external exposure further to surface contaminations (at an automatic injector and a radiation-proof enclosure), an over– exposure of three workers who spent time in an area that should have been classified as restricted (room next to an RPD delivery air lock), an overexposure of workers during an intervention to cope with tank overflows and an unintentional exposure of workers and the public due to a delivery error. No exceeding of regulatory values was reported in 2021. Significant events concerning the public (18 ESRs, i.e. <10% of the reported ESRs) All the events concerning members of the public in nuclear medicine, with one exception, concerned the exposure of the foetus in women unaware of their pregnancy. The doses received had no consequences for the child to be born (source: ICRP, 2007). A Patient safety newsletter published in 2021 was devoted to this type of event (see point 2.7). The last ESR that concerned a member of the public was the exposure of a parent who, contrary to the procedure, remained in the examination room during X-ray emission of their child’s CT scan. Significant events concerning radioactive sources, waste and effluents (20 ESRs, i.e. 11% of the reported ESRs) These ESR are mostly related to source losses/discoveries, the dispersion of radionuclides (resulting from overflows of radioactive effluent tanks), deliveries that do not comply with the licenses and unauthorised discharges of effluents into the environment (emptying of tanks, etc.). SUMMARY The inspections conducted in nuclear medicine reveal that radiation protection is duly taken into account in the large majority of the departments. Nevertheless, improvements must be made in effluent management in order to control discharges into the sewage networks, and in formalising the coordination of prevention measures with outside contractors (for maintenance, upkeep of the premises, the intervention of private practitioners, etc.) and the training of professionals. ASN notes a significant investment on the part of the nuclear medicine departments in the deployment of quality management systems and underlines the good adverse events reporting culture in the majority of departments inspected in 2021. The reported events nevertheless underline the need to regularly assess the drug administration process in order to control it, particularly in therapeutic procedures due to the potentially serious consequences of a drug administration error. 2.4 Fluoroscopy-guided interventional practices Fluoroscopy-Guided Interventional Practices (FGIPs) group all the imaging techniques using ionising radiation to perform invasive medical or surgical procedures for diagnostic, preventive and/or therapeutic purposes, and surgical and medical procedures using ionising radiation for the purpose of guidance or verification. They can be carried out in imaging departments dedicated to interventional imaging or in the operating theatre. If the fixedfacilty interventional radiology rooms have been designed and fitted out taking into account the use of ionising radiation, this cannot be said for all operating theatres, which are gradually undergoing compliance work. Moreover, these practices are growing rapidly and being used for diversified indications, concerning more and more surgeons and physicians from different disciplines who, although they are not specialists in ionising radiation, are becoming the practitioners of procedures involving ionising radiation. Furthermore, the devices used are increasingly sophisticated. On account of the new exposures involved, as much for the patients as for the professionals, who can be obliged to work close to the radiation, the FGIPs and operating theatres in particular –due to a less developed radiation protection culture– form part of ASN’s national inspection priorities. 2.4.1 Presentation of the techniques The health care centres According to the codes of the common classification of medical procedures and the activity data reported by the health care centres to the Agency for Information on Hospital Care (AIHC), 905 centres perform FGIPs involving risks (with regard to radiation protection) in one or more disciplines. The risk-prone FGIPs include cardiology (implanting a defibrillator, angioplasty, etc.), interventional neurology (embolization of arterioveinous malformation), vascular radiology (embolization of the coeliac artery), or uterine embolization. The distribution of the number of centres by category of FGIP is shown in Graph 9. The equipment The equipment items used in FGIPs are either fixed C-arm de– vices installed in the interventional imaging departments in which vascular specialities (neuroradiology, cardiology, etc.) are carried out, or mobile C-arm radiology devices used chiefly in operating theatres in several surgical specialities such as vascular surgery, gastroenterology, orthopaedics and urology. GRAPH Breakdown of the number of centres by category of fluoroscopy-guided interventional practices in 2021 9 0 100 200 300 400 500 600 700 800 900 FGIP on the musculoskeletal system FGIP in urological surgery FGIP in gastroenterology FGIP in vascular surgery FGIP in coronary cardiology FGIP in cardiology rhythmology FGIP on the spine Intracranial FGIPs ASN Report on the state of nuclear safety and radiation protection in France in 2021 221 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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