ASN Report 2017

30 ASN report on the state of nuclear safety and radiation protection in France in 2017 The events of which ASN was notified in 2017 reveal that the most significant activities from the radiation protection viewpoint concern: ཛྷ ཛྷ for workers: fluoroscopy-guided inter- ventional practices with overdoses (external exposure of operators and in particular their hands) and nuclear medicine (contamination of workers, external exposure); ཛྷ ཛྷ for patients: interventional practices with deterministic effects observed in patients having undergone long and complex procedures, radiotherapy with overdoses linked more particu- larly to overlapping procedures and prescription errors and, lastly, nuclear medicine, with radiopharmaceutical delivery errors; ཛྷ ཛྷ for the public and the environment: nuclear medicine, with source losses, leaks from pipes and radioactive effluent containment systems. Four level 2events (ASN-SFRO 1 scale)were notified in 2017 in radiotherapy. These were overdoses following overlapping of two treatments, a prescription error (target volume) and an overdose in contact radiotherapy. In addition, three events involving the regulation dose limits of the extremities (hands) of interventional practitioners being exceededwere notified at the end of 2017 and rated level 2 on the INES scale. State of radiation protection in external-beam radiotherapy and brachytherapy The safety of health care using external- beam radiotherapy and brachytherapy has been a priority area of regulation and oversight since 2007. ASN used to systematically inspect radiotherapy centres every two years, but since 2016 it inspects every three years. An annual frequency is however applied in certain particular cases, more specifically for centres which are at risk in terms of human resources or organisation. In external-beam radiotherapy, although the fundamentals of safety are in place (equipment checks, training of professionals, quality and risk management policy), ASN continues to observe considerable disparities between the centres. Difficulty is being experienced withmaintaining quality and 1. ASN-SFRO scale for classifying radiation protection events affecting patients undergoing medical radiotherapy procedures. in some cases it is even regressing, more particularly owing to a lack of evaluation or to the departure of the operational quality manager. In addition, risk assessments remain relatively theoretical and insufficiently deployed ahead of an organisational or technical change. ASN stresses that the long-term involvement of all professionals in the management of quality and risks, in particular radiation oncologists, is necessary to enhance health care security. With regard to brachytherapy, although the departments benefit from the organisation set up for external-beam radiotherapy, concerning the deployment of a quality management system, the same disparities are observed. ASN also considers that efforts must be continued to reinforce the radiation protection training of workers if a high-level source is present. The radiation protection situation in nuclear medicine ASN considers that the radiation protection of workers and patients and protection of the environment continued on the whole tomake progress, in particular in the performance of internal inspections and continuous training. However, shortcomings persist with regard to coordinating the general worker protection measures during an intervention by an outside contractor, and also with regard to improving the safe delivery of the radiopharmaceutical drug to the patients and optimisation of the protocols for the use of scanners coupled with gamma cameras. The radiation protection situation in computed tomography In 2017, ASN continued its monitoring of radiationprotectioninthefieldofcomputed tomography, given the increase in the contribution of this imaging technique to the exposure of the population. Even if radiationprotectionof theworkers is satisfactorily addressed, that of the patients must be improved. The justification for the examination request, the search for a non-irradiating alternative technique and the training of professionals in radiation protection of patients, inparticular external physicians on temporary assignment, must be reinforced. The same applies to optimisation of the examination protocols and the revision of practices after analysis of the diagnostic reference levels. The radiation protection situation in interventional practices Owing to the implications for both professionals and patients and owing to a lack of radiation protection culture among intervention personnel, in particular in the operating theatres, ASN maintained its monitoring of the facilities performing fluoroscopy-guided interventions as a national inspection priority. The inspection findings confirm the observations made over the last few years. Thus, radiation protection of professionals is still applied to a greater extent in the fixed interventional radiology facilities (cardiology, neuro-radiology, vascular imaging, etc.) than in the operating theatres in which mobile devices are used. Regulatory deviations are frequently observed during inspections, concerning radiation protection of both patients and professionals and ASN is regularly notified of overdoses on the hands of interventional surgeons. These inadequacies concern the training of all the professionals associated with health care, especially those who have not received initial university level patient radiation protection training, the intervention by the medical physicist and the means allocated to the Radiation Protection Experts-Officers 2 . As in the previous year, ASNconsiders that the measures it has been recommending for several years to improve the radiation protection of patients and professionals during interventional procedures in operating theatres are still not sufficiently implemented. 2. In France, the Radiation Protection Expert- Officer (RPE-O) [formerly referred to in ASN documents as the PCR (Person Competent in Radiation protection), reflecting the French term and acronym “Personne compétente en radioprotection (PCR)”], is appointed by the employer of persons exposed to ionising radiation in the course of their work. Under the responsibility of the employer, the RPE-O participates in preparing the notification or licensing file and assessing the nature and extent of the risks to which the workers are exposed and in organising radiation protection. The RPE-O carries out internal radiation protection controls and keeps track of third-party radiation protection controls carried out by approved organisations. The RPE-O monitors worker radiation protection. Lastly, the RPE-O is involved in defining and implementing worker safety training for aspects concerning radiation protection and participates in the management of cases where worker exposure limit values are exceeded. These duties correspond to those of both Radiation Protection Expert (RPE) and Radiation Protection Officer (RPO), hence the adoption of the umbrella term Radiation Protection Expert-Officer (RPE-O). Significant events and outlook