ASN Report 2020

Significant events concerning patients (93 ESRs, i.e. 70% of the reported ESRs) The majority of the reported ESRs concerning nuclear medicine patients are linked to errors in the administration of an RPD (interchanging of syringes or patients), errors during preparation of the medication (interchanging of bottles), in the scheduling of the examinations, to unnecessary or double exposure of the patient to the CT scanner linked to the non-administration of an RPD or the wrong RPD. One reported event concerned a scintigraphy procedure carried out between two colleagues with no medical prescription whatsoever. Two events occurred during therapeutic procedures: adminis­ tration of an iodine-131 capsule of 550 MBq intended for another patient instead of the 370 MBq capsule prescribed, and administration of a lower dose of Lutathera® (about 1,800 MBq) than the prescribed dose (3,900 MBq) due to overflowing of the bottle caused by a system pressure problem (without causing any external contamination). Significant events concerning medical professionals (20 ESRs, i.e. 15% of the reported ESRs) Twenty events concerning medical professionals were reported in 2020. They resulted from external contaminations, external exposure to non-decayed or externally contaminated technetium-99m gen­ erators. No exceeding of regulatory values was reported in 2020. Significant events concerning the public (10 ESRs, i.e. 8% of the reported ESRs) All these events concerned exposure of the foetus in women unaware of their pregnancy. The doses received had no conse­ quences for the child (source: ICRP, 2007). Three of these events concerned women who received a justified iodine-131 treatment while they were taking a contraceptive and had undergone pregnancy checks that gave a negative result. Significant events concerning radioactive sources, waste and effluents (9 ESRs, i.e. 7% of the reported ESRs) The majority of these ESRs are linked to the discovery of radioactive sources and the unauthorised discharge of effluents into the environment (emptying of tanks, etc.). One noteworthy case involved the triggering of a waste disposal site radiation portal monitor by waste from a patient hospitalised in a centre other than that in which they underwent the nuclear medicine procedure. One centre reported the dispersion of effluents caused by a leak in the wastewater drainage pipe from the toilets of the ITR rooms, at the pipe manhole situated below the rooms, inside the centre. Work has been carried out to replace sections of the wastewater drainage network. SUMMARY The radiation protection of patients and professionals in the inspected nuclear medicine departments is satisfactory. Progress is nevertheless required in the optimisation of practices and the training of medical professionals in occupational radiation protection must be continued. In addition, the coordination of preventive measures during work by outside contractors (for equipment maintenance, cleaning of the premises, etc.) must be improved. One of the radiation protection challenges is also to ensure good management of the radioactive effluents. This is all the more important given that therapies administering high activities to patients are going to increase in number, leading to an increase in the discharged radioactivity. The reported events underline that the radiopharmaceutical drug administration process must be regularly assessed in order to control it, particularly in therapeutic procedures. Transport of radioactive substances: vigilance required from start to finish The police were alerted on 6 October 2020 by a resident of Châtillon (a municipality in the Hauts-de-Seine département ) who discovered two packages of radioactive substances on the public highway, one in front of a nursery school, the other a little further along the road. This discovery led to the setting up of a wide security perimeter, triggering of the “Vigipirate” anti-terrorist procedure and evacuation of the children from the nursery school. The Central Laboratory of the Paris Police Prefecture (LCPP) rapidly informed the ASN Paris division, which went to the scene and confirmed that the two packages contained no radioactivity. The two packages were of the “excepted” type classified under the UN number 2908 corresponding to empty packages having contained radiopharmaceutical products used by a nuclear medicine department for diagnostic examinations, and sent back by this department after use to the supplier of the products. This event was caused by negligence on the part of the carrier transporting these packages: the driver ended his round without delivering the two packages to the addressee as required by the regulations, leaving them in the vehicle which was broken into during the night, and the following morning he did not notice that the two packages were missing. Good coordination between the LCPP, the nuclear medicine department that dispatched the packages and ASN enabled the situation to be resolved rapidly. Nonetheless, the following deviations from the requirements of radioactive substance transport regulations were noted concerning this event: ཛྷ the marking of the two packages dispatched was noncompliant because they bore the “type A” caption required for packages containing a much larger quantity of radioactive substance, which led to the deployment of a security perimeter that was much wider than necessary around the two empty packages; ཛྷ the transport document had not been kept for the minimum period of three months required by the regulations; ཛྷ the carrier company had not ensured accurate traceability of the two dispatched packages. The radioactive substance transport regulations apply to excepted packages classified under UN number 2908, even though they no longer contain radioactive products. To prevent the occurrence of this type of event, the transport carriers must not neglect these rules. 228 ASN Report on the state of nuclear safety and radiation protection in France in 2020 07 – MEDICAL USES OF IONISING RADIATION