287 ASN report on the state of nuclear safety and radiation protection in France in 2017 Chapter 09 - Medical uses of ionising radiation The investigations revealed that overexposure of the patient and/or workers was due to jamming of the fluoroscopy pedals in two cases and to a collimator defect and the lack of additional filtration in two other cases. These figures were comparable with those for 2016, during which four similar events were notified. These events indiscriminately concerned mobile equipment used in the operating theatre and fixed equipment in rooms dedicated to fluoroscopy- guided interventional procedures. In the other cases, overexposure of the patient and/or practitioner was due to long and complex procedures on account of the patient’s illness and/or body size. ASN observes that although knowledge of the ESR notification system has improved, under-notification is still an issue in this area. The on-line notification of ESRs (teleservices.asn.fr ) , which has been available since 1st April 2017, facilitates the notification of events and transmission of analysis reports within twomonths. 5.7.4 Summary ASN considers that the urgent measures it has been recommending for several years to improve the radiation protection of patients and professionals during interventional practices in the operating theatres have still not been taken. The inspections frequently reveal deviations from the regulations, concerning the radiation protection of patients as much as the radiation protection of medical staff, and ASN is regularly notified of events concerning interventional surgeons who have exceeded the dose limits for the extremities. Due to the implications for radiation protection of the medical staff and patients, and a lack of radiation protection culture among the staff, as observed during inspections and illustrated by the under-notification of ESRs, ASN has asked the GPMED to establish recommendations to improve radiation protection in the operating theatres. Its recommendations are to be submitted at the end of 2018. 6. Outlook In radiotherapy, although the safety fundamentals are in place (equipment verifications, medical staff training, quality and risk management policy), ASN still observes significant disparities between centres. The quality initiatives are struggling to achieve long-term continuity, or are even regressing. Furthermore, the experience feedback procedures are losing momentum and the risk analyses remain relatively theoretical and are insufficiently deployed prior to organisational or technical changes. ASN observes a lack of involvement in quality and riskmanagement on the part of the medical staff as a whole, and radiation oncologists in particular, which is nevertheless vital for improving safety. The opinion of the GPMED concerning the conditions of implementation of high-precision irradiation techniques in radiotherapy and the associated practices has led ASN to assist the learned societies in defining baseline requirements for clinical audits by peers. ASN will remain particularly attentive to the question of the means necessary for the deployment of these audits. ASN has also started to set up a new committee to ensure a coordinated watch over the new techniques and new practices using ionising radiation in the medical field, comprising institutions, learned societies and professional associations involved in radiotherapy. Lastly, the work to better anticipate and manage the organisational and technical changes will be continued in 2018, with volunteer radiotherapy centres and the assistance of the professionals, hospital federations and healthcare institutions. Verification of the control of doses in medical imaging remains a priority for ASN, particularly when associated with fluoroscopy-guided interventional practices. The recent and rapid development of new imaging techniques, including the arrival of CT scanners in the operating theatre and their implementation by specialists (surgeons, neurosurgeons, cardiologists, urologists, rheumatologists, orthopaedic surgeons, etc.) who too frequently are insufficiently trained in matters of radiation protection, justifies the reinforcing of the actions conducted by ASN. ASN has tasked the GPMEDwith issuing recommendations to improve the radiation protection of medical staff and patients in the operating theatre. In early 2018, ASN will publish a new action plan to improve the control of doses in medical imaging, which follows on from the plan developed in 2011, in order to continue promoting a radiation protection culture with medical professionals. The publication of this new plan in the ASN Official Bulletin will be accompanied by an ASNopinion intended to update deliberations 2011-DL-0018 and 0019 of 14th June 2011 relative to the improvement of radiation protection in interventional radiology and the increase in doses delivered to patients during computed tomography and conventional radiography examinations.