ASN Report 2015

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in an ASN circular letter dated 24th March 2014 7 , has
already highlighted substantial reductions in delivered
doses, ranging from40 to 70%, following the optimisation
measures implemented by the medical physicist.
These findings confirm insufficient application of the
optimisation principle and can lead to potential risk
situations.
5.7.3 Summary
As in 2014, ASN considers that the urgent measures it
has been recommending for several years to improve
the radiation protection of patients and professionals
in the exercise of interventional practices, particularly
in operating theatres, have still not been taken. These
measures concern increasing medical physicist staff
numbers and user training and quality assurance,
organising professional practice audits, increasing the
means allocated to PCRs, trainingmedical professionals
in patient radiation protection and the publication of
good practices guides by the learned societies.
In the field ofmedical physics inparticular, the effortsmade
since 2007 to boost the numbers of medical physicists
must be continued in order tomeet the medical imaging
needs.
ASN also asked the HAS (French National Authority
for Health) to draw up national recommendations for
monitoring patients having undergone interventional
radiology procedures that could lead to effects on tissues.
These recommendations were published in 2014 by the
HAS8. In connectionwith this publication, ASNconsiders
that the implementation of dosimetric reviews in order
to establish reference levels for the most common and/
or most irradiating procedures is to be continued for all
the specialities, and in particular in the operating theatre.
These evaluations will enable physicians to analyse their
practices and initiate appropriate patient monitoring if
necessary.
The reviewof the actions recommended byASN inmedical
imaging, published in 2015, provided the opportunity
to assess the situation concerning specific subjects in
the interventional areas, such as the issuance of good
practice guides for the various specialities, the training
of medical professionals in patient radiation protection,
the definition of DRLs, or the increase inmeans assigned
to the PCRs.
Due to the implications - as much for the radiation
protection of professionals, where limit exceedances are
still observed, as for that of patients, where significant
7.
interventionnelle/Lettres-circulaires-en-radiologie-interventionnelle
8. “Improving patient monitoring in interventional radiology and
fluoroscopy-guided procedures – reducing the risk of deterministic
effects”.
radiation protection events are notified - and because of
the shortcomings in the radiation protection culture of
medical workers, particularly in operating theatres, ASN
is maintaining the inspection of interventional radiology
as a national priority in its 2016 inspection programme.
6. OUTLOOK
In radiotherapy, themeasures taken since 2007 concerning
human resources and in the areas of training, equipment
control, quality and risk management, have enabled the
safety of treatments to be improved. However, although
ASN’s inspections enable the progress of the centres to
be measured, weaknesses are still observed in quality
management and risk management. The reason for this
is that although the quality systems are becoming more
precise and effective as time goes by and risk analyses
are spreading, quality and risk management are not
sufficiently assessed and their integration into working
practices is proving difficult. The events notified to ASN
underline the major radiation protection implications
of hypofractionated treatments for the patients.
With regard to the recommendations issued by the
GPMED on the conditions of implementation of high-
precision irradiation techniques in radiotherapy and
the associated practices, particularly those leading
to the delivery of hypofractionated treatments, ASN
will undertake – with the Ministry responsible for
Health, the INCa, the HAS and the learned societies –
the necessary actions to reinforce the safety and the
protection of patients during their implementation.
ASN will be particularly attentive to the monitoring of
these actions, especially those concerning adaptation
of the means necessary for the deployment of these
new techniques or practices, the implementation of the
clinical audit procedures, the prospective collection of
data concerning the patients so that the benefits and
the risks can be assessed, and involving the patients
more actively in their personal safety.
2015 saw the completion of the four-year (2012-2015)
inspection programme for the radiotherapy centres. The
newASN inspection programme for the years 2016-2019,
taking into account the recommendations made by a
working group comprising radiotherapy professionals,
will be widely communicated at the beginning of
2016. Risk management - particularly the evaluation
of the organisational and human barriers put in place,
hypofractionated treatments and the deployment of
new techniques or practices will be the focal points of
its inspections.
Verification of the control of doses in medical imaging
still remains a priority for ASN, particularly when
associated with interventional practices. The recent and
rapid development of new imaging techniques and their
implementation by specialists (surgeons, neurosurgeons,
320 CHAPTER 09: MEDICAL USES OF IONISING RADIATION
ASN report on the state of nuclear safety and radiation protection in France in 2015