Recommendations for improving radiation protection in the operating theatre during fluoroscopy-guided interventional procedures

The number of fluoroscopy-guided interventional procedures is constantly increasing, particularly surgical procedures in operating theatres. They bring considerable benefits for the patient but present significant risks in terms of radiation protection, for the medical staff and patients alike.

Although radiation protection during procedures performed on equipment with fixed C-arm units in interventional imaging services has significantly improved, ASN inspections reveal shortcomings with procedures performed in operating theatres. Exposure to ionising radiation in the operating theatre is perceived as a secondary risk compared with risks relating to anaesthesia or infection and other measures of vigilance expected of the medical staff (haemovigilance, identity monitoring, drug safety monitoring, etc.).

Given these findings, ASN called upon the expertise of the Advisory Committee for Medical Exposure (GPMED[1]). The GPMED designated a multidisciplinary group of experts, including health professionals involved in radiation protection in the operating theatre, to put forward recommendations allowing the deployment of practices using radiology C-arm units or mobile computed tomography devices in the operating theatre under satisfactory conditions of radiation protection for the patients and the medical staff.

The group's recommendations were set out in a report and a GPMED opinion in October 2019. The report underlines the generally poor embracing of the radiation protection culture by operating theatre staff. Levers of action have been identified for both the operating theatre medical staff and for the hospital governing bodies to promote this culture.

The recommendations focus on four areas: the quality and the management of radiation risks, the respective responsibilities of the players, radiation protection training and radiation protection tools.

ASN encourages all operating theatre medical staff, hospital decision makers and the general public to read these recommendations.

ASN recently published a document aiming to promote the setting up, within an operating theatre block, of a pragmatic teaching workshop adapted to professional practices and needs, entitled "The theatre of errors". Its aim is to foster collective awareness of radiation protection in medical professionals.

ASN is working with the Ministry of Health to have the recommendations concerning the involvement of medical physicists and radiographers in the operating theatres, and the development and interoperability of operating theatre information systems, taken into account in the new activity authorisation systems.