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1. ASSESSMENT BY DOMAIN
1.1 Radiation protection
in the medical field
Radiotherapy
ASN carried out 31 inspections of radiotherapy
departments in the Île-de-France region and the overseas
départements
in 2015.
In the majority of the inspected departments these
inspections revealed progress in the development of
quality assurance procedures and compliance with the
regulatory requirements demanded by ASN. The four
centres which were subject to tightened monitoring in
this respect in 2015 are now compliant. One centre in
which substantial lateness and organisational weaknesses
were observed in a first inspection in 2015 underwent a
tightened monitoring inspection six months later. This
centre will continue to remain under close scrutiny
in 2016.
Two brachytherapy departments display failings in their
compliance with the regulatory requirements relating
to occupational radiation protection. These two sites
will be re-inspected on this theme in 2016 to check that
the measures decided by the departments further to the
2015 inspections have effectively been implemented.
Otherwise, three inspections resulted from events
concerning radiotherapy patients rated level 2 on
the ASN-SFRO scale. Two events concerned errors in
defining the target volumes in the medical prescription
or in delimiting the contours of the organs to treat.
The third event rated level 2 concerned an undetected
overlapping
1
of irradiation fields
2
.
Interventional practices
ASN carried out 41 inspections in 2015 (compared
with 34 in 2014) in the field of interventional imaging
in Ile-de-France and the overseas
départements
.
The inspections during 2015 confirmed the strong
radiation protection implications for patients and
personnel during interventions carried out using
ionising radiation. ASN noted that the way the radiation
protection requirements have been integrated in this
sector varied greatly according to the departments and
specialities. Radiation protection is better integrated in
the medical specialities of interventional cardiology and
neuroradiology, where procedures are carried out in
dedicated rooms with professionals who are more aware
1. Superpositioning
2. Area of the body on which the radiation is projected
during radiotherapy treatment.
of the radiation protection issues than in specialities
in which the practitioners carry out interventional or
fluoroscopy-guided procedures in operating theatres.
As in 2013 and 2014, progress is expected in particular
in the optimisation of doses delivered to patients and
the development of the radiation protection culture
of the operators.
Seven significant radiation protection events were notified
to the Paris division, divided almost equally between
patients and medical staff.
An inspection was carried out in Guadeloupe further
to the notification of a significant radiation protection
event on 10th August 2015. This inspection revealed
serious shortcomings in compliance with the provisions
of the Public Health Code and the Labour Code with
regard to radiation protection of patients and workers.
The effectiveness of the corrective actions put in place
by the centre will be assessed by inspection in 2016.
Nuclear medicine
ASN carried out 21 inspections in 2015, including
five inspections of the commissioning of new facilities.
ASN observed that further progress is still required
in occupational radiation protection, as the risk of
external and internal contamination is often insufficiently
taken into account. With regard to the management of
contaminated effluents and waste, improvements are
required in the conformity of the waste management
plans.
Twenty-three significant radiation protection events
were notified by nuclear medicine departments.
Fourteen events involved errors in the preparation or
injection of radionuclides to the patient, leading to
either administration of the wrong radiopharmaceutical
or an error in the administered dose.
The second professional seminar on the subject of
radiation protection of patients, workers and the
environment in nuclear medicine organised by ASN
was held on 29th September 2015. This seminar was
attended by more than 140 people, including 94 nuclear
medicine professionals from the Ile-de-France region
and the overseas
départements
, that is to say 93% of
the Ile-de France and overseas nuclear medicine units.
Computed Tomography
ASN carried out 16 inspections in computed tomography
in 2015, one of the aims of whichwas to verify application
of the principle of optimisation of doses delivered to
patients. The main area for improvement detected
concerned the training of workers in radiation protection
at the frequency required by regulations. The efforts
made to control the dose delivered to patients must be
continued, particularly through greater involvement
of the medical physicists on the ground.
PARIS DIVISION
284
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