĶĴŇĸķ Ňł ŇĻĸ emergency department’s activity. According to the information ĶłĿĿĸĶŇĸķё ĸĴĶĻ ņĶĴŁŁĸŅ ŃĸŅĹłŅŀņ ņłŀĸ ӋёӃӃӃׇŃŅłĶĸķňŅĸņ ŃĸŅ ŌĸĴŅ on average. On the whole, the organisation of the emergency department including access to the CT scanner, particularly in the middle łĹ ŇĻĸ ŁļĺĻŇ ҎĵĸŇŊĸĸŁ ŀļķŁļĺĻŇ ĴŁķ ӉׇĴєŀєҏё ļņ ĹłŅŀĴĿļņĸķ ļŁ ŇĻĸ ŀĴĽłŅļŇŌ łĹ ŇĻĸ ĶĸŁŇŅĸņ ӄӄׇłňŇ łĹ ӄӈҏє ŅļŇŇĸŁ ŃŅłĶĸķňŅĸņ ļŁķļĶĴŇĸ the patient management actions. Job sheets exist for each category of medical professionals. Eight łĹ ŇĻĸ ӄӈׇĶĸŁŇŅĸņ ĻĴʼnĸ ŇŅĴļŁĸķ ŀłŅĸ ŇĻĴŁ ӋӈՌ łĹ ŇĻĸļŅ ŀĸķļĶĴĿ professionals in radiation protection, while the others have ŇŅĴļŁĸķ ĵĸŇŊĸĸŁ ӉӈׇĴŁķ ӋӈՌє Ļĸ ŊłŅľ ņŇĴŇļłŁ ńňĴĿļĹļĶĴŇļłŁ pathway remains to be defined, however. A request is normally drawn up for each examination and validated by a radiologist or a teleradiologist (this is the case in one centre). However, no procedures are formalised in writing. The medical physics organisation is systematically described in a POPM, but the ASN inspections find that the medical physicists are not allocated enough time to fulfil their duties. An optimisation procedure is in place (optimised examination protocols, collection and analysis of Diagnostic Reference Levels (DRLs), etc., with the utilisation of a Dose Archiving and Communication System (DACS) in half the inspected centres. The scanner quality controls are carried out at the required frequencies and any nonconformities are corrected. Radiation protection events are reported and analysed in half the inspected centres. ה ِ ג ³ǣǕȇǣǔǣƬƏȇɎ ƺɮƺȇɎɀ ȸƺȵȒȸɎƺƳ ǣȇ ȅƺƳǣƬƏǼ ƏȇƳ ƳƺȇɎƏǼ ȸƏƳǣȒƳǣƏǕȇȒɀǣɀ ӅӋӈׇņļĺŁļĹļĶĴŁŇ ŅĴķļĴŇļłŁ ŃŅłŇĸĶŇļłŁ ĸʼnĸŁŇņ ŊĸŅĸ ŅĸŃłŅŇĸķ ļŁ medical and dental radiodiagnosis: Ҋ ӌӄׇļŁ ĶłŁʼnĸŁŇļłŁĴĿ ŅĴķļłĿłĺŌё łĹ ŊĻļĶĻ ӈӉׇĶłŁĶĸŅŁĸķ ŊłŀĸŁ unaware of their pregnancy; Ҋ ӅׇļŁ ķĸŁŇĴĿ ŅĴķļłĿłĺŌђ Ҋ ӄӌӅׇļŁ ĶłŀŃňŇĸķ ŇłŀłĺŅĴŃĻŌє SUMMARY Given the expansion of the installed pool of CT scanners, diagnostic examinations using computed tomography contribute very substantially to the collective dose received by the public, as medical imaging is the leading source of artificial exposure of the public to ionising radiation. The medical justification for these procedures is as yet insufficiently operational, owing to the insufficient training of the prescribing physicians, or even the lack of availability of other diagnostic means (MRI, ultrasonography). In July 2018, ASN published a second plan of action for controlling ionising radiation doses delivered to persons during medical imaging. This plan aims to reinforce the justification of the procedures and the optimisation of the ionising radiation doses delivered to the patients. GRAPH 15 Breakdown, by ASN regional division, of the number of CT scanners and the number of licenses created or renewed in 2019 0 50 100 150 200 250 Strasbourg Division Paris Division Orléans Division Nantes Division Marseille Division Lyon Division Lille Division Dijon Division Châlons-en- Champagne Division Caen Division Bordeaux Division Devices Licensed centres Authorisations 226 ASN Report on the state of nuclear safety and radiation protection in France in 2019 ׎ ٲ ו MEDICAL USES OF IONISING RADIATION