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The actions relating to the periodic safety review will
continue in the coming years, with, among other
things, examination of the creation authorisation decree
modification file and the request tomodify the resolution
on discharges. ASN asks that the licensees organise
themselves to produce the studies substantiating the
safety of the facilities and meet the commitments given
in the periodic safety review file.
1.2 Radiation protection
in the medical field
Radiotherapy
TheNord-Pas-de-Calais regionhas 12 radiotherapy centres
equippedwith 29 accelerators, most of which are recent,
and implementing innovative techniques. ASNnotes that
for several years now the centres have been involved in a
real drive for progresswith the aimof improving the rigour,
organisation and traceability ofmedical interventions. The
quality approach implemented in the centres is giving
satisfactory results, althoughASNnotes disparities between
centres and a lack of consistency over time.
The seven inspections conductedbyASN in radiotherapy
centres in 2015 more specifically examined aspects
concerning their organisation, the implementation of a
quality management system and the management of the
skills of personnel involved in the delivery of treatments.
ASNobserves that themedical physicist staffing situation is
nowsatisfactoryon thewhole, although it remains unstable
in some centres. Lastly, as in 2014, ASN carried out a
campaign of unannounced inspections in a number of
radiotherapy centres during summer 2015. The aimwas to
verify the requiredminimumpresenceof radiotherapists and
technical personnel (medical physicists and technologists)
during the treatments. Today, all the centres in the Nord
- Pas de Calais region have undergone this verification.
The procedure for recording and analysing adverse events
is now in place in all the centres. However, ASN notes a
loss ofmomentumin the recording and analysis of adverse
and precursory events and the number of notifications
of significant radiation protection events, which remains
relatively low. In2015ASNwas informedof two significant
events rated level 2 on the ASN-SFRO scale relative to
patients.
Applicationof quality assurance to the patient care process
is progressing satisfactorilywith respect to the applicable
regulatoryprovisions. Theproceduresmust be consolidated
by implementing processmanagement verification tools.
Innovative technologies are being increasingly used in
radiotherapy,bringing, amongotherthings,greaterprecision
in treatments (image-guided radiotherapy for example).
ASN asks that the centres conduct an in-depth reflection
on the way their teams embrace these technologies.
Lastly, ASN notes that in the two brachytherapy centres,
the procedures for ensuring treatment quality and safety
are not as advanced as in the radiotherapy departments.
Interventional practices
In 2015, ASN carried out six inspections in the area of
interventional practices, particularly inoperating theatres.
Interventional practices involve invasivemedical procedures
– for diagnostic or therapeutic purposes – guided using
ionising radiation (see chapter 9, point 1.1.2). ASN has
notedprogress in the use of personal protective equipment
bymedical staff. Further efforts are nevertheless required,
notably in thewearing of dosimeters – by practitioners in
particular, in training in radiation protection of workers
and patients, and in the optimisation of doses delivered
to patients.
ASN’s inspections in interventional practices are based
on a study carried out in 2013 with centres in the region
performingprocedures inoperating theatres anddedicated
rooms This study served to enhance knowledge of the
interventional practices in the region, to study current
practices for protecting patients and personnel against
ionising radiation, and to gain a better understanding of the
medical specialities as awhole and themajor implications
of radiation protection for personnel and patients.
ASN observes currently that interventional practices are
beingusedmore andmore and that theyhave considerably
evolvedover the last fewyears. They present two-pronged
radiation protection risks: exposure of the practitioner
and the medical team, which can be significant, and
exposure of thepatient, particularlyduring longor repeated
procedures. ASN’s 2014 survey of interventional practices
in the Nord - Pas-de-Calais region reveals considerable
roomfor progress in addressing these risks, particularly by
optimising equipment parameters which enables patient
and worker exposure to be reduced.
Nuclear medicine
ASN carried out nine inspections in the field of nuclear
medicine in 2015. These inspections reveal progress in
the integration of radiation protection rules, but ASN
considers that it is nevertheless still too slow. Progress
is required more specifically in occupational radiation
protection, essentially in the defining of radiological
zoning and the analyses of working practices and
conditions. The management of liquid effluents can
also be improved. Lastly, ASN notes that the centres are
committed to a patient dose monitoring and optimisation
approach.
Computed Tomography
ASN’s inspections of computed tomography facilities
involved four centres in 2015. During these inspections
ASN found that, on the whole, occupational radiation
protection rules are applied satisfactorily. ASN
nevertheless notes that improvements must still be
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CHAPTER 08 :
REGIONAL OVERVIEW OF NUCLEAR SAFETY AND RADIATION PROTECTION
ASN report on the state of nuclear safety and radiation protection in France in 2015