ASN Report 2015

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5.4.3 Management of sources
Themajority of the centres have put in place appropriate
measures for:
• recording themovements of sources (93%of the centres);
• transmitting the inventory of sources to IRSN each
year (86% of the centres);
• managing waste and sources after implanting iodine
seeds, with systematic verification of the remaining
sources (number) with respect to the implanted and
ordered sources (100% of the centres).
Management of the brachytherapy sources is satisfactory;
nevertheless, 85% of the centres inspected in 2014 still
hold expired sealed sources.
5.4.4 Emergency situations and the management
of malfunctions
The majority of the centres have put in place appropriate
measures for:
• internal recording of events foreshadowingmalfunctions
or undesirable situations;
• an organisation allowing the multidisciplinary analysis
of the causes of internal malfunctions or ESRs;
• the implementation of an events management
procedure;
• seeking improvement actions for the analysed events.
Only 68% of the centres monitor improvement actions
following an event or a malfunction.
An event involving source jamming of an HDR
afterloader led to the exposure of workers and a female
patient. This event brought home the importance of
defining emergency measures, particularly within
the framework of the on-site emergency plan, and
of reinforcing worker training in these emergency
measures. Instructions on the risk of source jamming
are provided in the brachytherapy units. However,
exercises to prepare for and assess intervention methods
are very rare. Compliance with the requirements
relative to advanced training in worker radiation
protection for the use of high-activity sealed sources
is judged satisfactory (62% of the centres have carried
out this training). This advanced training must focus
in particular on the emergency measures to implement
in the event of possible loss of control of the high-
activity source (example: jamming of a high-activity
source).
With regard to PDR brachytherapy, the centres have
response procedures if an incident arises. However,
these procedures do not detail all the possible scenarios
for identifying the operations to perform, the people
who can perform them and the response time to
optimise worker and patient protection and thus
avoid inappropriate exposures. Actions are therefore
required in this respect.
5.4.5 Summary
ASN considers that the findings of the inspections carried
out in 2013 and 2014 are encouraging. With regard to
the deployment of a quality management system, the
brachytherapy units benefit from the organisation set
up in external-beam radiotherapy for both worker and
patient radiation protection.
Lateness in the deployment of aids specific tobrachytherapy
is nevertheless observed. Efforts must thus be made
regarding compliance with the regulatory requirements
relative to process mapping, training in patient radiation
protection and advanced training in worker radiation
protectionwhenhigh-activity sources are held, the removal
of expired sources, the scheduling and performance of
internal technical controls of radiation protection, the
completeness of the procedure report, the conducting of
the analysis of risks run by patients and the monitoring
of improvement actions following a significant radiation
protection event.
5.5 Radiation protection situation
in nuclear medicine
Over the period from 2012 to 2014, 263 inspections
were carried out in the 225 in vivo nuclear medicine
units. Comparedwith results established over the 2009-
2011 period, it was observed that the radiation protection
of workers, patients and the environment is taken into
account in an increasingly satisfactory manner.
5.5.1 Radiation protection of nuclear medicine
professionals
The main strong points have been confirmed:
• performance of the risk assessment, even if the risk
of external and internal contamination is not always
taken into consideration;
• implementation of dosimetric monitoring of the
personnel, appropriate for the modes of exposure,
notably the wearing of dosimetric rings and referring
to the recommendations of ORAMED (Optimization
of Radiation Protection for Medical Staff)6;
• the writing of a radiation protection control programme
and the performance of external technical controls;
• the use of automated systems for preparing the doses
and/or injecting radiopharmaceuticals marked with
fluorine-18.
However, particular efforts must still be made in order
to meet the following regulatory requirements:
• the performance of working practices and conditions
analyses for all the professionals involved, taking into
6.
316 CHAPTER 09: MEDICAL USES OF IONISING RADIATION
ASN report on the state of nuclear safety and radiation protection in France in 2015