ASN Report 2017

284 ASN report on the state of nuclear safety and radiation protection in France in 2017 Chapter 09  - Medical uses of ionising radiation doses (adult dose injected into a child, injection of a dose higher or lower than the prescribed dose, etc.) or to errors during the preparation of the medication (interchanging of bottles). Only a few patients were involved in patient identity errors. Six extravasations 9 were described, of which two occurred during treatment. One occurred after injecting lutetium-177, in a difficult treatment context due to the patient’s state of health. The second arose during a treatment of hepatic metastases with microspheres of yttrium-90, in which an arterial reflux occurred. The patients were subject to medical monitoring. Three patients were affected by an ESR resulting from failure to check radionuclide marking quality before giving the injection. Significant events concerning workers (14 ESRs, i.e. 10% of the notified ESRs) Fourteen events concerning workers were notified in 2017. Five involved a radiopharmaceutical coming into contact with the face, eyes or hands. Two resulted from pricks with needles during syringe depressurisation or the use of new injection devices. Delivery errors (bottles delivered in inappropriate packaging) and errors in the handling of shielded bins caused accidental exposure of workers. Significant events concerning the public (15 ESRs, i.e. 10% of the notified ESRs) Twelve of these ESRs resulted from the exposure of the foetus in women unaware of their pregnancy. The doses received had no consequences on the child after its birth (ICRP, 2007). The exposure of persons not in the category of workers exposed to ionising radiation was observed during work on the drain pipes of toilets used by patients or through the discovery of a bottle of urine from a patient treated with lutétium-177, which was found in an infectious waste disposal route. These events had no consequences on the exposed persons. Significant radiation protection events concerning radioactive sources, waste and effluents (18 ESRs, i.e. 12% of the notified ESRs) Most of these ESR were associated with the loss of radioactive sources (old sources or following the retrieval of sources), the dispersion of radionuclides (leaks of radioactive effluents from pipes or tanks) or the channelling of waste towards an inappropriate disposal route. One of the ESRs was linked to the discharging into the public sewage network of tanks containing iodine-131 with an activity level above the regulatory threshold of 100 Bq/l. The discharging occurred following plumbing work in 9 . The extravasation of a radiopharmaceutical, administered by a peripheral intravenous device, is an abnormal passage of the substance outside the catheterised vessel (passage through tissue). Its consequences in terms of lesions caused on neighbouring tissues depend primarily on the volume and the energy level of the extravasated radiopharmaceutical (diagnostic or therapeutic procedure). which a valve had not been properly closed. Deficiencies in management of the “high level” filling alarm prevented detection of the leak. 5.5.6 Summary The inspections carried out in 2016 had revealed progress in: ཛྷ ཛྷ the effective implementation of means of protection aiming to limit exposure of workers and the public when radiopharmaceuticals had to be transported for use outside the nuclear medicine department; ཛྷ ཛྷ the performance of external quality controls of the medical devices; ཛྷ ཛྷ the dispensing and recording of medical staff training in patient radiation protection; ཛྷ ཛྷ the training of personnel in the use of automated systems for preparing and injecting radiopharmaceuticals; ཛྷ ཛྷ the quality of the effluent and waste management plans produced by the nuclear medicine departments. Shortcomings were still found in: ཛྷ ཛྷ the coordination of the general prevention measures when outside companies work in the nuclear medicine facilities; ཛྷ ཛྷ the securing of the administration of the radiopharmaceutical and the use of automated devices to prepare the administered activities and/or give the injection with, more specifically, the radiopharmaceutical dispensing process being subject to strict quality assurance procedures; ཛྷ ཛྷ the optimisation of the protocols for the use of CT scanners coupled with gamma cameras; ཛྷ ཛྷ contaminated effluent management, consisting firstly in locating, identifying and monitoring the pipes carrying radioactive effluents, and secondly in formalising a response protocol in the event of leakage. 5.6 Radiation protection situation in conventional radiology and computed tomography In 2016, ASN renewed the verifications of the radiation protection regulations in the area of computed tomography, given the increase in the contribution of this imaging technique to the average effective dose per capita (chapter 1). The computed tomography inspections carried out in 2016 concerned 63 facilities dedicated exclusively to medical imaging. 56 centres were inspected in 2017. 5.6.1 Inspection results The organisation of worker radiation protection in 2016 was generally satisfactory, but a few points remained to be improved: ཛྷ ཛྷ The RPE-Os still did not have adequate means to fulfil their duties. ཛྷ ཛྷ The assessment of risks and ensuring zoning consistency accordingly, and the work environment analyses were carried out, but often required updating. ཛྷ ཛྷ The radiation protection technical controls were carried out at the required frequencies but were not followed up by corrective actions. ཛྷ ཛྷ The training of exposed personnel remains a weak point, particularly for private practice physicians working on a contract basis.