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 satisfactory as regards the appointment of an RPE-O (92% of the inspected departments) and the implementation of radiological zoning in the facilities (86% of the inspected departments). These findings have been stable for the last four years. The majority of the shortcomings observed in 2022 are due to noncompliance with the Order of 18 December 2019 amended concerning the RPE-O training procedures which enabled RPE-Os holding a valid certificate issued between 1 July 2016 and 31 December 2019 to assert their right to a temporary certificate under Article 23 of the 2019 Order. The application had to be made before 1 January 2022 in order to keep the certificate issued pursuant to the Order of 6 December 2013. The lack of training of medical professionals in occupational radiation protection has been a recurrent finding in inspections over the last four years. The situation in 2022 is even less satisfactory, as much in the operating theatres as in the interventional imaging departments and for the medical personnel in particular. In effect, for the operating theatre, only 10% of the departments have trained all their medical personal and 24% have trained all their paramedical personnel; for interventional imaging departments these figures are 20% and 25% respectively. The departments inspected in 2022 reveal poorer compliance with the requirements concerning occupational radiation protection training compared with previous years. The deterioration in this situation is undoubtedly partly due to the difficulty in catching up the training backlogs stemming from the Covid-19 pandemic, and the workload of the RPE-Os who do not always have sufficient resources to fully accomplish their duties. 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 prevention measures to ensure personnel safety, such as positioning the equipment such that exposure levels are limited, putting in place or wearing collective and personal protective equipment respectively, wearing of dosimetry devices, etc. Coordinating prevention measures with outside contractors, including private practitioners, is also an areas for progress in interventional imaging departments and operating theatres alike. The percentage of inspected departments having formalised prevention measures with all their service providers through a prevention plan varies between 17 and 28% for the 2018‑2022 period. In 2022, only 17% of the inspected centres had formalised these measures, compared with 28% in 2021. Yet knowledge of the risks linked to ionising radiation and of the appropriate prevention measures for the situations encountered, particularly by private practitioners, is a prerequisite for ensuring one’s own radiation protection and that of other professionals. In 67% of the inspected departments, the operating theatre staff have dosimetric monitoring devices available in sufficient quantity and appropriate for their type of exposure risk. This figure has remained relatively stable over the last four years with an average of 70%. ASN notes that the situation in the interventional imaging departments is worse in 2022 than in 2021, with only 69% of the departments providing appropriate dosimetric monitoring devices in sufficient numbers, particularly for the extremities and the lens of the eye, compared with 80% in 2021. Moreover, the effective wearing of passive and active dosimeters remains an area for improvement in many centres, as it has been for several years now. ASN does however observe that the analysis of dosimetric results by the RPE-Os in order to identify and correct bad practices has been improving over the last four years; the percentage of departments analysing dosimetric results for the operating theatres has increased from de 58% in 2018 to 73% in 2022. Radiation protection technical verifications ASN notes that radiation protection technical verifications were carried out at the required frequency in 81% of the interventional imaging departments and 61% of the operating theatres in 2022. When nonconformities had been identified, they had been corrected or were in the course of being corrected on the date of inspection in 81% of the cases. These findings have been stable for the last four years. 2.4.3.2 Radiation protection of patients The inspection findings concerning the radiation protection of patients over the last four years do not reveal any distinct trends. Of the departments performing FGIPs inspected in 2022, 66% call upon a medical physicist and have a POPM describing the organisation for involving a medical physicist, whose duties and times of presence on site are defined according to the centre’s activities; the figure for 2021 was 68%. This figure has remained relatively stable over the 2018‑2022 period. Recourse to outside contractors for medical physics services continues to expand in private sector centres and public hospitals alike. The outsourcing of medical physics duties is largely delegated to special advisors who intervene on site as and when required. ASN points out that close collaboration between operators and the medical physicist and regular presence of the physicist in the departments lead to optimised use of the equipment, with the setting up of protocols adapted to the procedures, recording of delivered doses and evaluation with regard to the locally-defined dosimetric reference levels. GRAPH Breakdown of the number of centres by category of fluoroscopy-guided interventional practices in 2022 9 0 100 200 300 400 500 600 Neuro-endocavitary FGIP FGI on the spine FGIP in cardio-rhythmology FGIP in cardio-coronary FGIP in vascular system FGIP in digestive and visceral system FGIP in urological surgery FGIP on the musculoskeletal system Other FGIPs 228 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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