ASN Report 2017

256 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 1.2 Radiation protection in the medical field External-beam radiotherapy Three external-beam radiotherapy accelerator replacements were registered in 2017. The change in equipment is accompanied by the development of new techniques (primarily stereotaxy) which lead to new risks. Two of the six external- beam radiotherapy centres of the Pays de la Loire region were inspected in 2017. Risk management and the implementation of new treatment techniques (stereotaxy, etc.) were verified in depth. As in 2016, following a phase of consolidation of the quality approach, the inspected centres are now resolutely engaged in a phase of quality management and continuous improvement. Although the “quality” objectives are regularly updated by their respective governing bodies, their monitoring and assessment can still be improved in some cases. The risks induced by the new techniques are integrated in the prospective risk analysis with the putting in place of new requirements or defence barriers. However, deadlines and the people responsible for their implementation are not always specified. The organisation for detecting and analysing adverse events is effective on the whole and contributes to the development of the risk analysis. A total of 7 significant radiation protection events concerning patients were reported to ASN in 2017 and rated level 1 on the ASN-SFRO scale. Among these events, 2 concerned medical prescription errors and gave rise to reactive inspections. Several common lessons have been learned from these events, particularly the difficulty in defining and putting in place effective barriers in order to detect this type of error as early as possible. Furthermore, one event concerning a symmetry defect in the treatment beam due to premature wear of the accelerator target will be made known at national level in view of its potentially generic nature. As this event concerned a cohort of patients it was rated level 1+ on the ASN-SFRO scale. Finally, the efforts made in the last few years to recruit medical physicists, dosimetrists and physical measurement technicians nowmean that all the centres can ensure, each day, the presence of at least one medical physicist during the treatment periods while freeing up medical radiation physicist time for the deployment of new treatment techniques. Nevertheless, the assessment of needs in medical physics merits being better finalised in most of the centres. Fluoroscopy-guided interventional practices Oversight of interventional practices has figured among the priority objectives of the Nantes division since 2014 1 . Despite the effort made over the last few years in the number of inspections and their prioritisation, the division has not yet inspected each centre at least once, emphasis having been placed on monitoring the sites presenting the most serious radiation protection issues. However, to raise radiation protection awareness within the centres and to reinforce the 1. 62 inspections carred out in the Bretagne – Pays de la Loire regions during the 2014-2017 period, out of a total of 77 centres (82 sites). prioritisation approach, a survey was carried out in 2017 with the centres that had never been inspected and with a few centres with a very low level of activity in this area but whose practices nevertheless were considered to merit monitoring in view of the findings of the first inspection. This initiative moreover allowed the volume of activity of these centres to be updated and the two sites which in the first survey had declared they did not carry out fluoroscopy-guided interventional procedures to be identified. This instrument was also used to refine the targeting of the inspections on the 2018 schedule. Ten centres were inspected in 2017 out of the 40 centres in the Pays de la Loire region. The results show that the situation with regard to radiation protection remains contrasted. Thus, despite the generally active involvement of the radiation protection expert-officers, their action suffers from a lack of coordination and institutional follow-up, which limits its impact. Among the inspected centres, the Angers University Hospital, which performs procedures involving significant radiation risks, has made little progress in radiation protection in the operating theatres despite the regular inspections by ASN and the involvement of its radiation protection and medical physics department. The inspection scheduled for this hospital in 2018 will serve to check the effectiveness of the measures to improve radiation protection in the operating theatres defined by the hospital general management in the action plan it presented to ASN in January 2018. Generally speaking, radiation protection is better taken into account for workers than for patients, even if continued efforts are required in the quantification of doses and protection of the lens of the eyes and the extremities of health professionals. Regarding the radiation protection of patients, there is significant room for progress in the training of practitioners in the radiation protection of patients and in terms of effective implementation of the optimisation procedures, particularly when using third-party medical physics services. The creation of regional hospital groupings could provide an opportunity for pooling medical physics functions and developing the effective presence of medical physicists in the hospitals. Nuclear medicine Five nuclear medicine units were inspected in 2017. These inspections on the whole revealed an improvement in the integration of ASN’s demands. With regard to occupational radiation protection, the involvement of the radiation protection expert-officers and the efforts devoted to the radiation protection training and the medical monitoring of workers are to be underlined. Worker dosimetric monitoring means are also satisfactory, save for nuclear medicine physicians, who do not make sufficient use of dosimeters. Coordination of radiation protection measures for outside companies, such as cleaning contractors, can be improved in the majority of the centres inspected. As far as patient radiation protection is concerned, the analysis of the dosimetric readings with respect to the diagnostic reference levels in order to optimise the doses administered to the patients can be improved. PAYS DE LA LOIRE