The ESRs concerning the professionals, all of which occurred in the operating theatre, result from accidental exposures without exceeding regulatory dose limits. The events analysis also reveals a lack of training of various employees required to work in operating theatres (hospital service employees, nursing auxiliaries, State-registered nurse anaesthetists, State-registered nurses). Lastly, events were reported concerning accidental exposures of the foetus of pregnant women unaware of their pregnancy, who underwent a therapeutic procedure in the pelvic region. A Patient safety newsletter published in 2021 addressed the lessons learned specifically from this type of event (see point 2.7). SUMMARY In the area of FGIPs, the inspections of 2022, considered alongside those performed over the period 2018-2021, allowing coverage of all the facilities considered to have radiation exposure risks, highlight the fact that radiation protection makes little progress from one year to the next, that the situation is always better in the interventional procedure rooms than in the operating theatres, and there are persistent weaknesses. Thus, in most facilities, the premises are slowly being brought into conformity to comply with the technical design rules, even though these modifications are essential in order to prevent the occupational risks. Even if the appointment of RPE-Os, the delimiting of restricted areas, the performance of technical verifications and quality controls of medical devices are considered satisfactory, deviations from the regulations are still frequently observed, in the radiation protection of the professionals and patients alike, with unsatisfactory situations concerning training in occupational and patient radiation protection and the coordination of prevention measures during concomitant activities, particularly with private practitioners. Although the use of medical physicists and formalising of the POPMs is gaining ground, further progress must be made in implementation of the optimisation procedure, particularly in the operating theatres where doses are still insufficiently analysed and findings of inappropriate or non-existent protocols subsist. The reporting culture, however, has been spreading in the past five years, with the deployment of events recording systems. The reporting of ESRs underlines that maintenance operations, which can have consequences on the delivered doses, must be correctly supervised and that the training of practitioners in the use of medical devices is crucial for control of the doses. Extensive work to raise the awareness of all the medical, paramedical and administrative staff in the centres is still necessary to give them a clearer perception of the risks, especially for operating theatre staff. 2.5 Medical and dental radiodiagnosis 2.5.1 Overview of the equipment Medical radiodiagnosis is based on the principle of differential attenuation of X-rays in 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 (conventional radiology, radiology associated with interventional practices, computed tomography, mammography) and a very wide variety of examinations (retroalveolar, radiography of the thorax, chestabdomen-pelvis computed tomography 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 practitioners (Guide to good medical imaging examination practices) indicates the most appropriate examinations to request according to the clinical situations. GRAPH Development of the compliance of FGIP facilities inspected on the theme of patient radiation protection in 2022 (operating theatres and interventional departments) 11 Organisation for monitoring the patient if an HAS threshold is exceeded 100% of medical personnel trained Patient doses recorded, analysed and optimised POPM describing an organisation that is appropriate for the risks 0% 20% 40% 60% 80% 100% 10% 30% 50% 70% 90% Blocs opératoires 2018 2019 2020 2021 2022 FGIP in operating theatre FGIP in interventional imaging 230 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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