ASN Report 2020

ASN ASSESSMENTS BY AREA OF ACTIVITY THE MEDICAL SECTOR 2020 was marked by the Covid-19 pandemic, which considerably disrupted the health care system and required that the health care facilities adapt their patient care procedures to ensure compatibility with the two-fold radiation protection and health constraints. ASN therefore adapted its oversight procedures, by opting for remote-inspections whenever necessary. ASN considers that on the basis of the inspections carried out in 2020, the state of radiation protection in the medical sector is comparable to that of 2019. However, the signif icant radiation protection events reported are a reminder of the need for regular evaluation of practices and reinforcement of the radiation protection culture. In radiotherapy , the inspections conf irm that the safety fundamentals are in place (equipment verif ications, medical staff training, quality and risk management policy) and that quality assurance initiatives are progressing satisfactorily. However, the risk analyses are not updated suff iciently to take account of organisational or technical changes. The occurrence of events, such as laterality or f ractionation errors, which sometimes have serious health consequences, shows that there are still organisational deficiencies. The inspections carried out in 2020 did however reveal that the radiation protection conditions had signif icantly improved in the centres which had received formal notice from ASN or which had undergone reinforced monitoring over the course of the previous years. In brachytherapy , occupational radiation protection and the management of high-level sealed sources are considered satisfactory on the whole, but this level must nevertheless be maintained through a continuous training effort. Increased attention must be given to the security of access to these sources. In nuclear medicine , the radiation protection of patients and medical staff in the nuclear medicine units inspected is satisfactory. Progress is however still required in terms of optimisation of practices and the efforts made in occupa­ tional training in worker radiation protection must be maintained. The events reported underline the fact that the radiopharmaceuticals administration process must be regularly evaluated, to ensure that it is correctly managed, in particular for therapeutic procedures. In the area of fluoroscopy-guided interventional practices , and as in previous years, ASN f inds that the measures taken are still insufficient to improve the radiation protection of patients and professionals, more particularly for surgical procedures performed in operating theatres. Events are still being reported to ASN with the dose limits for the extremities of interventional practitioners being exceeded. The radiation protection situation is however signif icantly 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. Considerable work is still needed to raise the awareness among all professionals if a radiation protection culture is to be developed among medical and paramedical professionals, notably those working in the operating theatres. Continuous training of professionals, practitioners in particular, and the intervention by the medical physicist to optimise the radiation protection aspect of the procedures, are the two key areas for managing the doses delivered to the patients during interventional procedures. In computed tomography , diagnostic examinations contribute very substantially to the collective dose received by the public, as medical imaging is the leading source of artif icial exposure of the public to ionising radiation. The medical justif ication remains insuff iciently traceable. During its inspections, ASN observes a lack of traceability of this justification and difficulties encountered by the professionals in implementing it. The lack of training on the part of the requesting physicians, or of use of the Guide to good medical examination practices , and the lack of justification protocols for the most common procedures, partly explain why this justification principle is not always followed. In addition, the lack of availability of other diagnostic procedures (MRI, ultrasonography) and of health professionals, limits the extent to which irradiating procedures can be replaced by non- irradiating procedures. THE INDUSTRIAL AND RESEARCH SECTOR Among the nuclear activities in the industrial sector , industrial radiography and more particularly gamma radiography, are priority sectors for ASN oversight owing to their radiation protection implications. ASN considers that the risks are addressed to varying extents depending on the companies, even though worker dosimetric monitoring is generally carried out correctly. If the risk of incidents and the doses received by the workers are on the whole well managed by the licensees when this activity is performed in a bunker in accordance with the applicable regulations, ASN is still concerned by the observed shortcomings in the signage of the operations area during on-site work, even if a slight improvement on this point is observed by comparison with 2019. ASN also recalls the need for regular maintenance and periodic checks on the correct working of the safety systems integrated into the bunkers, so that they represent an effective line of defence against unintentional exposure. More generally, ASN considers that the ordering parties should give priority to industrial radiography services in bunkers and not on the worksite. In the other priority sectors for ASN oversight in the industrial sector (industrial irradiators, particle accelerators including cyclotrons, suppliers of radioactive sources and devices containing them) the state of radiation protection is considered to be on the whole satisfactory. With regard to suppliers, ASN considers that advance preparations for the expiry of the sources administrative recovery period (which by default is 10 years) and the checks prior to delivery of a source to a customer, are areas in which practices still need to be improved. The actions carried out in recent years have led to improvements in the implementation of radiation protection within the research laboratories. The most notable improvements concern the conditions of waste and effluent storage, more particularly the setting up of pre-disposal inspection procedures; nevertheless, progress is still needed on this point, particularly with a view to the retrieval of unused “legacy” sealed radioactive sources. In addition, the registration and analysis of events which could lead to accidental or unintentional exposure of persons to ionising radiation, notably as a result of insuff icient 20 ASN Report on the state of nuclear safety and radiation protection in France in 2020 ASN ASSESSMENTS PER LICENSEE AND BY AREA OF ACTIVITY