ASN Report 2015

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Diagnostic reference levels
The Diagnostic Reference Levels (DRL) are one of the
tools used for dose optimisation. As required in Article
R. 1333-68 of the Public Health Code, the DRL are
defined in the Order of 24th October 2011 concerning
diagnostic reference levels in radiology and nuclear
medicine. For radiology, this consists of dose values,
while for nuclear medicine it consists of activity levels
administered in the course of the most common or
most heavily irradiating examinations. Depending on
the type of examination, periodic measurements or
readings shall be taken in each radiology and nuclear
medicine unit.
Dose constraints
In the field of biomedical research, where exposure to
ionising radiation is of no direct benefit to the persons
exposed, dose constraints designed to optimise the doses
delivered must be established by the medical doctors.
Medical radiation physics
The safety of radiotherapy and optimisation of the doses
delivered to the patients in medical imaging require
particular expertise in the field of medical physics. The
employment of a SpecialisedMedical Radiation Physicist
(PSRPM), formerly called a “radiophysicist”, has been
extended to radiology, having already been compulsory
in radiotherapy and nuclear medicine.
The duties of the PSRPM were clarified and broadened
by the Order of 19thNovember 2004. Thus the medical
radiation physicistsmust ensure the appropriateness of the
equipment, data and computing processes for determining
and delivering the doses and activity levels administered to
the patient in any procedure involving ionising radiation. In
the field of radiotherapy, they guarantee that the radiation
dose received by the tissues due to be irradiatedmatches
that prescribed by the prescribing physician.
Furthermore, they estimate the dose received by the
patient during diagnostic procedures and play a part
in quality assurance including inspecting the quality of
the medical devices.
Temporary criteria determining the conditions for the
presence of radiation physicists in radiotherapy centres
have beendefined by decree (Decree 2009-959 of 29th July
2009). Since the end of the transitional period (May
2012), the criteria defined by theNational Cancer Institute
(INCa) are now applicable pursuant to Decree 2007-
388 of 21st March 2007, and in particular the criterion
concerning the obligatory presence of a radiation physicist
during the treatment sessions.
Since 2005, heads of facilities have had to drawup plans
for medical radiation physics, defining the resources
allocated, primarily in terms of staffing, in the light of the
medical procedures carried out in the establishment, the
actual or probable patient numbers, existing dosimetry
skills and resources allocated to quality assurance and
control.
The conditions of training of the PSRPMs were updated
by the Orders of 28th February and 6thDecember 2011.
In the same way as the physician or the radiographer, the
PSRPMcan be designated as the PCR by the employer in
accordance with the Labour Code. In operating theatres
using X-ray generators, optimisation of the doses delivered
to the patients, which is the competence of the PSRPM,
contributes to optimisation of the doses delivered to the
professionals performing the procedure.
Radiotherapy quality assurance
The quality assurance obligations of radiotherapy
centres, provided for in Article R.1333-59 of the
Public Health Code, were specified by ASN resolution
2008-DC-0103 dated 1st July 2008, which mainly
concerns the Quality Management System (QMS),
the management’s commitments as stipulated in the
QMS, the documentary system, staff responsibility, the
analysis of the risks incurred by the patients during
the radiotherapy process, and the identification and
handling of undesirable situations or malfunctions,
whether organisational, human or equipment-related.
These obligations entered into force in September 2011.
Medical imaging quality assurance obligations also appear
in the Public Health Code but have not yet been clarified
by an ASN resolution. Faced with the regular increase
in the doses of ionising radiation delivered to patients
over the past decade, ASN intended to publish this
resolution in 2017. This action is part of the Cancer
Plan 3 adopted by the Minister responsible for Health
in January 2014.
SPECIALTIES
MEDICAL RADIOLOGY NUCLEAR MEDICINE RADIOTHERAPY DENTAL RADIOLOGY
DOCUMENTS Procedure guide Referral criteria for imaging guide Referral criteria for imaging
and procedure guide
External radiotherapy procedure
guide
Referral criteria for imaging
and procedure guide
AVAILABLE ON
TABLE 1: List of Referral Criteria for Imaging and Procedure Guides for the performance of medical procedures entailing exposure to ionising radiation
104 CHAPTER 03: REGULATIONS
ASN report on the state of nuclear safety and radiation protection in France in 2015