of the patient is not always found or recorded. The specific work tasks qualification procedures, often carried out for the paramedics, are still incompletely applied for the medical staff. The ASN inspectors observe that the departments are turning increasingly to teleradiology, creating a high level of activity during the teleradiology time slots, which sometimes creates operational problems (inter-software communication, task delegation, heavy workload for radiographers). The recourse to teleradiology is no longer limited to maintaining an out-of-hours service, but aims to allow shifts to be scheduled during working hours due to the shortage of radiologists. The inspections of the centres using teleradiology have detected inconsistencies in the agreements (several service providers for the same duty time slots and scheduled shifts), failure to present radiation protection training certifications for the service providers, incomplete POPMs that do not always take into account the teleradiology activity and the associated dose optimisation measures. Furthermore, the specific work task qualification procedures are to be continued, or in some cases started, for the contract personnel. ASN notes moreover that 25 ESRs out of the 237 ESRs reported in computed tomography (about 10.5%) occur in a teleradiology context and are linked to communication problems between the on-site and the remote medical professionals. 2.5.4 Significant events reported in medical and dental radiodiagnosis In 2023, 322 ESRs were reported in medical and dental radiodiagnosis (+12% compared with 2022): ∙ 81 in conventional radiology, of which 35 concerned women unaware of their pregnancy; ∙ 237 in computed tomography, off which 93 concerned women unaware of their pregnancy; ∙ four in dental radiology. The ESRs mainly concern women who were unaware of their pregnancy (128 notifications). A specific Patient safety bulletin was produced and published in September 2021 to improve the organisational measures to reduce the number of events of this type. The analysis of the reported ESRs shows that checking for pregnancy when registering the appointment, checking-in and installing the patient can be further improved. The β-HCG level is not always assayed, or is sometimes incorrectly interpreted or not consulted. Urinary self-tests are little used. The other causes of ESRs are linked to shortcomings in the patient management process (errors in identity monitoring, in the anatomical region exploration protocol, in examination scheduling). ASN oversight in computed tomography mainly concerns checking implementation of the requirements of ASN resolution 2019-DC-660 of 15 January 2019 more specifically regarding formalising of the justification and optimisation principle. The departments still have to assimilate the quality assurance procedures and the associated tools (risk mapping, action plan, lessons learned from adverse events, etc.). Furthermore, efforts must be maintained in the application of the justification principle with a description of the various steps from reception of the request, analysis of its justification and its validation, through to the decision to perform the procedure or not, or to use an alternative procedure. ASN notes that teleradiology is progressing constantly with technical and organisational constraints that are frequently underestimated by the centres (software interfaces, communication problems) which are liable to foster the occurrence of ESRs if the service is not managed properly. Lastly, ASN notes the emergence of a mobile radiology offering to meet particular healthcare needs (treating strokes, ageing population, medical deserts in certain regions, etc.) with no visibility at present of how this trend will evolve. It will keep a watchful eye on these developments in order to assess the impacts with regard to radiation protection. SUMMARY 2.6 HUMAN BODY PRODUCT IRRADIATORS 2.6.1 Description The irradiation of products from the human body is used in particular to prevent post-transfusion reactions in bloodtransfusion patients. The blood bag is irradiated with a dose of about 20 to 25 grays. Since 2009, source irradiators have been gradually replaced by X-ray generators, which have been subject to notification to ASN since 2015. In 2023, the inventory stood at 135 irradiator devices equipped with X-ray generators. 2.6.2 Technical rules applicable to facilities A blood product irradiator must be installed in a dedicated room designed to provide physical protection (against fire, flooding, break-in, etc.). Access to the device, which must have a lockable control console, is limited to the persons authorised to use it. The fitting out of premises accommodating irradiators equipped with X-ray generators must comply with the provisions of ASN resolution 2017-DC-0591 of 13 June 2017. 2.7 SIGNIFICANT RADIATION PROTECTION EVENTS The number of ESRs reported to ASN (657) in 2023 is slightly higher than in 2022 (619), but has remained relatively stable over the last five years, with the exception of 2020 due to the Covid‑19 pandemic (see Graph 13 next page). ASN underlines the importance of reporting ESRs in order to share ILS’s and improve radiation protection. Graphs 13 and 14 (see next page) illustrate how the number of ESRs has evolved by activity category since 2010. Graphs 15 and 16 (see next page) illustrate the breakdown of the number of ESRs in 2023 by area of exposure (environmental impact, exposure of the general public, exposure of patients, exposure of professionals) and by category of activity. Although the number of ESRs in radiotherapy and been dropping steadily since 2012, it has been increasing in CT and nuclear medicine since 2010. CT is thus the activity for which the number of ESRs reported is the highest (237), whereas until 2016 radiotherapy held this position. In the light of the events reported to ASN in 2023, the most significant findings from the patient radiation protection aspect occurred in radiotherapy (see point 2.1.3.3) and brachytherapy (see point 2.2.3.5) and reveal that lessons learned from past ESRs have been forgotten. With regard to occupational radiation protection, it is in the area of FGIPs that the risks are greatest, with cases of exceeding regulatory dose limits (see point 2.4.3.3). 236 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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