In 2024, nine events that occurred during therapeutic procedures were notified, five linked to complications associated with either the use of yttrium-90 microspheres (3 ESRs), or cases of extravasation(9) with lutetium-177 (2 ESRs). One “Experience feedback” sheet concerning complications during a liver cancer treatment by radioembolisation using yttrium-90 was drawn up in 2024 in order to share good practices to limit the frequency of occurrence of such events. The other ESRs concern errors in the handling or injection of RPDs (two ESRs with lutetium-177 and two with iodine-131). ASN alerts nuclear medicine departments to the risk of extravasation during therapy with lutetium-177 PSMA which can lead to local exposure to the skin of several grays and necessitate a special medical response. In 2025, ASNR will establish, jointly with the medical professionals, the lessons learned from the notified ESRs. 9. Extravasation is an inappropriate accidental and unintentional injection or leakage of drugs into the perivascular or subcutaneous spaces rather than into the target vascular compartment. Significant events concerning medical professionals (14 ESRs, i.e. 5% of the notified ESRs) Fourteen events concerning nuclear medicine professionals were notified in 2024. They result from contaminations that led to internal or external exposures (surface contaminations as a result of handling errors or reception of a broken vial). None of these ESRs led to exceeding of the regulatory dose limit for the workers concerned, but one was rated level 1 on the INES scale because it led to exposure exceeding, on a one-off basis, a quarter of the regulatory limit for exposure to the extremities. This ESR led to the publication of an incident notification on the ASN website (see box previous page). Significant events concerning the public (19 ESRs, i.e. 7% of the notified ESRs) Eighteen ESRs result from exposure of the foetus in women who were unaware of their pregnancy. The doses received had no consequences for the unborn child. A “Patient safety” bulletin published in 2021 was devoted to this type of event. The 19th ESR concerns a high dose rate (hot spot) detected in a corridor and caused by pipes displaying a high level of crystallisation necessitating specific servicing work to remove the source of exposure. Significant events concerning radioactive sources, waste and effluents (31 ESRs, i.e. 10% of the notified ESRs) These ESRs are mostly related to source losses/discoveries, the dispersion of radionuclides (resulting from overflows of radioactive effluent tanks or leaks in the effluent evacuation circuit), deliveries that do not comply with the licenses and unauthorised discharges of effluents into the environment (emptying of tanks, etc.). Difficulties have recently emerged in the management of the solid waste produced in the ITR treatments of certain prostate cancers with RPDs using lutetium-177, leading notably to the triggering of radiation Non-compliant disposal of radionuclide-contaminated waste from nuclear medicine departments An ESR was notified to ASN in early August 2024 following triggering of the radiation portal monitor on a waste disposal site receiving waste from one of the centres of a hospital group. This ESR follows on from a series of other reports of radiation portal monitor triggering on reception of waste from centres of this same hospital group. Altogether, five containers of waste contaminated by radionuclides used in nuclear medicine where sent to the waste treatment sites without the regulatory waste management by decay requirements having been observed. The nuclear medicine departments that use radioactive preparations for diagnostic or therapeutic purposes routinely produce waste contaminated by radioactive elements. Due to their rapid radioactive decay, these elements lose their radioactivity in a time ranging from a few hours to a few days; consequently, they can only be disposed of in the waste treatment routes after a period of radioactive decay, which is the natural phenomenon of disintegration of the radioactive atoms over time whereby the radioactivity is gradually reduced until it becomes equivalent to the background radiation. Disposal of this waste remains conditional on the results of checks, one of which uses an on-site fixed radiation portal monitor, as defined by ASN resolution 2008-DC-0095 (Articles 15 and 16). The waste treatment centres, pursuant to the regulations relative to Installations Classified for Protection of the Environment, are equipped with radiation portal monitors enabling them to detect any contamination of the waste they receive immediately on reception and to take the necessary measures where applicable for the said waste to be treated via appropriate routes. The analysis of these events revealed firstly a malfunction of the fixed detection system of one centre, and secondly deviations in the disposal procedures, as one container of waste contaminated by radionuclides triggered the detection system of the waste sorting area without having been placed in the radioactive decay area prior to its disposal. ASN rated the last event in the series level 1 on the INES scale due to the repeated nature of the events over a short time frame (4 ESRs in less than three months) and reiterated in the incident notification published on its website the importance of keeping the radiation portal monitors of the areas for sorting waste contaminated by radionuclides in the healthcare centres in good working order, along with the importance of training the operators responsible for sorting this waste in the instructions applicable in the centre. This type of radiation portal monitor triggering event can also occur on reception of radiation-contaminated waste produced by patients in their home after an ITR medical procedure if this waste is disposed of with the household waste without having observed the required decay period, or if the waste contains radionuclides with a longer half-life, as is the case with the metastable lutetium-177 that is sometimes present as in impurity in lutetium-177-based radiopharmaceutical preparations. In view of the large increase in patients receiving ITR treatments, the preference given to out-patient treatment methods and the difficulty in making provisions for the retention and collection of radiationcontaminated waste produced by certain patients in their home, the frequency of these events is tending to increase. The management of such events mobilises considerable resources (intervention of the fire brigade or specialised personnel, additional waste sorting, radiological characterisations, separate management, etc.) and can have highly penalising operational consequences for the household waste collection and management system: in some cases waste collection strikes or refusals to accept waste have been observed, illustrating the major and specific impact that an incident can have from the moment it has a radiological dimension. ASNR urges all the actors concerned (promoters, departments, healthcare centres, professional organisations, local authorities, etc.) to make every effort to put in place the necessary means to reliably prevent the occurrence of these incidents, in a context where a significant increase in ITR treatments is expected in the coming years. 232 ASN Report on the state of nuclear safety and radiation protection in France in 2024 Medical uses of ionising radiation
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