276 ASN report on the state of nuclear safety and radiation protection in France in 2017 Chapter 09 - Medical uses of ionising radiation 4. Blood product irradiators 4.1 Description The irradiation of blood products is used to prevent post- transfusion reactions in blood-transfusion patients. The blood bag is irradiated with an average dose of about 20 to 25 grays. Since 2009, source irradiators have been gradually replaced by X-ray generators, for which notification to ASN has been required since 2015. In 2017, the inventory stood at 29 irradiator devices equipped with X-ray generators. 4.2 Technical rules applicable to facilities A blood product irradiator must be installed in a dedicated room designed to provide physical protection (fire, flooding, break-in, etc.). Access to the device, which must have a lockable control console, must be limited to authorised persons only. Irradiators equipped with X-ray generators must be installed in rooms that comply with the provisions of ASN’s new technical resolution 2017-DC-0591 of 13th June 2017 (see chapter 3). 5. The state of radiation protection in the medical sector Radiation protection in the medical sector concerns patients receiving treatment or undergoing diagnostic examinations, health professionals (physicians, medical physicists, radiographers, nurses, nursing auxiliaries, etc.) who are required to use or participate in the use of ionising radiation, and also the population, such as members of the public who may be present within a health facility, or population groups that could be exposed to waste or effluents from nuclear medicine units. Since 2008, ASN has periodically produced documents presenting a national synthesis of the main lessons learned from inspections, based on indicators that determine compliance with the regulatory radiation protection requirements. These syntheses enable the state of radiation protection in the different areas (radiotherapy, nuclear medicine, interventional radiology, etc.) to be assessed for publication in the annual report. The syntheses are based on the findings established during the year preceding their publication. ASN also publishes annual or several-year national appraisals of inspection results; these are available at www.asn.fr . The results of the inspections carried out in 2016 in computed tomography, radiotherapy, nuclear medicine and in facilities practising fluoroscopy-guided interventional practices, were published in 2017. These results are used to present the situation of radiation protection in the medical sector; they are supplemented by the review of significant radiation protection events in 2017. 5.1 Exposure situations in the medical sector 5.1.1 Exposure of health professionals The risks for health professionals arising from the use of ionising radiation are above all the risks of external exposure generated by the medical devices (devices containing radioactive sources, X-ray generators or particle accelerators) or by sealed and unsealed sources (particularly after administering radiopharmaceuticals). When using unsealed sources, the risk of internal contamination must be taken into consideration in the risk assessment (in nuclear medicine and in the laboratory). FOCUS ASN initiatives concerning the training of medical professionals in patient radiation protection The substantial work undertaken by ASN since 2014 in training in patient radiation protection further progressed in 2017: ཛྷ ཛྷ as far as continuous training is concerned, the publication of ASN resolution 2017-DC-585 of 14th March 2017 relative to the training of professionals in the radiation protection of persons exposed to ionising radiation for medical purposes updates the preceding training arrangement. The training guides called for by this resolution shall be submitted to ASN for approval in 2018; ཛྷ ཛྷ following its approval by the Ministry of Higher Education on 21st April 2017, the initial training of physicians in patient radiation protection is now included in the university curriculum of medical studies. It is part of the post-graduate cycle training syllabus dispensed to all future physicians without exception. This is a three-level scheme comprising: -- first, the acquisition of generic knowledge by all medical students, whatever their specialist subject (including general practitioners), chiefly oriented towards the justification of imaging examinations, -- followed by a complementary course for specialists performing fluoroscopy-guided procedures (interventional cardiologists, rhythmologists, rheumatologists, digestive tract endoscopists and surgeons), oriented towards dose optimisation and the use of X-ray generators, -- and lastly an expert-level course (which already exists) for specialist areas in which ionising radiation is at the core of the activity (oncology-radiotherapy, nuclear medicine and radiology-medical imaging).