SUMMARY In nuclear medicine, the inspections in 2022, considered alongside those performed over the period 2018-2021, enabling all the departments to be covered, reveal that radiation protection is correctly taken into account in the vast majority of the departments, with improvements observed for those departments inspected in the past two years, in particular for radiation protection of patients. Improvements are nevertheless required in three recurrent areas: in effluent management in order to control discharges into the sewage networks, 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. Similarly, the organisation of medical physics was considered inadequate in 20% of the departments inspected in 2022, particularly with regard to the radiation protection risks associated with the therapeutic treatments, and constitutes an area for progress in a context where new RPD-based therapies are being deployed. The engagement of the nuclear medicine departments in the deployment of quality management systems is continuing and ASN notes progress in formalising the specific work tasks qualification for medical staff. Even if the adverse events reporting culture is present in most of the departments inspected in 2022, it must be further developed. The reported events again reveal that the drug administration process must be regularly evaluated in order to control it, particularly for therapeutic procedures, due to the potentially serious consequences of a drug administration error. 7. Form that the centres had to fill out with the information requested in paragraph I of article 12 of ASN resolution 2021-DC-0704 relative to the registration system in the medical field “For fluoroscopy-guided interventional practices having been notified to ASN, a description of the types of procedures performed in accordance with the list figuring in article 1 (of the resolution), and the references of the notification concerned, must be submitted within twelve months following entry into effect of this resolution (before 1 July 2022)”. 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. These practices are constantly evolving, with continuing diversification of their indications. They can be carried out in imaging departments dedicated to interventional imaging or in the operating theatre. Fixed interventional radiology rooms have been designed and fitted out taking into account the utilisation of ionising radiation. This is not the case for all operating theatres, which are gradually being brought into compliance. The surgeons and physicians from different disciplines who work in these departments do not always master the use of ionising radiation with increasingly sophisticated medical devices. FGIPs, especially when conducted in operating theatres, are part of ASN’s national inspection priorities, due firstly to a weaker radiation protection culture, and secondly to the exposure levels involved, as much for the patients as for the practitioners who can be required to work close to the radiation beams. 2.4.1 Description 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), about 900 centres perform FGIPs involving risks (with regard to radiation protection) in one or more disciplines. The riskprone FGIPs include cardiology (implanting a defibrillator, angioplasty, etc.), interventional neurology (embolization of arterioveinous malformation), vascular radiology (embolization of the coeliac artery), or uterine embolization. Graph 9 shows the breakdown of the number of centres by FGIP category for the centres having declared the FGIPs(7) they practice. Based on available information, the most widely practised procedures in the centres are those performed on the digestive and visceral system in urology, and on the musculoskeletal system (some 450 centres concerned). The equipment The equipment items used in FGIPs are either fixed C-arm devices 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 GRAPH Breakdown of ESRs in nuclear medicine in 2022 8 73% Patients 7% Public 14% Sources, waste, effluents 5% Workers 1% Others Significant events concerning the public (15 ESRs, i.e. <10% of the reported ESRs) All the events concerning the public except one result from 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 involving the public concerned the exposure of people who entered a building contaminated by former nuclear medicine activities (malicious act). Significant events concerning radioactive sources, waste and effluents (26 ESRs, i.e. 14% 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.). 226 ASN Report on the state of nuclear safety and radiation protection in France in 2022 • 07 • Medical uses of ionising radiation 07
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