these training sessions. To overcome this problem, several centres are trying to deploy new training methods, such as e-learning, flash training in the operating theatre or even training through immersive 3D headsets, with positive feedback from the trainees. In 2023, ASN observes significant use of RPOs, either as a specialised contributor to assist a RPE-O, or as an RPA. The use of RPOs can partly explain the difficulties in training the personnel due to the lower organisational flexibility of outsourced training sessions. Furthermore, calling upon an RPOs necessitates supervision of this service with strong internal mobilisation and an interlocutor who is capable of following through with the radiation protection questions, because the on-site presence of the RPOs personnel is often very limited. Without close involvement of the centres, the RPO’s will use standard documents that ignore the departments’ particularities. They are moreover often poorly known or unknown to the teams, who have difficulties in assimilating them. ASN observes that compliance with and assimilation of the requirements relating to occupational radiation protection is dependent on strong involvement of the persons responsible for radiological zoning, the radiation protection controls and the occupational radiation protection training courses. Coordinating prevention measures with outside contractors, including private practitioners, is also an area for progress in interventional imaging departments and operating theatres alike. The percentage of inspected departments having formalised prevention measures with all their service providers through a prevention plan varies between 17 and 28% for the 2019‑2023 period. In 2023, only 24% of the inspected centres had formalised these measures. Yet knowledge of the risks linked to ionising radiation and of the appropriate prevention measures for the situations encountered, particularly by private practitioners, is a prerequisite for ensuring their radiation protection and that of other professionals. In 90% of the operating theatres inspected in 2023, the medical personnel have dosimetric monitoring devices available in sufficient quantity and appropriate for their types of exposure, a great improvement on the preceding four years, where the average was about 70%. ASN also observes that the analysis of the dosimetric results by the RPE-Os has slightly improved over the last five years, enabling the bad practices to be identified and corrected; the situation is better in the interventional imaging departments than in operating theatres, with 83% of the departments having analysed the dosimetric results in 2023 compared with 71% in 2019, while the figures for the operating theatres stand at 70% in 2023 and 60% in 2019. Radiation protection technical verifications ASN notes that the verification programme for work equipment and radiation protection instrumentation is drawn up and implemented in 58% of the interventional imaging departments and 54% of the operating theatres. When nonconformities had been identified, they had been corrected or were in the course of being corrected on the date of inspection in 90% of the cases. 2.4.3.2 Radiation protection of patients Of the departments performing FGIPs inspected in 2023, 77% call upon a medical physicist and have a POPM describing the organisation for involving a medical physicist, whose duties and times of presence on site are defined according to the centre’s activities. This figure has remained relatively stable over the 2019-2023 period. Recourse to outside contractors for medical physics services continues to expand in private sector centres and public hospitals alike. The outsourcing of medical physics duties is largely delegated to special advisors who intervene on site as and when required. ASN points out that close collaboration between operators and the medical physicist and regular presence of the physicist in the departments lead to optimised use of the equipment, with the setting up of protocols adapted to the procedures, recording of delivered doses and evaluation with regard to the locally-defined dosimetric reference levels. ASN notes that the external medical physicists working under a service contract are rarely present on the sites, including when the presence of a medical physicist is required by the regulations, for example during medical device acceptance tests and the setting up of optimised protocols under article 10 of ASN resolution 2021-DC-0704. The training of physicians in patient radiation protection is a recurring weak spot: about 13% of the operating theatres have trained all the physicians. This finding, recurrent for some centres, has led ASN to issue a compliance notice to one centre for GRAPH Percentage of conformity of the FGI facilities inspected on the theme of medical staff radiation protection in 2023 (operating theatres and interventional departments) 11 0% 20% 40% 60% 80% 100% 10% 30% 50% 70% 90% 2018 2019 2020 2021 2022 2019 2020 2021 2022 2023 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 Ais 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 Interventional procedure departments Operating theatres ASN Report on the state of nuclear safety and radiation protection in France in 2023 231 • 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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