ASN Report 2020

The various stages in the verification of the examination requests (reception, prior analysis, validation, substitution, cancellation of the procedure) are formalised in writing by just 9 of the centres. The examination request, however, is validated in 17 of the 18 centres. The medical physics organisation concerning the CT scanner is described in a POPM by 15 centres, but the time allocated to medical physicists to accomplish their tasks was considered insufficient in 5 cases. An optimisation procedure is in place (optimised examination protocols, collection and analysis of Diagnostic Reference Levels, etc.), with the utilisation of a Dose Archiving and Communication System (DACS) in 14 of the inspected centres. The scanner quality controls are carried out at the required frequencies and any nonconformities are corrected. Radiation protection events are reported and analysed in 13 of the inspected centres. 6.4  Significant events reported in medical and dental radiodiagnosis 238 ESRs were reported in medical and dental radiodiagnosis: ∙ 73 in conventional radiology, of which 38 concerned women unaware of their pregnancy; ∙ 165 in computed tomography, of which 76 concerned women unaware of their pregnancy. The ESR primarily concern women unaware of their pregnancy (114), failings in the patient management process (identity monitoring error, protocols, etc.) and situations of inappropriate exposure of professionals (8). Checks by the medical staff for possible pregnancy in patients must be further increased. SUMMARY Diagnostic examinations using computed tomography contribute very substantially to the collective dose received by the public, as medical imaging is the leading source of artificial exposure of the public to ionising radiation. During its inspections, ASN observes a lack of traceability of justification of the examinations and of the difficulties medical professionals encounter in applying the principle. The lack of training of the referring practitioners, the lack of use of the guide to good medical imaging practices, and the lack of justification protocols for the most common procedures partly explain the fact that the justification principle is not always applied. Furthermore, the lack of availability of other diagnostic methods (MRI, ultrasonography) and of health professionals limits the replacement of irradiating procedures by nonirradiating procedures. In July 2018 ASN published a second plan of action for controlling ionising radiation doses delivered to persons during medical imaging. This plan aims to reinforce the justification of the procedures and the optimisation of the ionising radiation doses delivered to the patients. 7. Blood product irradiators 7.1  Description The irradiation of blood products is used to prevent post- transfusion reactions in blood-transfusion patients. The blood bag is irradiated with a dose of about 20 to 25 grays. Since 2009, source irradiators have been gradually replaced by X-ray generators, for which notification to ASN has been required since 2015. In 2019, the inventory stood at 29 irradiator devices equipped with X-ray generators. 7.2  Technical rules applicable to facilities A blood product irradiator must be installed in a dedicated room designed to provide physical protection (against fire, flooding, break-in, etc.). Access to the device, which must have a lockable control console, is limited to the persons authorised to use it. The fitting out of premises accommodating irradiators equipped with X-ray generators must comply with the provisions of ASN resolution 2017-DC-0591 of 13 June 2017. GRAPH 15 Breakdown, by ASN regional division, of the number of CT scanners and the number of licenses created or renewed in 2020 0 50 100 150 200 250 Strasbourg Division Paris Division Orléans Division Nantes Division Marseille Division Lyon Division Lille Division Dijon Division Châlons-en- Champagne Division Caen Division Bordeaux Division Devices Licensed centres Authorisations ASN Report on the state of nuclear safety and radiation protection in France in 2020 235 07 – MEDICAL USES OF IONISING RADIATION 07