In the same way as for external-beam radiotherapy, the safety of brachytherapy treatments has been a priority area of ASN oversight since 2007, because of the intensity of the doses delivered and, where applicable, the high dose rates. As brachytherapy is carried out within the radiotherapy departments, the inspection programme for the 2020‑2023 period is identical to that for external-beam radiotherapy, with a four-yearly frequency and checks similar to those applied in external-beam radiotherapy (see point 2.1.3.2). On account of the use of high activity sources, specific checks focus on medical staff training, such as knowledge of the action to take in the event of an emergency (source jamming), and the security of these sources (organisation in place for source management, appropriate measures to prevent unauthorised access to the sources, source inventory, protection against malicious acts and management of sensitive information). In 2023, 13 inspections were carried out on the theme of radiation protection, representing about a quarter of the licensed departments. 2.2.3.1 Management of sources The management of brachytherapy sources is deemed satisfactory. Thus, all the centres inspected in 2023 record the tracking of source movements, transmit the source inventory to IRSN and store the sources waiting to be loaded or collected in a suitable place. The organisational set-ups enable the category of each source or batch of sources to be identified in virtually all the centres inspected. Although 71% of the centres inspected have put in place appropriate measures to prevent unauthorised access to these sources, in 2023 only half of them have issued their personnel with the authorisations necessary for access to highactivity sealed sources, which is less than the proportion observed in 2022 (75%). ASN observes that deployment of the new requirements concerning safeguarding access to high-activity sources continues to progress, but some departments are having difficulties due to the configuration of the premises or the places in which the category C sources are stored pending recovery or loading, and the cost of the ensuing compliance work. 2.2.3.2 Emergency situations and management of malfunctions The malfunctions of brachytherapy devices which can result in jams or incorrect positioning of the source can lead to overexposure of staff or patients, sometimes with serious consequences (radiation necrosis). Consequently, this type of event underlines the need to comply with the technical requirements concerning the use of these devices, and the obligations to provide training in emergency situation management and to conduct exercises. 2.2.3.3 Radiation protection of medical professionals The occupational radiation protection measures deployed in 2023 by the brachytherapy departments were considered satisfactory in only half the departments. Of the 13 centres possessing highactivity sources inspected in 2023, only 46% have put in place enhanced training in emergency situations and have organised situational exercises, particularly for managing situations linked to source jamming. ASN considers that measures must be taken to enhance the radiation protection training of the medical professionals when high-activity sources are possessed, and to take source jamming situations into account in the individual assessments of exposure of medical professionals to ionising radiation. 2.2.3.4 Radiation protection of patients As with external-beam radiotherapy, the radiation protection of brachytherapy patients is assessed from the inspections concerning the implementation of the treatment quality and safety management system and the medical physics organisation. ASN notes that the requirements concerning the medical physics organisation and the presence of a medical physicist during the treatments are satisfied in all the inspected centres. 2.2.3.5 The treatment quality and safety management system The qualitative result of the inspections carried out in 2023 has shown that the majority of brachytherapy departments inspected have deployed a QMS, with the support of the external-beam radiotherapy departments (see Graph 4 below). GRAPH Percentage conformity of brachytherapy facilities in the management of events in 2023 4 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2023 2022 2021 2020 2019 Reporting culture and organisation A HDR validation procedures exists and is tracked Analysis, defining corrective actions, building on lessons learned Assessing corrective action effectiveness ASN Report on the state of nuclear safety and radiation protection in France in 2023 221 • 07 • Medical uses of ionising radiation 07 05 15 08 11 04 14 06 13 AP 03 10 02 09 12 01
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