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5.6 Radiation protection
situation in conventional radiology
and computed tomography
ASNhasmaintained the oversight of radiation protection
in computed tomography among its priorities because
CT examinations contribute significantly to the exposure
of the French population to ionising radiation of medical
origin. In 2012, computed tomography procedures
effectively accounted for 71%of the mean effective dose
received by the population, although they represent just
10% of the volume (see chapter 1).
Inspection results
In 2014, a new sample of 98 computed tomography
facilities was inspected. The inspection results confirm the
year-on-year trends which reveal a radiation protection
situation that is more satisfactory for workers than for
patients. Examination of the trends recorded on the
367 facilities inspected over the 2011 to 2014 period
(36%of the pool) confirms this assessment by highlighting
amore pronounceddeficiency in the practical applicationof
the principle of justification inpatient radiationprotection.
With regard to the assessment of professional practices,
70% of the inspected units conducted an assessment.
This is based essentially on the compulsory listing and
analysis of the diagnostic reference levels. To a lesser
extent, the computed tomography assessments focused
on the implementation of the principle of justification
(conformity of the imaging request and relevance of the
imaging examinations for diagnostic purposes).
Improvements are necessary, and more particularly by
reinforcing the analysis prior to referral for examinations,
the training of the personnel concerned in the radiation
protection of patients, the optimisation of the examination
protocols provided with CT scanners, the analysis of the
dosimetric data transmitted to IRSN for DRL updating,
and the assessment of professional practices. In 2014, ASN
initiated a first assessment of the radiation protection of
patients undergoing computed tomography examinations
by teleradiologywhich revealed shortcomings, particularly
in the practical application of the principle of justification.
In 2013, ASN asked the GPMED to establish
recommendations on measures to improve the
participation of imaging centres in the collection and
analysis of dosimetric data associatedwith theDRLs and on
any changes to be considered in the regulatory provisions
for radiology and nuclear medicine. The opinion of the
GPMED was published in 2015 and an update of the
Order of 24th November 2011 is expected in 2016.
ASN remains highly involved in the activities of
the HERCA working group responsible for medical
applications of ionising radiation and for which it ensures
the technical secretariat. This working group held two
seminars in 2015, one involving the stakeholders in
the application of the principle of optimisation, while
the other allowed discussions on inspection practices
in the field of imaging.
5.7 Radiation protection situation
in interventional practices
For several years now, significant radiation protection
events have been regularly notified to ASN following
the appearance of lesions (radiodermatitis, necrosis) in
patients having undergone particularly long and complex
interventional procedures. In addition to these events
which emphasise the major implications of radiation
protection for patients, onemust consider the notifications
concerning professionals whose exposure sometimes
exceeds the regulatory limits.
The verification of radiation protection in the area of
interventional practices has been a priority for ASN
since 2009.
The appraisal of radiation protection in radiology is based
on indicators allowing an assessment of the implementation
of the regulations relative to the radiation protection of
the medical staff and the patients and the regulations
concerning the medical devices (maintenance, quality
inspection, dose measuring systems).
5.7.1 Radiation protection of interventional
radiology professionals
The findings established on completion of the inspections
in 2014 confirm the observations made over the last few
years. Thus, radiation protection of medical staff is still
applied to a greater extent in the fixed and dedicated
radiology facilities (interventional radiology) than in
the operating theatres in whichmobile devices are used.
The inspections on the whole still reveal inadequacies
in the performance of the analyses of working practices
and conditions, particularly with respect to doses to the
extremities and to the lens of the eye, and in dosimetric
monitoring (active and at extremities).
The lack of training of medical staff, especially private
practitioners, working in operating theatres is a fact and
a poor radiation protection culture can be observed in
this sector. Moreover, collective radiation protection
equipment is available for the dedicated activities, but still
too rarely in operating theatres. With regard to Personal
Protective Equipment (PPE), it is available and is worn,
with the exception of lead glasses. Furthermore, the
personnel in question show little concern for their own
radiation protection and are not aware of the doses they
can and/or do receive, due in particular to the failure to
wear the appropriate and regulatory dosimeters.
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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