See glossary pages 33 to 36 In its 2006 report, ASN underlined that “the importance of the organisation factor in risk prevention is poorly known. Our health system approves people and structures if, on a given day, they satisfy requirements concerning skills and resources, but once these requirements have been satisfied, it shows no further concern for the satisfactory overall functioning. Yet skills are not acquired forever, equipment ages and the use of approximate methods can render costly resources inefficient”. The tone was set and the measures that were taken radically changed this situation. Épinal hospital, the risks elsewhere than in nuclear facilities “The Épinal events were a catalyst for radiation protection. In a way it was radiation protection’s Chernobyl. Just after the Épinal case, I was astonished that the discussions at the Ministry of Health revolved around legal questions and the financial impact. The health professionals, who were opposed to anything that resembled an inspection, especially coming from nonmedics, adopted a more flexible attitude. They had to face patients who were worried. It must be pointed out that on average 180,000 people per year follow a radiotherapy treatment, therefore statistically the risk of an incident remains very low. Remarkable work has been carried out internationally on the notification of events in radiotherapy. We started out with the model used in the nuclear industry, the scale of severity applied in the nuclear installations, namely defence in depth. The other important event which followed on from the Épinal accident was the seminar organised in Versailles in 2009 (see box p. 25). We managed to get patients who had been victims to take part in a round table with medical professionals. This exceptional moment of dialogue was a very moving experience. It represented a ground-setting event, in the presence of Roselyne Bachelot who was Minister of Health and Sport at the time.” Jean-Christophe Niel Former Director-General of ASN Director-General of IRSN In November 2007, after the Épinal accident, the Minister of Health and Sport announced national measures to guarantee the safety and quality of radiotherapy procedures. These measures provided a way out of a health crisis and a means of approaching the transition period (2009-2010) before the deadline for bringing all the radiotherapy centres into compliance (2011). Human resources and training • Continue the efforts to train and recruit medical physicists in the field of radiotherapy. • Train a sufficient number of interventional radiology radiographers in the operating theatres for the fluoroscopy guided procedures. • Render obligatory the presence of a medical physicist from the start to the end of the treatment. The safety of the facilities • Render obligatory the installation of a device indicating the radiation dose emitted (feasibility) for the interventional radiology devices put into service before 2004. • Evaluate the quality of practices at national level, in both radiotherapy and medical imaging; in vivo dosimetry (real-time dose measurement); double calculation of monitor units, tighten the methods for checking that the beam delivers the expected dose, and render obligatory this precaution – which already existed at the time of the Épinal issue. Relations with the patients and the various audiences • With the patients’ associations, continue the information drives on the radiotherapy treatment safety, based on the conclusions of the ASN conference in Versailles (2009). • Inform the patients about the benefits of medical imaging and the associated risks, and involve them in the decisions. ? How has the radiation protection of patients and medical personnel evolved further to the Épinal accident 24 • Les cahiers Histoire de l’ASN • November 2023
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