ASN Report 2018

3.3.3  –  Management of sources Management of the brachytherapy sources is satisfactory. All the centres inspected record the tracking of source movements, transmit the source inventory to IRSN and store the sources waiting to be loaded or collected in a suitable place. Areas for improvement have nevertheless been identified regarding the safeguarding of access to the high activity sources, given that only 54% of the centres inspected in 2018 have put in place appropriate measures to prevent unauthorised access to these sources. ASN will remain attentive to the progress to be made and this inspection theme shall be a priority in 2019 for the centres holding high- activity sealed sources. 3.3.4  –  Emergency situations and management of malfunctions An event involving the jamming of a source in a PDR afterloader was reported in 2018. There was no risk of overexposure for either the personnel or the patient given that the emergency procedure planned for by the centre was duly applied. This event, like those reported in the preceding years, underlines the importance of training personnel in emergency measures. This training must focus in particular on the emergency measures to implement in the event of loss of control of a high-activity source (jamming of the source, for example). Nevertheless, the exercises intended to prepare for and assess the intervention procedures are still insufficiently deployed by the centres (only 67% of the inspected centres have put such exercises in place). 3.3.5  –  Significant events in brachytherapy Seven ESRs concerning brachytherapy were reported in 2016. Furthermore, the jamming of an iridium-192 source in a PDR afterloader without any radiation protection consequences for the staff or patients workers was reported, as was the interruption of an HDR brachytherapy treatment because the patient removed the treatment material. It was decided to stop the treatment. Lastly an error occurred in the dosimetric planning of an HDR brachytherapy treatment resulting in an incorrect treatment time during one session (treatment time underestimated) and underdosing of the area to treat. The analysis of these events underlines that the control of risks in brachytherapy must be based on appropriate quality controls and the implementation of organisational measures to better manage the sources and emergency situations. SUMMARY With regard to treatment safety, the situation in brachytherapy is comparable with that of external- beam radiotherapy. Occupational radiation protection and the management of high-activity sealed sources are considered satisfactory on the whole, but the standard must nevertheless be maintained through continuous training actions. In the current context, increased attention must be devoted to safeguarding access to prevent unauthorised access to these sources. 4 —  Nuclear medicine 4.1  ̶  Presentation of nuclear medicine activities Nuclear medicine includes all uses of unsealed radioactive sources for diagnostic or therapeutic purposes. Diagnostic uses can be divided into in vivo techniques, based on administration of radionuclides to a patient, and exclusively in vitro applications (medical biology). Functional exploration examinations can combine in vitro and in vivo techniques. An investigation conducted in early 2018 with all the nuclear medicine units licensed by the ASN divisions enabled an inventory of the equipment pool in 2017 to be drawn up, and provided information on the number of procedures performed using the different technologies and on the human resources. The data collected for 2017 are presented below. According to this investigation, the total annual number of nuclear medicine procedures in France is about 1,537,000, of which about 900,000 are Single Photon Emission Scintigraphy (SPECT), 125,000 procedures with semiconductor camera detection and about 500,000 positron emission tomography (PET) (see point 4.1.1). • The nuclear medicine units At the end of 2017, this sector comprised 236 nuclear medicine units licensed by ASN. These units group the patient management facilities ( in vivo diagnosis) and in a small number of them, a medical biology activity using unsealed sources ( in vitro diagnosis). Lastly, slightly more than 80 departments participate in research protocols involving humans. The distribution of the nuclear medicine units under the oversight of the ASN regional divisions, of the number of cameras installed (SPECT and PET) and of the number of hospital rooms dedicated to internal targeted radiotherapy (ITR) is shown in Graph 9. Some fifty in vitro diagnostic laboratories were inventoried in 2017, but this number is tending to drop due to the gradual phasing out of this activity in favour of analysis methods that do not use radionuclides. The nuclear medicine facilities are located in public healthcare institutions (40%), in private companies (40%) and in Non-profit Private Healthcare Institutions (ESPIC) (10%), the remaining 10% being managed by Economic Interest Groupings (GIE), Sanitary Cooperation Groupings (GCS) or others. Some 160 licenses were issued by the ASN divisions in 2018. They concerned more particularly changes of cameras or license extensions to allow the use of new radionuclides. • Medical dispensaries When a medical dispensary is authorised in a healthcare centre, the room in the nuclear medicine department in which the radiopharmaceutical drugs are prepared, called the «nuclear pharmacy» or «radiopharmacy», are part of the medical dispensary. There are 128 nuclear pharmacies among the 236 nuclear medicine units in public healthcare institutions and non-profit private healthcare institutions, such as the cancer centres. The radiopharmacist is primarily responsible for managing the radiopharmaceutical drug circuit (procurement, possession, preparation, control, dispensing and traceability) ASN report on the state of nuclear safety and radiation protection in France in 2018  215 07 – MEDICAL USES OF IONISING RADIATION 07