ASN Report 2017

261 ASN report on the state of nuclear safety and radiation protection in France in 2017 Chapter 08  - Regional overview of nuclear safety and radiation protection PROVENCE-ALPES-CÔTE D’AZUR 1.2 Radiation protection in the medical field External radiotherapy and brachytherapy ASN carried out 4 inspections in external-beam radiotherapy and 2 in brachytherapy in the radiotherapy departments of the PACA region in 2017. ASN observed the continued efforts made by the radiotherapy departments to effectively implement a treatment quality and safety management system. Nevertheless, proper implementation of management reviews that take into account experience feedback, internal and external audits, patient satisfaction analyses and continuous improvement loops still requires particular attention. ASN observes moreover that the prospective risk analysis procedure, which should result in the setting up of appropriate barriers, is still not carried out in sufficient depth. This procedure must be carried out and updated prior to the installation of a new device or a new technique in order to avoid adverse events concerning patient radiation protection. In this respect the departments will have to ensure that their approach is formally structured, in accordance with the opinion of the Advisory Committee for Radiation Protection in Medical and Forensic Applications of Ionising Radiation. Fluoroscopy-guided interventional practices ASN carried out 7 inspections of centres performing fluoroscopy- guided interventional procedures in the PACA region in 2017. These inspections, carried out as much in the operating theatre as in facilities dedicated to cardiology, neuroradiology and vascular radiology, revealed disparities between dedicated structures, which on the whole comply with regulatory requirements, and operating theatres, where there is a lack of radiation protection culture in the medical personnel. In this respect, ASN notes that in 2017 it received no significant event notifications relating to patient radiation protection from any of the 108 centres concerned. The regulatory provisions relative to worker dosimetric monitoring are poorly applied and the use of collective protective equipment, the provision and wearing of dosimeters and the performance of radiation protection technical controls remain weak points. With regard to patient radiation protection, the observed weaknesses concern aspects such as the generally insufficient number of medical physicists and radiographers, the technical training of practitioners in the use of the machines (and the possibilities of patient dose optimisation that they offer), or the drawing up of dose optimisation protocols for the most common procedures and the indication of dosimetric information in the procedure reports. Nuclear medicine ASN carried out four inspections in nuclear medicine in the PACA region in 2017. The generally positive momentum in taking radiation protection into account in the inspected departments and centres is continuing, with the noteworthy gradual involvement of senior management. The inspected departments have increasingly modern premises and equipment at their disposal further to the relocating of departments and the replacement of old equipment. Patient radiation protection is satisfactory. Worker radiation protection is generally satisfactory, but the coordination of preventionmeasures must be improved, not only with the private practitioners but also with the outside contractors performing work in the departments concerned. The improvement in the management of radioactive waste and effluents noted in 2016 continued in 2017, with ASN noting in particular a substantial increase in the number of authorisations to discharge non-domestic wastewater into the public sewage networks, as provided for by the Public Health Code. The waste management plans on the other hand, are most often either incomplete or require updating. Computed Tomography ASN performed three inspections in computed tomography in 2017 and considers that the radiation protection implications of this activity are on the whole well taken into account given the risks inherent to the activity. ASN notes a relatively stable number of significant radiation protection event notifications in computed tomography, with 10 events reported in 2017 compared with 12 in 2016, which adds to the experience feedback and lessons learned, while remaining low with respect to the 104 computed tomography licenses currently in effect in the PACA region. As far as worker radiation protection is concerned, ASN takes positive note of the involvement of the radiation protection expert-officers in the centres, the means allocated to them and the recognition of their role by senior management. Progress is however still required in the medical monitoring of exposed workers, particularly private-sector physicians. With regard to patient radiation protection, ASN considers that the robustness of the patient identity verification process needs to be improved. Furthermore, the medical physics organisation plans remain incomplete, particularly with regard to the coordination of several centres belonging to a same given structure. ASNalso remains attentive to the use of the computed tomography scanner in particular conditions. More specifically, the provisions for radiation protection when mobile CT scanners are installed and used in vehicles when centres are undergoing works can usually be improved. Furthermore, ASN can only authorise the use of remote scanners (teleradiology) if particular radiation protection measures can be guaranteed. 1.3 Radiation protection in the industrial and research sectors Industrial radiography ASN carried out 11 inspections of industrial radiography activities in bunkers or on worksites in 2017, and the overall radiation protection result is satisfactory. ASN nevertheless observes a contrasted situation regarding the transmission of work schedules, with the improvement that began in 2016 remaining gradual and vulnerable. Universities and laboratories or research centres In 2017, ASN carried out one inspection in a university that uses ionising radiation, and in which the management of