2.3.3.3 Protection of the general public and the environment Compliance with the requirements concerning protection of the general public and the environment was checked in all the inspected centres. Thus, 87% of the departments have a dedicated and protected deliveries area that complies with the requirements of ASN resolution 2014-DC-0463 of 23 October 2014. In 88% of the departments the activity concentration of the effluents discharged after decay complies with the regulatory limits (10 becquerels per litre –Bq/L– for contaminated effluents after storage, or 100 Bq/L for effluents from the rooms of patients treated with iodine-131) (see Graph 7). In 10% of the cases, documentation tracking (registers) needs to be improved. The storage tank leak detectors in the retention trays are checked at the required frequency and the verifications are duly formalised in 83% of the departments. In 13% of the cases, the frequencies defined in the Effluents and Waste Management Plan (PGED) are not observed and verification traceability is poor. Only two inspected departments (3%) did not check the leak detectors. 2.3.3.4 Significant events reported in nuclear medicine Out of the 79 departments inspected, 74% have a system for recording adverse events. These latter departments analysed the events and reported them to ASN when necessary. However, 21% of the inspected departments had not reported their ESRs to ASN, primarily due to the personnel’s lack of awareness of events reporting. After a drop in the number of ESRs reported for two years in succession, a total of 186 ESRs were reported in 2021, a figure comparable with that of 2018. As in the preceding years, most of the reported events (>70%) concerned patients who had undergone a nuclear medicine procedure. The majority of the reported events have no expected clinical consequences, in view of the activities injected (see Graph 8). Significant events concerning patients (133 ESRs, or >70% of the reported ESRs) The large majority of the ESRs concerning nuclear medicine patients are due to an identity monitoring problem, that is to say the administration of an RPD to the wrong patient, and result from organisational and human malfunctions, usually in heavy workload situations. Although most of the departments have put in place events recording systems in application of ASN resolution 2019-DC-0660, the experience feedback procedures need to be improved in the large majority of the departments, particularly to further the analyses and to assess the robustness of the corrective actions. In addition to the identity monitoring problems, errors in the preparation of RPDs or in prescriptions, proportionally fewer in the latter case, are also reported. In 2021, five events that occurred during a therapeutic procedure were reported: one identity monitoring error resulting from confusion between two patients treated by iodine-131 capsule (one patient received a dose lower than the prescribed dose but consistent with their pathology), two targeting errors with yttrium-90 microspheres leading to exposure of organs at risk, one case of skin contamination with lutetium-177 at the seat of catheter insertion (failure to clean the point of injection) and one case of extravasation with no consequences. Significant events concerning nuclear medicine professionals (7 ESRs, i.e. <4% of the reported ESRs) Seven events concerning nuclear medicine professionals were reported in 2021. They result from external contaminations, GRAPH Breakdown (in %) of ESRs in 2021 8 71 Patients 10 Public 11 Sources, waste, effluents 4 Workers 4 Other GRAPH Conformity of the inspected facilities with regard to protection of the public and the environment in 2021 7 Source delivery room is secured, dedicated and kept closed Contamination checks performed at end of therapeutic procedures outside the department Regular verification of operation of tank alarms Compliance with regulatory values for effluent discharges 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 220 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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