portal monitors in the sorting centres for waste coming from hospitals (see box previous page) or private individuals. The patient is given instructions on leaving the nuclear medicine department regarding the management of the waste produced at home (sanitary protections, for example) in the days following treatment, including storage of their waste in the home for several weeks. At present these instructions are not harmonised nationally. Storage of this type of waste in the home can be difficult (lack of space or a suitable area). Consequently, it can happen that waste arrives at the waste treatment facilities before the time indicated in the patient’s discharge instructions has lapsed, triggering the radiation portal monitors. Solutions have been proposed by domestic waste treatment centres, such as providing patients with larger-volume collectors and having them picked up by a door-to-door service, while at the same time enhancing patient awareness. Further to an increase in the triggering of radiation portal monitors at the entrance to waste treatment centres, linked to the introduction of new RPDs (especially those containing lutetium-177), ASN initiated studies in 2024, assisted in particular by the GPRP and a WG comprising representative of the French Society of Nuclear Medicine and Molecular Imaging (SFMN), IRSN, DGS, DGOS, ANSM, the General Directorate for Risk Prevention (DGPR) and Departmental Fire and Emergency Services (SDIS). The aim of these studies is to identify areas for improvement to better manage these situations and to propose information to enhance communication, particularly with the waste management professionals. 2.4 Fluoroscopy-guided interventional practices Fluoroscopy-Guided Interventional Practices (FGIPs) group all the imaging techniques using ionising radiation for the purpose of imaging, guidance or verification, for performing invasive medical or surgical procedures for diagnostic, preventive or therapeutic purposes. The practices are therefore based on the use of real-time radiological imaging to guide precise and mini-invasive medical operations. Today it is possible to treat patients previously considered inoperable or who required major surgical operations. The patients thus benefit from less traumatic procedures with shorter recovery times and lower risks of complications. These medical practices have been evolving constantly for several years now, and are used for an ever-increasing number of pathologies, providing opportunities for new therapeutic and diagnostic possibilities. Due to their interventional nature, these procedures are carried out in two separate environments – either operating theatres or interventional imaging departments – depending on the target and the pathology. Fixed interventional radiology rooms have been designed and fitted out taking into account the utilisation of ionising radiation. This is not the case for all operating theatres, which are gradually being brought into compliance. On account of the exposure levels involved, as much for the patients as for the professionals who can be obliged to work close to the radiation sources, and the increase in the number of procedures performed using ionising radiation, FGIPs and operating theatres in particular, due to a less well-developed radiation protection culture, are part of ASN’s national inspection priorities. 2.4.1 Description of the techniques The healthcare centres According to the codes of the common classification of medical procedures and the activity data notified by the healthcare centres to the Agency for Information on Hospital Care (AIHC), about 900 centres perform FGIPs involving risks with regard to radiation protection in one or more disciplines. The risk-prone FGIPs include cardiology (implanting pacemakers and defibrillators, angioplasty, etc.), interventional neurology (embolization of arterioveinous malformation), vascular radiology (embolization of the coeliac artery), or uterine embolization. Graph 10 shows the breakdown of the number of centres by FGIP category for the centres SUMMARY The inspections carried out in 2024 in a quarter of the nuclear medicine departments, considered alongside those carried out over the 2020-2024 period, enabling all the departments to be covered, reveal – despite progress in the training of the medical professionals – a less satisfactory occupational radiation protection situation in 2024, particularly in the monitoring and analysis of exposure of the professionals, in the workplace verifications and the equipment and sealed sources. Three inspections conducted with IRSN experts during which measurements were taken indicate good overall control of the contamination risk in the inspected departments. The inspections in 2024 confirm, as in the preceding years, that particular attention must be paid to observance of the statutory provisions concerning effluent management (particularly the verification of the decay tank alarms and their transfer outside working hours) and of the waste produced by the patients, associated with the introduction of new radiopharmaceutical drugs which can cause triggering of radiation portal monitors at the entrance to waste treatment facilities. With regard to patient radiation protection, implementation of the principle of optimisation with the collection and analysis of DRLs has improved. Further progress is needed in the deployment of the QMS’s and in the quality of the ESR analyses. The ESRs reveal that the drug preparation and administration processes, particularly the utilisation of the dose calibrator, must be regularly assessed in order to control the medication circuit (see Patient safety bulletin “Safeguarding the medication circuit in nuclear medicine”). In addition, measures to prevent the risk of extravasation and to treat patients if such a situation arises, must be defined in all the departments because these situations can lead to significant exposure at the injection site. The growing emergence of clinical trials involving new vectors and new radionuclides (lutetium-177, actinium-225, holmium-166, etc.) makes it necessary to deepen knowledge of the associated radiation protection risks, not only for the patients and their family circles, but also for the medical professionals, the public and the environment. ASNR will publish an opinion in 2025 based on the opinions of the experts it has consulted and the work undertaken with all the actors concerned. The commitment and collaboration of all the stakeholders – inspection agencies, manufacturers, promoters, investigators, healthcare service providers and professional associations – is essential to allow the development of innovation in a safe environment for the benefit of the patients. Lastly, ASNR will adapt the frequency of its inspection in 2025, to five years for departments performing diagnostic procedures only and three years for departments performing therapeutic procedures, and will continue the inspections with measurement campaigns to assess the control of the contamination risk in nuclear medicine departments. ASN Report on the state of nuclear safety and radiation protection in France in 2024 233 Medical uses of ionising radiation 07 01 02 03 04 05 06 08 09 10 11 12 13 14 15 AP
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