ASN Report 2017

222 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 CENTRE-VAL DE LOIRE In addition, regular meetings took place with the bodies representing the personnel at the meetings of the Committee for Health, Safety and Working Conditions and when the personnel representatives made specific requests on subjects essentially addressing application of the labour laws. 1.2 Radiation protection in the medical field Radiotherapy and brachytherapy The Centre-Val de Loire region has 8 external-beam radiotherapy departments and 3 brachytherapy departments. The two regional hospital centres of Tours and Orléans implement advanced treatment techniques in external-beam radiotherapy such as tomotherapy and stereotactic treatments. The oversight action conducted in 2017 endeavoured to integrate the new inspection guidelines set out by ASN for the 2016-2019 period relative to risk management (prospective and retrospective risk analysis), experience feedback (management of internal notifications, continuous improvement of treatment quality and safety in radiation therapy) and the deployment of new techniques (management in project mode). In view of the findings of the 2017 inspections, ASN considers that patient radiation protection is generally properly catered for in the radiotherapy centres of the Centre-Val de Loire region. These inspections did nevertheless highlight significant disparities between external-beam radiotherapy centres in the safeguarding of the patient care pathway. Fourteen significant events in external-beam radiotherapy were notified to ASN in 2017. These events were mainly caused by patient positioning errors. Eight of these events were rated level 1 on the ASN-SFRO scale, while one was rated level 2. The level-1 rating is assigned to events having consequences as regards the administered dose but no expected clinical consequences for the patient. The level-2 rating is assigned to events that could cause moderate alteration of a function. In the present case, this event was associated with a palliative treatment. Fluoroscopy-guided interventional practices In the light of the 5 inspections carried out in interventional imaging in the Centre-Val de Loire region, ASN considers that occupational radiation protection still gives cause for concern even if there is a tendency towards improvement, particularly thanks to the observed hands-on investment of the Radiation Protection Expert-Officers. ASN still notes a lack of occupational radiation protection culture, more particularly in the operating theatres (procedure reports only partially completed, regulatory training not carried out or lacking traceability, failure to systematically wear personal protective equipment and dosimeters). With regard to patient radiation protection, it is still not adequately integrated in the operating theatres due to medical physics resources that are insufficiently directed towards interventional practices, whether this concerns the internal resources of large institutions or of service providers in the smaller healthcare centres. No significant radiation protection event concerning interventional imaging was notified in the Centre-Val de Loire region. In view of the number of centres or departments using these techniques, the absence of event notifications reveals the necessity to continue putting in place tools to identify and analyse abnormal situations. Nuclear medicine ASN inspected two of the ten centres practising nuclear medicine in the Centre-Val de Loire region. The overall findings are positive with regard to the measures taken in response to the radiation protection challenges. Findings regarding the optimisation of doses delivered to patients and the medical monitoring of personnel were nevertheless notified and were subject to particular monitoring by ASN. Alongside this, ASN continued its inspections relating to the transport of unsealed sources. The need for the inspected centres to continue upgrading their organisation in this area was observed. One significant event was notified for the Centre-Val de Loire region in 2017. This incident, which concerned repeated failures affecting a PET-CT scanner (positron emission tomography scanner combined with a computed tomography scanner) had no clinical consequences for the patients or personnel. 1.3 Radiation protection in the industrial and veterinary sectors Industrial radiography ASN carried out four inspections in companies using X-rays for the Non-Destructive Testing (NDT) of industrial parts, particularly in the weapons industry. Occupational radiation protection is satisfactory despite some shortcomings in the application of the installation standards in effect. The personnel assigned to NDT tasks are trained and have an appropriate understanding of the radiation protection issues. Two inspections of worksites using gamma radiography, one in a nuclear power plant, were carried out in 2017. As one of these inspections revealed shortcomings in worksite preparation (marking out, verification of exposure in actual situation), these points are now examined systematically and brought to the attention of service providers. Veterinary ASN carried out 2 inspections in veterinary facilities in 2017 (1 inspection was in a facility equipped with a CT scanner). Occupational radiation protection is satisfactory and takes into account the implications in this respect.