2.6 Blood product irradiators 2.6.1 Presentation of the techniques The irradiation of blood products is used to prevent posttransfusion reactions in blood-transfusion patients. The blood bag is irradiated with a dose of about 20 to 25 grays. Since 2009, source irradiators have been gradually replaced by X-ray generators, for which notification to ASN has been required since 2015. In 2019, the inventory stood at 29 irradiator devices equipped with X-ray generators. 2.6.2 Technical rules applicable to facilities A blood product irradiator must be installed in a dedicated room designed to provide physical protection (against fire, flooding, break-in, etc.). Access to the device, which must have a lockable control console, is limited to the persons authorised to use it. The fitting out of premises accommodating irradiators equipped with X-ray generators must comply with the provisions of ASN resolution 2017-DC-0591 of 13 June 2017. 2.7 Significant radiation protection events The number of ESRs reported to ASN in 2021 (642) has increased compared with the preceding years, and especially with respect to 2020 (a low year with 532 ESRs for all the activities combined, with the Covid-19 pandemic very probably being one of the explanatory factors). ASN reiterates the importance of reporting ESRs in order to define shared experience feedback and improve radiation protection. Graphs 12 and 13 illustrate how the number of ESRs has evolved by activity category since 2011. Graphs 14 and 15 illustrate the breakdown of the number of ESRs in 2021 by area of exposure (environmental impact, exposure of the general public, exposure of patients, exposure of professionals) and by category of activity. In view of the events reported to ASN in 2021, the most significant findings concerning patient radiation protection are, in radiotherapy, wrong-side errors, identity monitoring errors and calibration errors (four ESRs rated level 2 on the ASN-SFRO scale, see box); in brachytherapy, the unidentified disconnection of an applicator source transfer tube (one ESR rated level 3 on the ASN‑SFRO during an HDR brachytherapy treatment, see box); in diagnostic nuclear medicine, identification errors, that is to say administration of an RPD to the wrong patient as a result of organisational and human malfunctions, usually in the context of heavy workloads ; in therapeutic nuclear medicine, one identity monitoring error with no consequences (underdosing) and two leaks of yttrium-90 microspheres towards areas that should not have been exposed. Lastly, most of the ESRs concerning FGIP patients are due to long and complex procedures (in interventional neuroradiology and cardiology). Two other events having led to overexposures relate to deficiencies in communication be– tween maintenance operators and the interventional cardiology departments. Pregnant women unaware of their pregnancy represent one third of the ESRs reported annually to ASN, i.e. about 200 cases per year. In order to share feedback on these situations, a Patient safety newsletter published in 2021 was devoted to this subject –which essentially concerns diagnostic examinations– in order to increase the vigilance of the medical teams and raise awareness in women of reproductive age to limit the occurrence of such exposures. PATIENT SAFETY NEWSLETTER “IONISING RADIATION: LIMITING EXPOSURES OF WOMEN UNAWARE OF THEIR PREGNANCY” The exposure to ionising radiation of pregnant women who were unaware of their pregnancy is the main cause of ESRs reported to ASN in computed tomography and conventional radiology. This represents nearly 200 cases per year, or one third of the 600 ESRs reported annually to ASN. With nearly one million pregnancies per year in France (total number of pregnancies, including births and pregnancy terminations), the issue concerns all health professionals, whether referring patients or performing diagnostic or therapeutic procedures, because they are all liable to treat female patients of reproductive age. The Multidisciplinary Working Group, through this newsletter, calls for the teams to step up their vigilance to avoid delivering doses to the embryo or foetus. If a woman is known to be pregnant, only the radiological examinations necessary for her health are to be carried out. All the professionals (secretary, radiologist, physicist, general practitioner, mid-wife, radiologist or other specialist) must share the same concern to raise patient awareness and to investigate possible pregnancies. 1 • LA SÉCURITÉ DU PATIENT • Rayonnements ionisants : limiter les expositions des femmes ignorant leur grossesse POUR UNE DYNAMIQUE DE PROGRÈS LA SÉCURITÉ DU PATIENT # RAYONNEMENTS IONISANTS : LIMITER LES EXPOSITIONS DES FEMMES IGNORANT LEUR GROSSESSE Bulletin à l’attention des demandeurs et réalisateurs d’actes médicaux utilisant les rayonnements ionisants Conseil National professionnel de radiologie et imagerie médicale (G4) AUTORITÉ DE SÛRETÉ NUCLÉAIRE Septembre 2021 ASN Report on the state of nuclear safety and radiation protection in France in 2021 229 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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