ASN Report 2020

neuroradiology). One of them concerned overexposure linked to a medical device defect. One patient was exposed accidentally by the personnel, the fluoroscopy pedal being blocked in the X-ray emission “mode” under the medical device. The ESRs reported for medical professionals were due to acci­ dental overexposure. For three professionals, the regulatory limits at the extremities or for the whole body were exceeded. Two events occurred during the stowage of the device emitting ionising radiation (device powered on) or the bio-cleaning. SUMMARY In the area of FGI practices, ASN observes that, as in the preceding years, the level of radiation protection of patients and professionals – particularly for surgical procedures performed in operating theatres – is still insuff icient. This is why new recommendations to improve radiation protection in the operating theatres were issued in 2020. Deviations from the regulations are still noted frequently during inspections, in the radiation protection of patients and professionals alike, and events are still reported to ASN concerning interventional practitioners having exceeded dose limits. The radiation protection situation is however significantly 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. Extensive work to raise the awareness of all the medical, paramedical and administrative professionals in the centres is still necessary to give them a clearer perception of the risks, especially for operating theatre staff. Continuous training of medical professionals, especially practitioners, and the involvement of the medical physicist to optimise the radiation protection aspects of intervention protocols, are two key focuses for controlling the doses delivered to patients during interventional procedures. 6. Medical and dental radiodiagnosis 6.1  Overview of the equipment Medical diagnostic radiology is based on the principle of differential attenuation of X-rays by the organs and tissues of the human body. The information is collected on digital media allowing computer processing of the resulting images, and their transfer and filing. Diagnostic X-ray imaging is one of the oldest medical applications of ionising radiation; it encompasses all the methods of mor- phological exploration of the human body using X-rays produced by electric generators. It occupies an important place in the field of medical imaging and comprises various techniques (conventional radiology, radiology associated with interventional practices, computed tomography, mammography) and a very wide variety of examinations (radiography of the thorax, chest- abdomen-pelvis CT scanner, etc.). The request for a radiological examination by the physician must be part of a diagnostic strategy taking account of the patient’s known medical history, the question posed, the expected bene­ fit for the patient, the examination exposure level and the dose history and the possibilities offered by other non-irradiating investigative techniques. A guide intended for general practi­ tioners ( Guide to good medical imaging examination practices ) indicates the most appropriate examinations to request according to the clinical situations. 6.1.1 Medical radiodiagnosis Conventional radiology Conventional radiology (producing radiographic images, or radio­ graphs), if considered by the number of procedures, represents the large majority of radiological examinations performed. The examinations mainly concern the bones, the thorax and the abdomen. Conventional radiology can be carried out in fixed Fluoroscopy-Guided Interventional practices in the operating theatre: the recommendations of the Advisory Committee for Radiation Protection in Medical and Forensic Applications of Ionising Radiation Fluoroscopy-Guided Interventional (FGI) practices in the operating theatres are in full expansion, in both the diversity of the procedures and the number of specialist areas concerned and the medical devices used. If radiation protection in FGI procedures performed on fixed X-ray equipment has significantly improved in the last decade, ASN inspections highlight shortcomings in procedures performed in the operating theatre. The radiation exposure risks for each patient are usually low. On the other hand, occupational exposure risks are increasing due to the large number of procedures carried out. The risks are primarily linked to a poor culture in the basic rules of radiation protection. Significant progress remains to be made in the context of surgical procedures. In 2020, ASN published a report setting out recommendations with a view to improving radiation protection during FGI procedures in operating theatres. This report proposes 20 recommendations focusing on four areas: ཛྷ quality and risk management; ཛྷ the responsibilities of each player; ཛྷ radiation protection training; ཛྷ the radiation protection tools to develop. On the basis of these recommendations, a circular letter dated 29 July 2020 was sent to all the health care institutions. 232 ASN Report on the state of nuclear safety and radiation protection in France in 2020 07 – MEDICAL USES OF IONISING RADIATION