ASN Report 2017

279 ASN report on the state of nuclear safety and radiation protection in France in 2017 Chapter 09  - Medical uses of ionising radiation The notified events in the medical sector chiefly concern the exposure of patients (53%) and foetuses in pregnant women unaware of their pregnancy (30%), a figure which has risen markedly. In the light of the events notified to ASN in 2017, the most significant consequences from the radiation protection aspect concern: ཛྷ ཛྷ for workers: fluoroscopy-guided interventional practices (external exposure of operators, and their hands in particular) with cases where dose limits are exceeded, and nuclear medicine (contamination of workers, external exposure); ཛྷ ཛྷ for patients: interventional practices with deterministic effects observed in some patients having undergone long and complex procedures, radiotherapy with excess doses associated in particular with treatment overlaps 8 , prescription errors and, lastly, nuclear medicine, with radiopharmaceutical administration errors; ཛྷ ཛྷ for the public and the environment: nuclear medicine, with losses of sources, leaks from radioactive effluent pipes and containment structures. Information detailed by area is provided on the following points. In late 2016, supported by ASN, HERCA organised a seminar on accidental and unintentional medical exposures. The report and conclusions of this seminar were published in May 2017( www.herca.org ). 5.3 Radiation protection situation in radiotherapy The safety of radiotherapy treatments has been a priority area of ASN oversight since 2007. The programme of inspections defined for the 2016-2019 period, the orientations of which were communicated to all the radiotherapy departments in early 2016, was continued in 2017. The inspections focused on the ability of the centre to deploy a risk-management procedure and, depending on the situation found by the inspectors, on the implementation of hypofractionated 8 . Treatment overlap: irradiation during a second treatment of an anatomical region which has already been irradiated; the area concerned by the overlap receives summed doses resulting from several separate irradiations. treatments, skills management, the implementation of new techniques or practices, and control of the equipment. ASN is continuing its graded approach to oversight: ཛྷ ཛྷ by reducing, in the light of the progress made in the control of treatment safety, the average frequency of inspection, which since 2016 has been reduced to once every three years (instead of the previous two-yearly frequency); ཛྷ ཛྷ by maintaining a higher inspection frequency for the centres displaying vulnerabilities or risks. In 2016, ASN carried out 89 inspections in 79 external- beam radiotherapy centres, that is to say 46% of the centres in France. In 2017 it carried out 95 inspections. 5.3.1 Radiation protection of radiotherapy professionals When the facilities are correctly designed, the radiation protection risks for the professionals in radiotherapy are limited due to the protection provided by the walls of the irradiation room. 5.3.2 Radiation protection of radiotherapy patients Although the requirements set by ASN technical resolution 2008-DC-0103 of 1st July 2008 for the management of quality and safety in radiotherapy departments are complied with on the whole, there are still disparities between centres. Experience feedback The results of the inspections carried out in 2016 showed that the experience feedback process gave overall satisfaction in only 41% of the centres inspected. While the detection of adverse events, their notification (internally or to ASN) and their recording were deemed satisfactory on the whole in about 90% of the centres, the analysis of these adverse events was only satisfactory on the whole in 63% of the inspected centres: ཛྷ ཛྷ The analysis of the causes of an event is still too succinct, often not going beyond the immediate causes. ཛྷ ཛྷ Similarly, the analyses of recurrent events are still poorly developed even though recurrent events constitute alert signals. 2016 2017 2012 2011 2010 2015 2014 2013 0 100 200 300 NUMBER OF SIGNIFICANT EVENTS by type of activity over the years Interventional radiology Radiotherapy Nuclear medicine Conventional and dental radiology Computed Tomography