minimum technical rules of design, operation and maintenance to be satisfied by in vivo nuclear medicine facilities. This resolution details in particular the rules for the ventilation of nuclear medicine department premises and the rooms accommodating patients receiving, for example, treatment for thyroid cancer with iodine-131. Guide No. 32 detailing certain aspects of this resolution was published by ASN in May 2017 and was updated in February 2020. In addition, facilities equipped with a CT scanner coupled with a gamma-camera or a PET camera must comply with the provisions of ASN resolution 2017-DC-0591 of 13 June 2017 laying down the minimum technical design rules to be satisfied by premises in which electrical devices emitting X-rays are used. Management of waste and effluents from nuclear medicine departments The management of waste and effluents potentially contaminated by radionuclides must be described in a management plan which includes, more specifically, the conditions of monitoring of discharged effluents in accordance with Article R. 1333‑16 of the Public Health Code and ASN resolution 2008-DC-0095 of 29 January 2008. Premises must be dedicated to these activities, as must specific equipment for monitoring the conditions of effluent discharges (tank filling levels, leakage alarm systems, etc.). The compliance of the facilities for collecting the effluents and wastes produced by nuclear medicine departments must be verified regularly. Revision of this resolution began at the end of 2020 and will also lead to an update of ASN Technical Guide No. 18 of 26 January 2012. One of the 15 recommendations of the Working Group report “Discharging of effluents containing radionuclides from nuclear medicine units and research laboratories into the sewage network” published in June 2019 on asn.fr introduces the notion of setting “contractual” or “management” guidance levels, if applicable, in the discharge license mentioned in Article L. 1331-10 of the Public Health Code. These guidance levels, whose value would be specific to each centre, are management levels which, in the event of a drift in the measurement results, must trigger an investigation and, if necessary, corrections in the centre’s effluents collection and disposal system. ASN has asked IRSN to propose a measurement protocol and provide the centres with a method to use the results to define their own “local” guidance levels, which could figure in the discharge licenses between the centre producing these discharges and the sewage managers. The IRSN recommendations are expected in 2022. 2.3.3 The radiation protection situation in nuclear medicine The nuclear medicine facilities base in 2021 comprises 239 licensed nuclear medicine departments, of which 45 practice high-activity ITR requiring hospitalisation in an ITR room, 137 practice moderate-activity ITR on an out-patient basis, and 57 only carry out diagnostic examinations. To have a situation assessment for France as a whole, ASN conducted a survey with all the nuclear medicine departments in 2018. The results of this survey gave a total of about 1,537,000 annual procedures in France in 2017, including some 900,000 scintigraphy or SPECT procedures, 125,000 procedures using semiconductor camera detection and about 500,000 PET procedures. 134 nuclear medicine licenses were delivered during 2021, most of which concerned changes of cameras or license extensions to allow the use of new radionuclides. ASN inspections in nuclear medicine are scheduled applying a graded approach that takes into account the breakdown of the types of procedures performed in the departments, with risks that differ depending on whether they concern diagnostic or therapeutic procedures. In this context, the inspection frequency is five-yearly for departments that only perform diagnostic examinations, four-yearly for departments performing diagnostic examin– ations and out-patient therapeutic procedures (delivery of iodine with activities below 800 MBq, synoviortheses, etc.) and threeyearly for the departments performing complex therapies using iodine with delivered activities exceeding 800 MBq, lutetium- 177, yttrium-90 (with hospitalisation in a room that may or may not be radiation-proof). Consequently, about a quarter of the French nuclear medicine base is inspected each year, that is to say about 15 of the 45 departments performing complex therapies, 34 of the 137 departments performing diagnostic examinations and out-patient therapies, and 11 of the 57 departments only performing examinations for diagnostic purposes. GRAPH Conformity of the inspected facilities with regard to radiation protection of medical professionals in 2021 5 Radiation Protection Expert-Officer with valid certificate Dosimetric results analysed and any disparities explained Delimiting of restricted areas is consistent with the local environment dosimetry Coordination of prevention measures established with all outside contractors Radiation protection training received by all workers and dating back less than 3 years 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 218 ASN Report on the state of nuclear safety and radiation protection in France in 2021 07 – MEDICAL USES OF IONISING RADIATIONS
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