Ever more efficient and sophisticated techniques are developing in environments with little experience of the radiological risk. In this context, it is essential to optimises the doses, as much for the patients as for the personnel. This is why ASN’s inspections focus in particular on the rules for the fitting out of premises, the delimiting and signalling of restricted areas, dosimetric (extremities, lens of the eye) and medical monitoring of the personnel, the provision of personal protective equipment. Concerning patients, particular attention is paid to the optimisation of doses delivered to the patient (putting in place DRLs and dose analysis), personnel training in patient radiation protection and the use of the medical devices. As FGIPs are numerous, varied, and performed in many different departments (neuroradiology, interventional cardiology, interventional radiology and operating theatres) within a given centre, the inspection programme is established so that all the departments performing radiation-risk procedures are inspected every 5 years. Inspection prioritisation is based on the number of procedures performed within a centre, the nature of these procedures, on which depend the radiation protection risks for the patients and professionals, the state of the facilities (conformity with the facility fitting-out rules), the radiation protection culture of the teams and current situation factors (ESRs, vulnerabilities identified in the previously inspected centres). Some 200 inspections are carried out each year. In 2021, the operating theatre complexes of the university hospital centres and the largest hospital centres, and the departments licensed by the ARS (licensed for treatments in cardiac rhythmology, interventional cardiology and neuroradiology) were prioritised. Two hundred and ten centres were thus inspected, representing a total of 260 departments performing FGIPs. 55% of the inspections in 2021 were carried out in operating theatre departments. To adapt to the departments’ organisational constraints on account of the Covid‑19 pandemic, ASN inspected 17 centres entirely remotely and 38 in a mixed format with a remote inspection followed by a short on-site visit. Characteristics of the inspected departments The breakdown of the 260 departments having undergone an inspection in 2021 is as follows: ∙ The 117 interventional imaging departments inspected com– prise 40 coronary angiography departments, 34 cardiac rhythmology departments, 34 interventional vascular and osteoarticular radiology departments and, lastly, 9 neuroradiology departments. 77 had at least one fixed C-arm, 12 had mobile C-arms, 9 had fixed CT scanners and 1 had a mobile CT scanner. ∙ Among the 143 operating theatre departments inspected in 2021, 123 had at least one mobile C-arm, 7 had fixed C-arms, 2 had a mobile CT scanner and 1 a fixed CT scanner. Sixty-eighty per cent of the interventional imaging departments inspected have fixed C-arms, whereas in the operating theatres the physicians mainly use mobile C-arms (86%) to guide their surgical procedures. Slightly over 50% of the departments inspected in 2021 have rooms that meet the requirements of ASN resolution 2017-DC-0591 of 13 June 2017 laying down the technical fitting-out rules and have established a conformity report. The situation is progressing in pace with the renovations or fitting-out of new rooms. Conducting compliance work in the oldest operating theatre rooms still poses problems, notably regarding the technical solutions for meeting the lighted signalling requirements in restricted areas. The conformity of interventional radiology departments is better than that of operating theatres (73 versus 53 respectively), and is mainly attributable to the more stringent technical constraints for the latter, with more complex work environments. 2.4.3.1 Radiation protection of medical professionals In interventional imaging departments and in operating theatres The radiation protection of the professionals is deemed highly satisfactory as regards the appointment of an RPE-O (about 97% of the inspected departments) and the implementation of radiological zoning in the facilities (85% of the inspected departments). For the remaining 3%, there is either no internal RPE-O or the external RPE-O is not present during the FGIPs as required by ASN resolution 2009-DC-0147 of 16 July 2009 (see Graph 10). The lack of training of the medical professionals in occupational radiation protection is a recurrent finding in inspections, as much for the operating theatres as for the interventional imaging departments. Thus, for the operating theatre departments, only 13% of them have 100% of their medical personnel duly trained, and 24% of them have 100% of their paramedical personnel trained; the figures for the interventional imaging departments are 17% and 36% respectively. If we take 85% of the personnel trained as the indicator, the percentage of departments having trained their medical and paramedical personnel is respectively 24% and 32% for the operating theatres and 32% and 53% for the imaging departments. These figures are lower than those for 2020, very probably due to the health context, which led to the postponement of training courses and the noncompliance with the regulatory training frequencies noted in 2021. Yet this training is essential to get a full grasp of the radiation protection risks and identify the risk situations, in order to be capable of implementing the prevention measure to ensure personnel safety, such as positioning of the equipment limiting exposures levels, the putting in place or wearing of collective and personal protective equipment respectively, the wearing of dosimetry devices, etc. Lastly, the coordination of prevention measures with the outside contractors working in the interventional imaging departments and in the operating theatres is better in 2021, with 31% of the centres having formalised these coordination measures in a prevention plan signed with all the outside contractors, compared with 20% in 2020 for the centres that were inspected. This coordination is particularly insufficient in the case of private practitioners in the centres where they exercise their activity. Spotlight on the operating theatres In 71% of the inspected sites, the operating theatre professionals have dosimetric monitoring devices that are appropriate for worker exposure and in sufficient quantity, a less satisfactory situation than in 2020 (76% of the inspected sites). The lack of appropriate dosimetric monitoring for certain fluoroscopy-guided procedures, particularly at the extremities, and the absence of medical monitoring of the practitioners, make it difficult to assess the radiation protection situation of these professionals in the operating theatres. There are still organisational difficulties for the RPE-Os, who do not always have sufficient means to perform their duties in full. Furthermore, the time allocated to their duties is not always appropriate, particularly in some centres which rely on the RPE-O to ensure patient radiation protection. ASN notes that the RPE-Os analyse the dosimetric results in order to detect incorrect practices and remedy them. In operating theatres in the private sector, dosimetric monitoring, medical monitoring and, where applicable, employee monitoring, represent a recurrent difficulty. ASN Report on the state of nuclear safety and radiation protection in France in 2021 223 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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