In interventional imaging departments and in operating theatres The training of physicians in patient radiation protection is a recurrent weak point, with about 15% of the operating theatres having trained all the physicians. Although the medical personnel are better trained in the interventional radiology departments, ASN observes a deterioration in the situation since 2018. 24% of the departments inspected in 2022 have trained all the physicians compared with 37% in 2018. In the course of the last four years, 30% of the interventional departments on average have recorded, analysed and optimised the doses, whereas only 14% of the operating theatres have done so. The corresponding figures for 2022 are 24% for the interventional imaging departments and 15% for the operating theatres respectively. ASN makes the same finding of weakness in applying the procedures optimisation principle as concerns setting the machine parameters and optimising the protocols used. The staff training time is insufficient and the shortage of paramedical personnel, partly as a result of the Covid-19 crisis, does not facilitate the following of training courses; the time dedicated to training often comes on top of the effective working time. Nevertheless, 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. 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 optimisation of the dose delivered to the patient. For the first time, patient monitoring in the event of exceeding the skin exposure threshold defined by the HAS(8) is formalised to a greater extent in the operating theatres (90%) inspected in 2022 than in the interventional imaging departments (70%) which 8. Improving patient monitoring in interventional radiology and fluoroscopy-guided procedures – reducing the risk of deterministic effects of 21 May 2014. are more frequently concerned by procedures leading to such exposure levels. 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 reported in relation with fluoroscopy-guided interventional practices An events recording system is in place in more than 74% of the inspected sites performing FGIPs. In 2022, 25 significant events were reported in this area: ∙ 15 events concerned overexposure of patients, some having led to tissue effects (one case of radiodermatitis); ∙ 8 concerned exposure of medical professionals; ∙ 2 concerned pregnant women exposed during a fluoroscopyguided interventional examination; these women were unaware of their pregnancy at the time of exposure. Among these ESRs, four were linked to a medical device malfunction (malfunction of pedals or machine) and were reported as part of medical devices vigilance. Some of these events are linked to noncompliance with the obligatory quality controls of medical devices. The majority of patient exposures are due to long and complex procedures (in interventional neuroadiology and in cardiology) and for some patients to overexposures resulting from successive procedures with a very high accumulation of doses. Analysis of the events reveals a lack of protocol optimisation, inappropriate utilisation of the devices by the operators, the use of inappropriate protocols or the absence of protocols revealing deficiencies in operator training and the importance of implementing a specific work task qualification procedure. These weak spots constitute areas for improvement. GRAPH Development of the compliance of FGIP facilities inspected on the theme of medical staff radiation protection in 2022 (operating theatres and interventional departments) 10 0% 20% 40% 60% 80% 100% 10% 30% 50% 70% 90% RPE-O with valid certificate All the medical workers have received radiation protection training dating back less than 3 years All the paramedical workers have received radiation protection training dating back less than 3 years Delimiting of restricted areas is consistent with the local environment dosimetry Appropriate dosimeters available in sufficient quantity Dosimetric results analysed and any disparities explained Coordination of prevention measures established with all outside contractors FGIP in operating theatre FGIP in interventional imaging 2018 2019 2020 2021 2022 ASN Report on the state of nuclear safety and radiation protection in France in 2022 229 • 07 • Medical uses of ionising radiation 07 01 08 13 AP 04 10 06 12 14 03 09 05 11 02
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