2.4 FLUOROSCOPY-GUIDED INTERVENTIONAL PRACTICES Fluoroscopy-Guided Interventional Practices (FGIPs) group all the imaging techniques using ionising radiation for the purpose of imaging, guidance or verification, for performing invasive medical or surgical procedures for diagnostic, preventive and/ or therapeutic purposes. These practices are constantly evolving, with continuing diversification of their indications. They can be carried out in imaging departments dedicated to interventional imaging or in the operating theatre. Fixed interventional radiology rooms have been designed and fitted out taking into account the utilisation of ionising radiation. This is not the case for all operating theatres, which are gradually being brought into compliance. On account of the exposure levels involved, as much for the patients as for the professionals who can be obliged to work close to the radiation sources, FGIPs and operating theatres in particular, due to a less well-developed radiation protection culture, are part of ASN’s national inspection priorities. 2.4.1 Description of the techniques The healthcare centres According to the codes of the common classification of medical procedures and the activity data reported by the healthcare centres to the Agency for Information on Hospital Care (AIHC), about 900 centres perform FGIPs involving risks (with regard to radiation protection) in one or more disciplines. The risk-prone FGIPs include cardiology (implanting a defibrillator, angioplasty, etc.), interventional neurology (embolization of arterioveinous malformation), vascular radiology (embolization of the coeliac artery), or uterine embolization. Graph 10 (see below) shows the breakdown of the number of centres by FGIP category for the centres having declared the FGIPs they practice(10). Based on available information, the most widely practised procedures in the centres are those performed on the digestive and visceral system, in urology, and on the musculoskeletal system (some 450 centres concerned). The equipment The equipment items used in FGIPs are either fixed C-arm devices installed in the interventional imaging departments in which vascular specialities (neuroradiology, cardiology, etc.) are 10. Form that the centres had to fill out with the information requested in paragraph I of article 12 of ASN resolution 2021-DC-0704 relative to the registration system in the medical field “For fluoroscopy-guided interventional practices having been notified to ASN, a description of the types of procedures performed in accordance with the list figuring in article 1 (of the resolution), and the references of the notification concerned, must be submitted within twelve months following entry into effect of this resolution (before 1 July 2022)”. carried out, or mobile C-arm radiology devices used chiefly in operating theatres in several surgical specialities such as vascular surgery, gastroenterology, orthopaedics and urology. The detectors present on the devices with C-arms are image intensifiers or flat panel detectors. These devices employ techniques that use fluoroscopy and dynamic radiography (called “photofluorography”, or “cineradiography”) intended to produce images with high spatial and temporal resolution. Practitioners can also use the subtraction method to obtain images, after injecting a contrast agent. The centres practising FGIPs are equipped with ever‑more efficient and sophisticated medical devices. “Hybrid” operating room facilities, which combine the characteristics of a conventional operating theatre with those of an interventional imaging room, are continuing to develop. These operating rooms contain fixed or mobile C-arm units and fixed or mobile scanners. This combination enables the surgeon to perform “mini-invasive” surgery with 2D and 3D imaging. Give that the delivered dose levels are higher than in other interventional procedures, practices must be optimised in order to reduce the exposure doses for both the patients and the operators, who often work in the immediate proximity of the patient. 2.4.2 Technical rules for the fitting out of medical rooms The rooms in which FGIPS are carried out, operating theatres and interventional imaging rooms, must be organised in accordance with the provisions of ASN resolution 2017-DC-0591 of 13 June 2017 laying down the technical design rules to be satisfied by rooms in which electrical devices emitting X-rays are used. The design rules for the rooms, set by the above resolution, aim to protect the workers by limiting their exposure to ionising radiation. The arrangements must make it possible for any member of personnel entering a room in which an electrical device emitting X-rays is present and used, to assess the risk in order to take appropriate radiation protection measures on entering or when inside the room. With regard to signalling systems, they are obligatory at the point of access to the operating rooms and inside the rooms when a device is present and to signal the emission of radiation. It is important to point out that many medical and non-medical staff members intervene in the GRAPH Breakdown of the number of centres by category of fluoroscopy-guided interventional practices in 2023 10 0 100 200 300 400 500 600 Neuro-endocavitary FGIP FGIP 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 ASN Report on the state of nuclear safety and radiation protection in France in 2023 229 • 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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