315 / 536
5.4 Radiation protection situation
in brachytherapy
Fourteen inspections were carried out in brachytherapy
in 2014 (about 22% of the centres).
5.4.1 Worker radiation protection
Themajority of the centres have put in place appropriate
measures for:
•
having a PCR designated by the employer (100% of
the centres);
•
defining the PCR’s duties (100% of the centres) and
resources (100% of the centres) ;
•
passive dosimetry monitoring of workers that could
be exposed (100% of the centres);
•
active dosimetry monitoring of personnel working in
controlled areas (95% of the centres).
The organisation put in place by the brachytherapy units
for worker radiation protection is judged satisfactory.
93% of the brachytherapy units inspected in 2014 have
a PCR dedicated to this activity. The inspectors noted
that the necessarymeans for fulfilling their assignments
were available in 100%of the centres inspected in 2014.
Training actions for paramedical personnel are held at
the required frequency on the whole. However, training
in worker radiation protection is rarely provided for
physicians andmedical physicists. The radiationprotection
of nurses present in the brachytherapy unit, when they
belong to a structure other than the radiotherapy centre
concerned, needs to be improved (training, dosimetric
monitoring, analysis of working practices and conditions).
The external technical verifications of radiation protection
are carried out in 86% of the centres inspected. Only
63%of the centres inspected perform internal technical
verifications and produce a technical schedule for the
verifications.
Progress is required in the performance of analyses of
working practices and conditions (carried out in 8% of
the centres inspected in 2014).
5.4.2 Radiation protection of patients
The treatment quality and safety
management system
Themajority of the centres have put in place appropriate
measures for:
•
appointing the manager of the treatment quality and
safety management system (93% of the centres);
•
producing the document management procedure;
•
internal communication.
The inspections performed since 2013 have shown that
two requirements concerning the implementation of the
care quality and safety management system have not
been satisfactorily met. They concern the formalising
of process mapping which is only carried out in 64% of
the inspected centres, and the conducting of the analysis
of risks run by the brachytherapy patient.
Although the brachytherapy units are assisted by
the external-beam radiotherapy departments in the
deployment of the quality approach, further progress
is required.
Training and information
Training in patient radiation protection hasmade progress
and is carried out in 89%of the centres inspected in 2014.
Themandatory inclusion of the necessary information in
the report formedical procedures using ionising radiation
was not considered satisfactory for the inspections carried
out in 2014. More specifically, in 62% of the centres
the reports did not contain any information on the
identification of the treatment device.
Maintenance and quality controls
In 2014, themajority of the centres had an inventory of the
medical devices and a register for recordingmaintenance
operations and quality controls. In 20%of the inspected
centres however, the organisation for carrying out and
tracking maintenance operations and quality controls
remains to be finalised. It was notedmore specifically that
the traceability of the internal verifications andmaintenance
operations is not always ensured satisfactorily.
In the absence of an ANSMdecision defining the quality
controls for brachytherapy devices, the nature of the
quality controls results from past practices and is based
on recommendations provided by devicemanufacturers
or professionals.
Maintenance of the HDR and PDR afterloaders is ensured
by themanufacturers. More specifically, themanufacturers
perform the afterloader operating verifications when the
sources are replaced. The brachytherapy units rely on
these verifications to guarantee correct operation of the
devices. The source activity is verified at each delivery
and source removal verifications are also carried out.
315
CHAPTER 09:
MEDICAL USES OF IONISING RADIATION
ASN report on the state of nuclear safety and radiation protection in France in 2015