Another ESR was notified further to the use of X-rays with an extracorporal lithotripsy device on a patient by a person external to the hospital who was neither a physician nor a radiographer. The utilisation of X-rays on the human body in this way breaches the provisions of Article R. 1333-68 of the Public Health Code. ASN conducted an inspection within the service provider company further to this event Analysis of the events reveals diverse causes such as a lack of protocol optimisation, inappropriate utilisation of the devices by the operators revealing deficiencies in operator training and the importance of implementing a specific work task qualification procedure. These weak points constitute areas for improvement. ASN reiterates the importance of the radiation protection culture and compliance with its rules, in particular the providing of all the tools allowing the optimisation of practices, the use of personal and collective protective equipment, and compliance with the rules concerning the wearing of passive and active dosimeters, including their stowage on the panels provided for this purpose, for exposure monitoring and reactive alert in the event of abnormal exposure. Lastly, events were notified concerning accidental exposures of the foetus of pregnant women unaware of their pregnancy, who underwent a therapeutic procedure in the pelvic region. A “Patient safety” bulletin entitled Ionising radiation: limiting the exposure of women who are unaware of their pregnancy published in 2021 addressed the lessons learned specifically from this type of event. 2.5 Medical and dental radiodiagnosis 2.5.1 Overview of the equipment Medical radiodiagnosis is based on the principle of differential attenuation of X-rays in the organs and tissues of the human body. The information is collected on digital media allowing computer processing of the resulting images, and their transfer and filing. Diagnostic X-ray imaging is one of the oldest medical applications of ionising radiation; it encompasses all the methods of morphological exploration of the human body using X-rays produced by electric generators. It occupies an important place in the field of medical imaging and comprises various techniques (conventional radiology, radiology associated with interventional practices, computed tomography, mammography) and a very wide variety of examinations (retroalveolar, radiography of the thorax, chest-abdomen-pelvis CT scan, etc.). The request for a radiological examination by the physician must be part of a diagnostic strategy taking account of the patient’s known medical history, the question posed, the expected benefit for the patient, the examination exposure level and the dose history and the possibilities offered by other non-irradiating investigative techniques. The French Society of Radiology and Medical Imaging issues a Guide for Radiology and Medical Imaging Examination Referrals (ADERIM) to enhance the relevance of the examinations requested by referring physicians. If the dose delivered does not in itself represent a radiation protection health risk, it is the large number of examinations carried out among the population that contributes significantly to the collective dose of medical origin. 2.5.1.1 Medical radiodiagnosis Conventional radiology Conventional radiology (producing radio- graphic images, or radiographs), if considered by the number of procedures, represents the large majority of radio- logical examinations performed. The examinations mainly concern the bones, the thorax and the abdomen. Conventional radiology can be carried out in fixed facilities reserved for diagnostic radiology or, in certain cases, using portable devices if justified by the clinical situation of the patient. Angiography This technique, used for exploring blood vessels, involves injecting a radio-opaque contrast agent into the vessels which enables the arterial (arteriography) or venous (venography) tree to be visualised. Angiography techniques benefit from computerised image processing (such as digital subtraction angiography). SUMMARY The inspections conducted in 2024 in the area of FGIPs, considered with those performed over the period 2019-2023, allowing coverage of all the facilities considered to have radiation protection risk implications, reveal the fact that radiation protection makes very little progress from one year to the next, with a situation that still remains better in the interventional imaging departments than in the operating theatres. In most facilities, the premises are slowly being brought into conformity to comply with the technical design rules, even though these modifications are essential in order to prevent the occupational risks. Even if the appointment of RPE-Os, the delimiting of restricted areas, the performance of technical verifications and quality controls of MDs are considered satisfactory, deviations from the regulations are still frequently observed, in the radiation protection of the professionals and patients alike, with unsatisfactory situations concerning training in occupational and patient radiation protection and the coordination of prevention measures during concomitant activities, particularly with private practitioners. The inspections of employer private practitioners highlighted nonconformities with regard to the occupational radiation protection obligations and the fact that they were poorly aware of their responsibility, as employers, with respect to the protection of themselves and their employees. ASN found moreover that several medical centres were using MDs that were not registered and decided to take enforcement action by giving one hospital formal notice to submit a registration application immediately. ASN observes that the trend noted in 2023 is developing and that the centres are turning increasingly to RPOs, either as specialised contributors to assist an internal RPE-O, or as an RPE and that this outsourcing, if it is not adequately managed, leads to a dilution of the responsibilities of the RNAs and poorer assimilation of, or even a deterioration in radiation protection. Although the use of medical physicists and formalising of the POPMs is gaining ground, further progress must be made in the implementation of the optimisation procedure, particularly in the operating theatres where doses are still insufficiently analysed and inappropriate or non-existent protocols are still observed. The reporting culture, however, has been spreading in the past five years, with the deployment of events recording systems. The notification of ESRs underlines that maintenance operations, which can have consequences on the delivered doses, must be correctly supervised and that the training of practitioners in the use of medical devices is crucial for control of the doses. Extensive work to raise the awareness of all the medical, paramedical and administrative staff in the centres is still necessary to give them a clearer perception of the risks, especially for operating theatre staff. 238 ASN Report on the state of nuclear safety and radiation protection in France in 2024 Medical uses of ionising radiation
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