ASN Report 2020

radiation. On the other hand, radioactivity measurements in major rivers or wastewater treatment plants of large towns occasionally reveal the presence of artificial radionuclides used in nuclear medicine ( e.g. iodine-131) exceeding the measurement thresholds. However, no trace of these radionuclides has been measured in water intended for human consumption (see chapter 1). 1.2.5 Significant radiation protection events Significant Radiation Protection Events (ESRs) are required to be notified to ASN since 2007. These notifications provide the professionals with increasingly valuable experience feedback, helping to improve radiation protection in the medical field. In 2020, ASN published two Patient Safety newsletters entitled “Safeguarding the medication circuit in nuclear medicine” and “Prior radiotherapy treatments”, and three experience feedback sheets, one in nuclear medicine “Choice of activimeter calibration channel”, the other two in radiotherapy, “Overdosing during a stereotactic radiotherapy treatment of multiple intracranial locations” and “Accidental irradiation at a distance from the target volume further to a malfunction during target volume delineation”. These documents have been widely distributed in France. In addition to this, the incident notices are published on asn.fr . Since July 2015, radiotherapy departments can report ESRs online. Teleservices .asn.fr was extended to cover the entire medical sector in April 2017. This portal is integrated in the one-stop vigilance portal created by the Ministry of Health. In 2020, 532 ESRs (Graph 1) were reported to ASN in the medical field, fewer than in 2019 (617 ESRs). This drop in the total num- ber of reported events with respect to 2019 concerns all the activities. The Covid‑19 pandemic is very probably one of the factors explaining this, insofar as medical activity was reduced during this period. However, we cannot confirm this hypothesis until the health care activity data have been published. ASN emphasizes the importance of reporting significant radiation protection events in order to share experience feedback and improve radiation protection. Graphs 2, 3 and 4 illustrate the distribution of the number of ESRs in 2020 by activity category, how they have evolved since 2010, and the distribution of events by area of exposure (impact on the environment, exposure of the public, exposure of patients, exposure of medical workers), and by activity category concerned. The reported events originate mainly from Computed Tomography (31%), radiotherapy (23%) and nuclear medicine (25%) departments. Furthermore, the events chiefly concern exposure of patients (65%) and foetuses in pregnant women unaware of their pregnancy (24%). In the light of the events reported to ASN in 2020, the most significant findings from the radiation protection aspect are: ∙ for medical professionals: Fluoroscopy-Guided Interventional (FGI) practices (external exposure of operators, and their hands in particular) with cases where dose limits are exceeded, and nuclear medicine (contamination of workers, external exposure); ∙ for patients: ‒ radiotherapy, with overdoses linked in particular to target errors, wrong-side errors and fractionation errors; ‒ nuclear medicine, with radiopharmaceutical drug admin­ istration errors; ∙ for the public and the environment: nuclear medicine, with losses of sources, leaks from radioactive effluent pipes and containment structures. Detailed information per category is provided in sections 2 to 6. 1.2.6 The risks and the oversight priorities In order to establish its oversight priorities, ASN has classified the nuclear-based medical activities according to the risks for the patients, the personnel, the public and the environment. This classification takes particular account of the doses delivered or administered to the patients, the conditions of use of ionising radiation sources by the medical professionals, the possible impact on the environment, the significant events reported to ASN and the radiation protection situation in the institutions exercising these activities. On the basis of this classification (Table 1), ASN considers that its oversight must focus in priority on external-beam radiotherapy, brachytherapy, nuclear medicine and FGI practices. As from 2018, ASN began implementing a new inspection strategy in the medical field based on systematic verifications of the regulatory provisions concerning radiation protection of the workers, the patients and the public. These verifications concern a limited number of inspection points, combined with GRAPH 1 Trends in the number of annual ESR notifications from 2010 to 2020 0 130 260 390 520 650 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 257 435 531 553 564 534 497 559 592 617 532 ASN Report on the state of nuclear safety and radiation protection in France in 2020 209 07 – MEDICAL USES OF IONISING RADIATION 07