Radiation protection technical verifications The external radiation protection technical verifications of were carried out at the required frequency in only 40% of the interventional imaging departments and 40% of the operating theatres, very much less than in 2020, when the figures for these radiation protection verifications were 79% and 69% respectively. When nonconformities had been identified, they had been corrected or were in the course of being corrected on the date of inspection in 53% of the cases. On account of the pandemic, a large number of departments were unable to perform the regulatory verifications in 2020, creating a backlog which explains the noncompliance with the verification frequency in 2021. 2.4.3.2 Radiation protection of patients The findings from the inspections of 2021 reveal better integration of patient radiation protection (see Graph 11). ASN thus observe that 73% of the departments performing FGIPs, compared with 60% in 2020, call upon a medical physicist and have a POPM describing the organisation in place for the involvement of a medical physicist, and defining their duties and times of presence on site according to the centre’s activities. In effect, close collaboration between operators and the medical physicist, with regular presence of the physicist in the departments, would allow better use of the equipment with the setting up of protocols adapted to the procedures performed, recording of the delivered doses and evaluation in the light of locally defined dosimetric reference levels. When medical centres use outside contractors for medical physics services, it is found that the optimisation approach is less well embraced. These findings have been noted in particular in the operating theatres, where the optimisation approach is rarely put in place, a situation that must be remedied. In interventional imaging departments and in operating theatres The observed shortcomings concern firstly the training of medical professionals in patient radiation protection (all the personnel are up to date in their training in 23% of the interventional imaging departments and 13% of operating theatres), and secondly, 5. Improving patient monitoring in interventional radiology and fluoroscopy-guided procedures– reducing the risk of deterministic effects of 21 May 2014. application of the principle of procedure optimisation in the setting of device parameters and the protocols used. ASN observes that the recording, analysis and optimisation of doses are more widely deployed in the interventional imaging departments (59%) than in the operating theatres (36%). Likewise, patient monitoring in the event of exceeding the skin exposure threshold defined by the HAS(5), is formalised more often in interventional imaging departments (64%), which are more concerned by procedures leading to such levels of exposure, than in operating theatres (36%). Reference levels for the most common examinations are being developed locally more and more often. This approach makes it possible, among other things, to set alert levels for triggering appropriate medical monitoring of the patient according to the dose levels delivered to the patient. The patient dose archiving and analysis systems currently being deployed facilitate the development of local reference levels and alert levels per machine and per type of procedure. These systems are an asset for tracking the doses previously received by the patient and for patient monitoring, and they contribute to the principle of optimisation of the dose delivered to the patient. The External (third-party) Quality Controls (EQC) of the medical devices are generally carried out at the right frequency and on the day of the inspection any previously detected nonconformities had been or were being corrected, equally well in the operating theatres as in the interventional imaging departments. 2.4.3.3 Significant events relating to fluoroscopy-guided interventional practices An events recording system is in place for FGIPs in more than 76% of the sites inspected. 22 significant events were reported in this area in 2021 (14 of which concern the operating theatre): ∙ 10 events concerned overexposure of patients, some having led to tissue effects (one case of radiodermatitis); ∙ 9 concerned exposure of medical professionals; ∙ 3 concerned pregnant women exposed during a fluoroscopyguided interventional examination; these women were unaware of their pregnancy at the time of exposure. GRAPH Percentage conformity of the FGIP facilities inspected on the theme of radiation protection of patients in 2021 11 The POPM describes an appropriate organisation for the risks Patient doses recorded, analysed and optimised 100% of medical personnel trained Organisation for monitoring the patient if an HAS threshold is exceeded 0% 20% 40% 60% 80% 100% FGIP in operating theatre FGIP in interventional imaging 224 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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