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forum for expression and free questioning on the texts
applicable to the BNIs, shedding light and introducing
perspectives on the issues which arise in practice and
fostering the sharing of experience between licensees.
1.2 Radiation protection
in the medical field
Radiotherapy
ASN carried out 13 inspections in external-beam
radiotherapy and brachytherapy in 2015. A target volume
error during a second stereotactic radiotherapy treatment
resulted in an event rated level 2 on the ASN-SFRO scale.
ASN considers that the setting up and effective
implementation of a treatment quality and safety
management system are on the whole satisfactory.
Improvements are still required in the interconnection
between specified requirements to be satisfied and studies
of the risks run by the patients.
ASNexpects improvements in the implementation of true
multi-year training plans with inputs from the annual
personnel interviews in particular, in the preparation of
medical physics organisation plans that are representative
of staffing requirements and not staff numbers present,
and in conductingmanagement reviews that take account
of experience feedback, audits and the measurement of
patient satisfaction.
Several centres are putting in place new treatment
techniques or new equipment, the project management
culture being insufficiently developed. Improvements
are expected in the identification of specific training and
documentation needs.
ASN also expects to see progress in the performance of
external quality controls and audits of the internal and
external quality controls.
One radiotherapy centre had been summoned by ASN
in 2014 further to an inspection which revealed failure
to meet several commitments. The efforts made to meet
the commitments given following this summons were
measured during a new inspection at the end of 2015.
Interventional practices
ASN carried out 11 inspections focusing on interventional
practices in 2015 (see chapter 9, point 1.1.2). Although
it was found that radiation protection is well catered
for in small structures, some major centres did not
demonstrate satisfactory involvement in this matter.
This particularly concerns the operating theatres of the
medico-technical building of the La Timone Hospital in
Marseille, for which ASN noted the recent putting into
service of operating theatres that do not comply with
the regulatory provisions in effect.
ASN observes a pronounced lack of radiation protection
culture in the operating theatres, particularly among
the medical staff. The main weaknesses in the radiation
protection of patients concern the medical physics
organisation plan, the generally insufficient number
of medical physicists and technologists, the technical
training of the practitioners in the use of themachines, the
writing of protocols from the most common procedures,
the indication of the dosimetric information in the
procedures reports, the performance of dosimetric reviews
and the post-interventional follow-up. With regard to
occupational radiation protection, weaknesses are noted
in the zoning, the collective protective equipment, the
provision andwearing of dosimeters and the performance
of radiation protection technical controls.
Nuclear medicine
ASN carried out six inspections in nuclear medicine in
2015. The generally positive dynamics regarding the
integration of radiation protection within the inspected
services is maintained.
The departments coming under the competence of the
Marseille division have increasingly modern premises
and equipment, with the relocating of departments
and replacement of old equipment. Thus, more than
30 authorisations were delivered in 2015 or under
examination as at 31st December 2015, which is a
relatively significant increase with respect to 2014. The
year 2015 was marked by the follow-ups to the case
concerning the nuclear medicine unit of the La Timone
Hospital inMarseille, particularly the compliance notice
issued in 2014. ASN considers that AP-HM (Public
Assistance - Marseille Hospitals) must continue its
efforts to bring this unit into compliance regarding
the radiation protection requirements for persons and
the environment.
With regard to waste and effluent management,
significant improvements were noted in the content of
themanagement plans, which represent the starting point
for putting in place preventive measures for monitoring
the radioactive pipes. ASN also notes that the majority
of the units have mapping of the pipes constituting the
contaminated effluents collection system. With regard
to delivery of an authorisation to discharge waste water
other than domestic water into the public network, about
one third of the units have such an authorisation. The
other units have at least undertaken to make contacts
in order to obtain this authorisation.
In addition, all the centres now have a programme
of periodic regulatory checks and better compliance
with the frequency of these checks is noted. Progress is
however still required with regard to the contamination
checks when leaving controlled areas.
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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