failing to meet these requirements (see box page 230). The medical personnel in the interventional imaging departments medical are trained to a greater extent, with 31% of the departments having trained all their medical personnel, an improvement compared with 2022 (24%). Over the last five years, 58% of the interventional imaging departments on average have collected, analysed and optimised the doses. ASN notes a better situation in 2023, where 69% of the interventional imaging departments have met these obligations compared with 40% of those inspected in 2022. On the other hand, only 30% of the operating theatres on average have satisfied these optimisation requirements over the last five years. ASN finds the same weakness in the application of the optimisation principle in setting machine parameters and optimising the protocols used. The training time for the medical staff is insufficient and the recurrent shortage of paramedical personnel does not facilitate the scheduling and following of training courses. Nevertheless, reference levels for the most common examinations are being developed locally more and more often. This approach makes it possible, among other things, to set alert levels for triggering appropriate medical monitoring of the patient according to the dose levels delivered to the patient. Patient dose archiving and analysis systems are also deployed and facilitate the development of these reference levels and the programming (or adaptation) of local alert levels per machine and by type of procedure. These systems are an asset for tracking the doses previously received by the patient and for patient monitoring, and they contribute to the optimisation of the dose delivered. ASN is regularly alerted by situations of noncompliance with the required qualifications in the operating theatre. The shortage of radiographers in operating theatres means that nurses are required to operate devices emitting ionising radiation under the responsibility of the physicians. ASN is also questioned about the scopes of intervention and the patient radiation protection training obligations of State-Registered Operating Theatre Nurses (SROTNs) and State-Registered Nurses (SRN). ASN reiterates that devices emitting ionising radiation may only be operated by radiographers whose training in patient radiation protection is current and under the responsibility of a physician. With regard 11. Improving patient monitoring in interventional radiology and fluoroscopy-guided procedures – reducing the risk of deterministic effects of 21 May 2014. to SROTNs, they now have new prerogatives and can, under the responsibility of a surgeon, assist in certain interventional procedures (performed under mobile C-arm unit in the operating theatre, not requiring a protocol adjustment and delivering a dose of less than 10 grays per square centimetre (Gy/cm2) (Dose Area Product – DAP – at end of procedure) without being authorised to operate or set the parameters of the medical device. They must also have a specific work tasks qualification and be current in their patient radiation protection training (ASN resolution approving the patient radiation protection continuous training guide for SROTNs). With regard to SRNs, they can only operate devices emitting ionising radiation under the responsibility of a physician in the context of a cooperation protocol approved by the ARS in accordance with the Article of Act 2019-774 of 24 July 2019 on the organisation and transformation of the health system. Patient monitoring if the skin exposure threshold defined by the HAS(11) is exceeded is formalised to a greater extent in the interventional imaging departments (81%) inspected in 2023 than in the operating theatres (62%); interventional imaging departments are more frequently concerned by procedures leading to such exposure levels than the operating theatres. The external quality controls of the medical devices are generally carried out at the right frequency, and on the day of the inspection, any previously detected nonconformities had been or were being corrected, equally well in the operating theatres as in the interventional imaging departments. 2.4.3.3 Significant events relating to fluoroscopy-guided interventional practices An events recording system is in place in more than 75% of the inspected sites performing FGIPs. In 2023, 26 significant events were reported concerning : ∙ overexposures of patients (8 ESRs); ∙ exposures of medical staff (11 ESRs); ∙ exposure of foetuses in women unaware of their pregnancy at the time of the procedure (5 ESRs). Among these ESRs, two are linked to an MD malfunction (stopping of the device or computing malfunction). GRAPH Percentage of conformity of the FGI facilities inspected on the theme of radiation protection of patients in 2023 (operating theatres and interventional departments) 12 0% 20% 40% 60% 80% 100% 10% 30% 50% 70% 90% Organisation for monitoring the patient if an HAS threshold is exceeded 100% of medical personnel trained Patient doses recorded, analysed and optimised The POPM describes an organisation that is appropriate for the risks 2018 2019 2020 2021 2022 2019 2020 2021 2022 2023 Interventional procedure departments Operating theatres 232 ASN Report on the state of nuclear safety and radiation protection in France in 2023 • 07 • Medical uses of ionising radiation
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