One of the events identified during a dosimetric analysis by the centre revealed an increase in the doses delivered during 2022. After seeking the causes, the centre identified that the increase came further to a maintenance operation in September 2022 during which the parameters displayed by default did not correspond to the initially set and optimised parameters. This event shows the importance of having good communication between the centre and the maintenance workers and the merits of defining the expected work scope of the maintenance contract. The analysis of this event also shows that all the people involved have a role to play. ASN has published a “Patient safety” bulletin on the role of the team in the management of MDs in FGIP. The majority of patient overexposures are due to long and complex procedures (in interventional neuroradiology, urology, digestive tract surgery, fitting Implantable Venous Access Devices – IVAD, also called “implanted ports”). Analysis of the events reveals various causes, such as a lack of protocol optimisation, inappropriate utilisation of the devices by the operators revealing deficiencies in operator training and the importance of implementing a specific work task qualification procedure. These weak points constitute areas for improvement. The FGIP sector involves significant occupational radiation protection risks. One ESR in 2023 led to exceeding of the equivalent dose to the extremities (500 mSv) for a surgeon after a temporary relocation in a room less suitable for the types of procedures performed. A second ESR concerns the exceeding, on the quarterly passive dosimeter, of the annual limit of 20 mSv for a State-Registered Nurse Anaesthetist (SRNA), even though the dose liable to be received in this type of job is very much lower than this value; the investigations could not identify another cause on exposure in the work environment. ASN reiterates the importance of the radiation protection culture and compliance with its rules, in particular the providing of all the tools allowing the optimisation of practices, the use of personal and collective protective equipment, and compliance with the rules concerning the wearing of passive and active dosimeters, including their stowage on the panels provided for this purpose, for exposure monitoring and reactive alert in the event of abnormal exposure. Lastly, events were reported concerning accidental exposures of the foetus of pregnant women unaware of their pregnancy, who underwent a therapeutic procedure in the pelvic region. A “Patient safety” newsletter published in 2021 addressed the lessons learned specifically from this type of event. The inspections conducted in 2023 in the area of FGIPs, considered with those performed over the period 2019-2022, allowing coverage of all the facilities considered to have radiation protection risk implications, reveal the fact that radiation protection makes very little progress from one year to the next, with a situation that remains better in the interventional imaging departments than in the operating theatres. In most facilities, the premises are slowly being brought into conformity to comply with the technical design rules, even though these modifications are essential in order to prevent the occupational risks. Even if the appointment of RPE-Os, the delimiting of restricted areas, the performance of technical verifications and quality controls of medical devices are considered satisfactory, deviations from the regulations are still frequently observed, in the radiation protection of the professionals and patients alike, with unsatisfactory situations concerning training in occupational and patient radiation protection and the coordination of prevention measures during concomitant activities, particularly with private practitioners. Having observed persistent weaknesses in this area for several years now, ASN has decided to adopt an enforcement policy, giving one centre formal notice in 2023 to comply with the regulatory requirements concerning the radiation protection training of the medical staff and the fitting out of the operating theatre rooms. ASN observes moreover that the centres are turning increasingly to RPOs, either as specialised contributors to assist an RPE-O, or as an RPA and that this outsourcing, if it is not adequately managed, leads to a dilution of the responsibilities of the RNAs and poorer assimilation of, or even a deterioration in, radiation protection. Although the use of medical physicists and formalising of the POPMs is gaining ground, further progress must be made in the implementation of the optimisation procedure, particularly in the operating theatres where doses are still insufficiently analysed and findings of inappropriate or non-existent protocols subsist. The reporting culture, however, has been spreading in the past five years, with the deployment of events recording systems. The reporting of ESRs underlines that maintenance operations, which can have consequences on the delivered doses, must be correctly supervised and that the training of practitioners in the use of medical devices is crucial for control of the doses. Furthermore, it is in this area that the events concerning occupational radiation protection are the most significant, with notifications of dose limit exceedances in 2023, underlining the importance of complying with the radiation protection rules, especially the use of personal and collective protective equipment. Extensive work to raise the awareness of all the medical, paramedical and administrative staff in the centres is still necessary to give them a clearer perception of the risks, especially for operating theatre staff. SUMMARY 2.5 MEDICAL AND DENTAL RADIODIAGNOSIS 2.5.1 Overview of the equipment Medical radiodiagnosis is based on the principle of differential attenuation of X-rays in the organs and tissues of the human body. The information is collected on digital media allowing computer processing of the resulting images, and their transfer and filing. Diagnostic X-ray imaging is one of the oldest medical applications of ionising radiation; it encompasses all the methods of morphological exploration of the human body using X-rays produced by electric generators. It occupies an important place in the field of medical imaging and comprises various techniques (conventional radiology, radiology associated with interventional practices, computed tomography, mammography) and a very wide variety of examinations (retroalveolar, radiography of the thorax, chest-abdomen-pelvis computed tomography scan, etc.). The request for a radiological examination by the physician must be part of a diagnostic strategy taking account of the patient’s known medical history, the question posed, the expected benefit for the patient, the examination exposure level and the dose history and the possibilities offered by other non-irradiating investigative techniques. The French Society of Radiology and Medical Imaging issues a Guide for Radiology and Medical Imaging Examination Referrals (ADERIM) to enhance the relevance of the examinations requested by referring physicians. If the dose delivered does not in itself represent a radiation protection health risk, it is the large number of examinations carried out among the population that contributes significantly to the collective dose of medical origin. ASN Report on the state of nuclear safety and radiation protection in France in 2023 233 • 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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