ASN Report 2020

However, the lack of training of the medical professionals in occupational radiation protection, especially practitioners working in operating theatres, is a recurrent inspection finding. Refresher training for all the personnel is provided in just one quarter of the departments inspected. The occupational radiation protection training of the medical and paramedical professionals who use machines with fixed C-arms in dedicated rooms also remains low, even if they are on the whole better trained. Although collective radiation protection equipment is available for the interventional imaging departments, it is still too rarely present in the operating theatres. The coordination of prevention measures with the outside contractors working in the interventional imaging departments and in the operating theatres was clearly inadequate in 2019, with only 26% of the centres having formalised these coordination measures in a prevention plan signed with all the outside contractors. This situation is even less satisfactory in 2020, with only 20% of the inspected centres having formalised their prevention plan with all the outside contractors. More specifically in the operating theatres In 76% of the inspected sites the operating theatre professionals have dosimetric monitoring devices that are appropriate for worker exposure and in sufficient quantity. Although this is still insufficient, ASN notes results that are slightly up on 2019. The lack of appropriate dosimetric monitoring for certain fluoroscopy-guided procedures, particularly at the extremities, and the absence of medical monitoring of the practitioners, make it difficult to assess the radiation protection situation of these professionals in the operating theatres. There are still organisational difficulties for the RPE-Os, who do not always have sufficient means to perform their duties in full. Furthermore, the time allocated to their duties is not always appropriate, particularly in some centres which rely on the RPE-O to ensure patient radiation protection. ASN notes that the RPE-Os analyse the dosimetric results in order to detect incorrect practices and remedy them. In operating theatres in the private sector, dosimetric monitoring, medical monitoring and, where applicable, employee monitoring, represent a recurrent difficulty. Radiation protection technical verifications Radiation protection external technical verifications were carried out in 79% of the interventional imaging departments and about 69% of the operating theatres. When nonconformities were identified, they were already corrected or were being corrected in 72% of the cases when the inspection was carried out, a result that up on 2019 (66%). There is nevertheless still room for progress in meeting the required verification frequencies. 5.3.2 Radiation protection of patients The findings established on completion of the inspections in 2020 with regard to patient radiation protection confirm the observations made over the last few years (see Graph 14). ASN thus still observes that little use is made of medical physicists in the departments practicing Fluoroscopy-Guided Interventional procedures, and that the POPMs contain very few details concerning the organisation of medical physics for radio-guided interventional practices (the duties and times of presence of the medical physicist according to the activities are not specified). This slows down implementation of the optimisation principle. Close collaboration between the operator and medical physicist and the regular presence of the latter would allow, among other 8. Improving patient monitoring in interventional radiology and fluoroscopy-guided procedures – reducing the risk of deterministic effects of 21 May 2014. things, the equipment to be better used, with the application of protocols adapted to the procedures performed, recording of the delivered doses and the evaluation in the light of dosimetric reference levels to be defined locally. When medical centres use outside contractors proposing medical physics services, it is observed that few centres embrace the optimisation approach. These findings have been noted in particular in the operating theatres, where the optimisation approach is rarely put in place, a situation that must be remedied. In interventional imaging departments and in operating theatres The observed shortcomings concern firstly the training of medical professionals in patient radiation protection (all the personnel are up to date in their training in 28% of the interventional imaging departments and 9% of operating theatres), and secondly, application of the principle of procedure optimisation, as much in the setting of device parameters and the protocols used as in the practices. ASN notes that the doses are recorded, analysed and optimised in 33% of the operating theatres and 62% of the interventional imaging departments inspected. Patient monitoring in cases where the exposure threshold for the skin is exceeded, defined by the HAS (8) is not very satisfactory, particularly in operating theatres (65% for operating theatres and 84% for interventional imaging departments). Reference levels for the most common examinations are being developed locally more and more often. This approach makes it possible, among other things, to set alert levels for triggering appropriate medical monitoring of the patient according to the dose levels delivered to the patient. The patient dose archiving and analysis systems currently being deployed facilitate the development of local reference levels and alert levels per machine and per type of procedure. These systems are an asset for determining the doses previously received by the patient and for monitoring the patient. The third-party quality controls of the medical devices are generally carried out at the right frequency and on the day of the inspection any previously detected nonconformities had been or were being corrected, equally well in the operating theatres as in the interventional imaging departments. More specifically in the operating theatres The medical personnel in the operating theatre has insufficient knowledge of the reference dose levels for the types of procedure performed. The theatre C-arms, due to their mobility, are more rarely connected to the centre’s archiving systems than the fixed C-arms of the interventional imaging departments. 5.3.3 Significant events relating to Fluoroscopy-Guided Interventional practices An events recording system is in place in more than 76% of the sites inspected. 28 significant events were reported in this area in 2020, of which 4 also formed the subject of a medical devices vigilance notification: ∙ 10 concerned overexposure of patients, some of which led to deterministic effects such as transient hair loss (alopecia – three cases) or radiodermatitis (1 case); ∙ 15 concerned exposure of medical professionals; ∙ 3 concerned pregnant women exposed during a FGI examin­ ation; these women were unaware of their pregnancy at the time of exposure. For the ESRs concerning patients, most of the overexposures are due to long and complex procedures (in cardiology and 230 ASN Report on the state of nuclear safety and radiation protection in France in 2020 07 – MEDICAL USES OF IONISING RADIATION