Five ESRs concern medical devices vigilance reports. For the ESRs concerning FGIP patients, most of the overexposures are due to long and complex procedures (in interventional neuroradiology and in cardiology). Two events relate to deficiencies in communication between maintenance operators and the interventional cardiology departments. In the first case, changes of setting carried out during the EQCs were not communicated to the physicist, even though they had a dosimetric impact; as the medical device concerned was not connected to a Dose Archiving and Communication System (DACS), the changes were only discovered when the EQC report was received. In the second case, poor coordination between the different medical teams involved and insufficient knowledge of the medical device functionalities caused the event, which occurred during a long, complex and rarely performed procedure. As for the ESRs concerning FGIP professionals, all of which occurred in the operating theatre, the reported overexposures result from accidental exposures without exceeding regulatory limits. Insufficient training of the professionals, some of whom did not regularly wear their dosimeter, and the absence of collective protective equipment were evidenced. All the ESRs concerning the public involved accidental exposure of the foetus of pregnant women unaware of their pregnancy, who underwent a therapeutic procedure in the pelvic region. Feedback specific to this type of event was provided in one of the Patient safety newsletters in 2021 (see point 2.7). SUMMARY In the area of FGIPS, ASN still observes lateness in bringing premises into conformity with the technical design rules, especially in the operating theatres, and points out that this f itting-out work is fundamental for the prevention of professional risks. Deviations from regulations are still noted frequently in inspections, as much in radiation protection of the professionals as of the patients, with unsatisfactory situations regarding training in the radiation protection of workers and patients, prevention measures during concomitant activities, particularly with private practitioners. Nonconformities associated with noncompliance with the radiation protection technical verification frequencies were observed in 2021, as the departments were unable to carry them out in 2020 due to the pandemic. Although the use of medical physicists and formalising of the POPMs appears to be gaining ground, progress must be made in the implementation of the optimisation procedure, particularly in the operating theatres where doses are still insufficiently analysed. The reporting culture, however, is spreading, with the putting in place of events recording systems. The reporting of ESRs underlines that the maintenance operations, which can have consequences on the delivered doses, must be correctly supervised and that the training or practitioners in the use of the medical devices is crucial for control of the doses. Extensive work to raise the awareness of all the medical, paramedical and administrative professionals in the centres is still necessary to give them a clearer perception of the risks, especially for operating theatre staff. The recommendations for improving radiation protection in the operating theatres, issued in 2020, are still applicable in this respect. 2.5 Medical and dental radiodiagnosis 2.5.1 Overview of the equipment Medical diagnostic radiology is based on the principle of differential attenuation of X-rays by the organs and tissues of the human body. The information is collected on digital media allowing computer processing of the resulting images, and their transfer and filing. Diagnostic X-ray imaging is one of the oldest medical applications of ionising radiation; it encompasses all the methods of morphological exploration of the human body using X-rays produced by electric generators. It occupies an important place in the field of medical imaging and comprises various techniques (con– ventional radiology, radiology associated with interventional practices, computed tomography, mammography) and a very wide variety of examinations (retroalveolar radiography, radiography of the thorax, chest-abdomen-pelvis CT scan, etc.). The request for a radiological examination by the physician must be part of a diagnostic strategy taking account of the patient’s known medical history, the question posed, the expected benefit for the patient, the examination exposure level and the dose history and the possibilities offered by other non-irradiating investigative techniques. A guide intended for general prac– titioners (Guide to good medical imaging examination practices) indicates the most appropriate examinations to request according to the clinical situations. If the dose delivered does not in itself represent a radiation protection health risk, it is the large number of examinations carried out among the population that contributes significantly to the collective dose of medical origin. 2.5.1.1 Medical radiodiagnosis Conventional radiology Conventional radiology (producing radiographic images, or radio– graphs), if considered by the number of procedures, represents the large majority of radiological examinations performed. The examinations mainly concern the bones, the thorax and the abdomen. Conventional radiology can be carried out in fixed facilities reserved for diagnostic radiology or, in certain cases, using portable devices if justified by the clinical situation of the patient. Angiography This technique, used for exploring blood vessels, involves in– jecting a radio-opaque contrast agent into the vessels which en– ables the arterial tree (arteriography) or venous tree (venography) to be visualised. Angiography techniques benefit from comput– erised image processing (such as digital subtraction angiography). Mammography Given the composition of the mammary gland and the fineness of detail required, screening for breast cancer necessitates the use of mammography units, specific radiology devices providing high-definition and high-contrast images. Two complementary imaging techniques are currently available, planar imaging (2D) and tomosynthesis imaging (3D). Only planar imaging, which function at low voltage and offers high definition and high contrast, is at present approved by the HAS for breast cancer screening. ASN participates in a working group coordinated by the HAS which is assessing the position of tomosynthesis mammography in the breast cancer screening strategy. ASN Report on the state of nuclear safety and radiation protection in France in 2021 225 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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