dynamic in recent years, primarily in the field of oncology therapy with the emergence of new vectors and radionuclides. ITR treatments can be administered either by mouth (e.g. capsule of iodine-131) or by systemic route (intravenous injection or via a catheter). Some treatments –depending on the administered activity or the nature of the radionuclide used– require patients to be hospitalised for several days in specially fitted-out rooms in the nuclear medicine department to ensure the radiation protection of the personnel, of people visiting the patients and of the environment. The radiological protection of these rooms is adapted to the nature of the radiation emitted by the radionuclides, and the contaminated urine of the patients is collected in tanks. 45 nuclear medicine departments have a combined total of 164 ITR rooms for therapeutic purposes (see Graph 4). Medical dispensaries When a medical dispensary is authorised in a health care centre, the room in the nuclear medicine department in which RPDs are prepared, called the “nuclear pharmacy” or “radiopharmacy”, is part of the medical dispensary. In 2019, there were 128 nuclear pharmacies in the nuclear medicine departments in public health care institutions and non-profit private health care institutions, such as the cancer centres. The radiopharmacist is primarily responsible for managing the RPD circuit (procurement, possession, preparation, control, dispensing and traceability) and the quality of preparation. The equipment In addition to the cameras installed in the nuclear medicine departments, about 400 radiation-proof enclosures are installed in the departments to permit safe handling of unsealed sources. There are also nearly 110 automated or semi-automated de– vices for preparing RPDs marked with fluorine-18 and about 60 automated injection devices. 2.3.2 Technical rules applicable to nuclear medicine facilities The radiation protection constraints specific to nuclear medicine are linked to the use of radionuclides in unsealed sources. The departments are designed and organised for the reception, storage and handling of these unsealed radioactive sources with a view to their administration to patients or in the laboratory (in the case of radioimmunology). Provision is also made for the collection, storage and disposal of radioactive wastes and effluents produced in the facility, particularly the radionuclides contained in patients’ urine. Compliance with the technical design, operating and maintenance rules of nuclear medicine departments Nuclear medicine departments must satisfy the rules prescribed by ASN resolution 2014-DC-0463 of 23 October 2014 relative to the TABLE Main radionuclides used in diverse in vivo nuclear medicine explorations TYPE OF EXAMINATION RADIONUCLIDES USED Thyroidmetabolism Iodine-123, technetium-99m Myocardial perfusion Rubidium-82, technetium-99m, thallium-201 Lung perfusion Technetium-99m Lung ventilation Krypton-81m, technetium-99m Osteoarticular process Fluorine-18, technetium-99m Renal exploration Technetium-99m Oncology –search for metastases Fluorine-18, gallium-68, technetium-99m Neurology Fluorine-18, technetium-99m 3 GRAPH Breakdown by ASN regional division of the nuclear medicine facilities, the number of departments with out-patient therapies and departments with hospitalisation rooms dedicated to internal targeted radiotherapy in 2021 4 Strasbourg Division Paris Division Orléans Division Nantes Division Marseille Division Lyon Division Lille Division Division Dijon Châlons-enChampagne Division Caen Division Bordeaux Division 0 10 20 30 40 50 Facilities Departments with out-patient therapic procedures Departments with ITR rooms ASN Report on the state of nuclear safety and radiation protection in France in 2021 217 07 – MEDICAL USES OF IONISING RADIATIONS 08 07 13 04 10 06 12 14 03 09 05 11 02 AP 01
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