ASN Report 2015

Several appraisals were published in 2015: one on

computed tomography (inspections of 2014), one on

teleradiology (inspections of 2014), one on radiotherapy

(inspections of 2014) andone onnuclearmedicine covering

three years (inspections of 2012, 2013, 2014).

It should be noted that since 2014, ASN checks the

implementation of the assessments of professional

practices exposing persons to ionising radiation for

medical purposes, which is compulsory in application

of Article R. 1333-73 of the Public Health Code

5. This provision entered into effect on 9th November 2007 with

Decree 2007-1582 of 7th November 2007, but the conditions of

implementation were not specified until 2012. In November 2012,

the HAS – in collaboration with ASN and the professionals – thus

published a guide to the evaluation of professional practices

entitled

Radiation protection of the patient and analysis of

professional practices, continuous professional development

and certification of health centres.

ASN’s action plan in the field of medical imaging

In May 2015 ASN published a first assessment of the

programme of actions to control the doses of ionising radiation

delivered to patients during medical imaging examinations.

Faced with the increase in radiation doses used for medical

diagnostic purposes, ASN had effectively adopted a position as

of 2011 on radiation protection in interventional radiology and

computed tomography, and initiated a programme comprising

32 actions involving the health authorities and learned

societies.

As a positive point, ASN underlines the publication of the good

practices guides distributed by the learned societies, particularly

concerning medical imaging and medical physics. These

guides give the professionals the means to reinforce practical

application of the principles of justification of the examinations

and optimisation of doses delivered to patients during these

examinations.

Significant actions have also been initiated with regard to

training:

• the university training of physicians, and more particularly the

initial training given to specialists (surgeons, neurosurgeons,

cardiologists, urologists, rheumatologists, orthopaedic

surgeons, etc.) who make increasing use of X-rays to guide

their surgical procedures, should in the long term include

courses on patient radiation protection;

• the system of continuous training in patient radiation

protection, which has been compulsory since 2004,

TO BE NOTED

is currently being updated with the aim of making it more practical

and extending it to all the health professionals concerned,

and in particular physicians referring patients for radiological

examinations;

• lastly, the training dispensed to operators when new equipment is

acquired should come with recommendations to ensure that the

dose optimisation potential of the new machines is used in full.

The convergence of several actions of ASN’s programme with

those of Cancer Plan 3 covering the 2014-2019 period, published

by INCa in February  2014, should ultimately enable certain

equipment utilisation procedures which help reduce doses delivered

to patients, to be placed under quality assurance, while at the

same time guaranteeing the quality of the images and therefore

the appropriateness of the diagnosis or the reliability of the surgical

procedure.

Shortcomings nevertheless subsist with regard to human resources:

• Although the number of medical physicists has doubled since

2006, particularly to reinforce staff numbers in radiotherapy, ASN

still observes that their involvement, which is necessary to optimise

the doses delivered to patients, particularly during interventional

procedures and in computed tomography, remains too limited.

• Providing a regulatory framework for the conditions of involvement

of nurses in the use of medical imaging equipment in the operating

theatre is also urgent, insofar as they participate in the delivery of

the doses received by the patients.

5.1 Exposure situations

in the medical sector

5.1.1 Exposure of health professionals

The risks for health professionals arising from the use

of ionising radiation are firstly the risks of external

exposure generated by the medical devices (devices

containing radioactive sources, X-ray generators or

particle accelerators) or by sealed and unsealed sources

(particularly after administering radiopharmaceuticals).

When using unsealed sources, the risk of contamination

must be taken into consideration in the risk assessment

(particularly in nuclear medicine).

The prevention of risks of exposure of health professionals

to ionising radiation is required by provisions of the Labour

Code concerning occupational radiation protection.

5.1.2 Exposure of patients

The exposure of patients to ionising radiation must be

distinguished fromthe exposure of workers and the public

insofar as it is subject to no dose limits whatsoever. The

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CHAPTER 09:

MEDICAL USES OF IONISING RADIATION

ASN report on the state of nuclear safety and radiation protection in France in 2015