2.5.4 Significant events reported in medical and dental radiodiagnosis In 2022, 288 ESRs were reported in medical and dental radiodiagnosis: ∙ 66 in conventional radiology, of which 25 concerned women unaware of their pregnancy; ∙ 219 in computed tomography, of which 94 concerned women unaware of their pregnancy; ∙ 3 in dental radiology (of which 1 concerned a women unaware of her pregnancy). The ESRs primarily concern women unaware of their pregnancy (120), failings in the patient management process (identity monitoring error, protocol errors, etc.) and situations of inappropriate exposure of professionals (20). The steps taken by medical staff to check for possible pregnancy in patients must be further increased. A specific Patient safety newsletter was published in September 2021 to improve the organisational measures to reduce the number of events of this type (see point 2.7). SUMMARY ASN oversight in computed tomography mainly concerns checking implementation of the requirements of ASN resolution 2019-DC-660 of 15 January 2019 more specifically regarding formalising of the justification principle in order to avoid delivering unnecessary doses to patients, along with the specific work tasks qualification for medical staff. During its inspections in 2022, ASN again observed contrasting deployment of the quality assurance system concerning the traceability of examination justification in the centres, with practices that are satisfactory in some units and far less so in others. Progress is also required in formalising the specific work tasks qualification for medical staff. 2.6 Blood product irradiators 2.6.1 Description 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, which have been subject to notification to ASN 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 in the medical field reported to ASN in 2022 (619) is similar the numbers for the last five years, with the exception of 2020, when fewer events were reported to ASN, probably on account of the Covid-19 pandemic. ASN underlines the importance of reporting ESRs in order to share ILS’s 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 2022 by area of exposure (environmental impact, exposure of the general public, exposure of patients, exposure of professionals) and by category of activity. In the light of the events reported to ASN in 2022, the most significant findings from the patient radiation protection aspect occurred in radiotherapy (see point 2.1.3.3) and brachytherapy (see point 2.2.3.5) and reveal that lessons learned from past ESRs have been forgotten. ASN Report on the state of nuclear safety and radiation protection in France in 2022 233 • 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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