ASN Report 2018

5 —  Interventional practices using ionising radiation 5.1  ̶  Overview of the techniques and the equipment Interventional practices using ionising radiation (fluoroscopy- guided interventional practices) group « all the techniques using ionising radiation to perform invasive medical or surgical procedures for diagnostic, preventive and/or therapeutic purposes, and surgical and medical procedures using ionising radiation for the purpose of guidance or verification ». • The equipment The equipment items used are either fixed C-arm devices installed in the interventional imaging departments in which vascular specialities (neuroradiology, cardiology, etc.) are carried out, or mobile C-arm radiology devices used chiefly in operating theatres in several surgical specialities, such as gastroenterology, orthopaedics and urology. The detectors present on the devices with C-arms are image intensifiers or flat panel detectors. These devices employ techniques that use fluoroscopy and dynamic radiography (called “photofluorography”, or “cineradiography”) intended to produce high-resolution spatial images. After injecting a contrast agent, practitioners can also use the subtraction method to obtain images. Surgeons have recently started to use CT scanners, sometimes mobile, in the operating theatre. This type of equipment helps the practitioner perform the procedure by providing multi-plane images allowing virtual navigation. These scanners however are not equipped with the latest dose reduction technologies. The personnel most often work in the immediate proximity of the patient and are also exposed to higher dose levels than in other interventional practices. In these conditions, given the exposure risks for both the operator and the patient, practices must be optimised to reduce doses and ensure the radiation protection of operators and patients alike. • The healthcare centres On the basis of the codes of the common classification of medical procedures and the activity data reported by the healthcare centres to the Agency for Information on Hospital Care (AIHC), 901 centres performing fluoroscopy-guided interventional practices involving risks (with regard to radiation protection) in one or more disciplines have been inventoried. The distribution of the number of centres by category of fluoroscopy-guided interventional practice is shown in Graph 12. 5.2  ̶  Technical rules for the fitting out of medical rooms The rooms in which fluoroscopy-guided intervention procedures are carried out, operating theatres and interventional imaging rooms must be organised in accordance with the provisions of the new ASN technical resolution 2017- DC-0591 of 13 June 2017 mentioned in point 4.2. ASN has noted that the interventional radiology departments comply with this resolution to a greater extent than the operating theatres. 5.3  ̶  Radiation protection situation in fluoroscopy-guided interventional practices For several years now, significant radiation protection events have been regularly notified to ASN in the area of fluoroscopy- guided interventional practices. Although these events represent just a small proportion of all the medical events reported to ASN, they most often have serious consequences with the occurrence of tissue damage (radiodermatitis, necrosis) in patients having undergone particularly long and complex interventional procedures. In addition to these events, which underline the major radiation exposure risks for the patients, are those concerning professionals, whose exposure can lead to the exceeding of regulatory limits, particularly at the extremities (fingers). On account of the radiation exposure risks, ASN has increased the number of inspections it carries out in this sector in the last few years. In 2018, 243 inspections were carried out in interventional imaging departments (rooms dedicated to interventional vascular and osteoarticular radiology, to neuroradiology and to cardiology) surgical departments (operating theatre) performing fluoroscopy-guided interventional procedures. • Characteristics of the inspected centres and departments Within these 243 inspected centres, 342 departments were visited (202 operating theatre departments, 46 cardiology - coronary angiography departments, 50 cardiology - rhythmology Breakdown of the number of centres by category of fluoroscopy-guided interventional practices 0 100 200 300 400 500 600 700 800 900 FGIP in orthopaedic surgery FGIP in urological surgery FGIP in gastroenterology FGIP in vascular surgery FGIP in coronary cardiology FGIP in cardiology/rhythmology FGIP on the spine Intracranial FGIP FGIP: fluoroscopy-guided interventional practices. Diagram 12 ASN report on the state of nuclear safety and radiation protection in France in 2018  221 07 – MEDICAL USES OF IONISING RADIATION 07