In this context, ASN has called upon the GTRPP to set up a WG to obtain its opinion on: ∙IRSN’s recommendations concerning DRLs in dental surgery; ∙the information to be provided by the device manufacturers and suppliers; ∙the need to update the Guide to radio- logical examination indications and procedures in odontostomatology, and more particularly in paediatrics; ∙the means available to dental surgeons to optimise delivered doses; ∙the initial and continuous training needs of the professionals involved in delivering the dose. The IRSN report and the GPRP recommendations revealed that dental surgeons lacked knowledge of the machine and command of the settings and main functions proposed by the devices despite the training that is obligatory for this technique. This finding has led ASN to schedule an inspection campaign in 2025 targeting dental surgeons who use CBCT and to provide them with a self-assessment matrix to raise their awareness of dose optimisation in dental CBCT. 2.5.2 Technical layout rules for medical and dental radiodiagnosis facilities Radiology facilities A conventional radiological facility usually comprises a generator (high-voltage unit, X-ray tube), associated with a support (the stand) for moving the tube, a control unit and an examination table or chair. Mobile facilities, but which are routinely used in the same room, such as the X-ray generators used in operating theatres, are to be considered as fixed facilities. Radiological facilities must be fitted out in accordance with the provisions of ASN resolution 2017-DC-0591 of 13 June 2017. This resolution applies to all medical radiology facilities, including CT and dental radio- logy. It does not however apply to X-ray generators that are used exclusively for bedside radiography and excluding any use in fluoroscopy mode. A technical report demonstrating conformity of the facility with the requirements of the ASN resolution must be drawn up by the RNA. Portable electrical X-ray generating ASN and the Dental Radiation Protection Commission published an information notice in May 2016 reiterating the rules associated with the possession and utilisation of portable X-ray generating devices: “The performance of radiological examinations outside a room fitted out for that purpose must remain the exception and be justified by vital medical needs, limited to intraoperative examinations or for patients who cannot be moved. Routine radiology practice in a dental surgery equipped with a compliant facility shall not be carried out using mobile or portable devices”. This position is consolidated by that adopted by the HERCA, for which the use of such devices should be reserved for invalid patients, for the forensic medicine sector and for military personnel in the field of action (Position statement on use of handheld portable dental X-ray equipment – HERCA, June 2014). ASN notes the emergence of a mobile radiology offering to meet specific healthcare needs (treatment of cerebrovascular accidents – CVA [strokes], ageing population, etc.) or the needs of regions confronted with medical deserts, without at present having any visibility on how this trend will evolve. Consequently, trucks providing dental care circulate in rural areas to relieve congested emergency services (trucks in the Alsace region equipped with MDs capable of responding to emergencies) or to provide care to patients who cannot travel (acquisition of new portable dentistry devices for people in retirement homes, autistic patients, etc.). Experimentation is in progress as part of the ASPHALT project involving the Paris SAMU (Emergency Medical Assistance Service) and nine Paris hospitals, with CT scanners carried in ambulances to treat CVA victims. 2.5.3 Radiation protection situation: focus on the computed tomography scanner In France, medical applications represent the primary source of artificial exposure of the public to ionising radiation, chiefly due to CT examinations (see chapter 1). Imaging examinations have proven their benefits for both diagnosis and treatment. The issue at stake however is to avoid examinations that are not really necessary or that offer no real benefit for the patients, or the results of which could be obtained by other available, non- irradiating techniques. In order to control the increase in doses observed over these last few years, two successive dose control plans (see chapter 1) have been developed in recent years. Issued in this context, ASN resolution 2019-DC-660 of 15 January 2019 relative to quality assurance in medical imaging contributes to the control of doses by requiring operational implementation of the justification and optimisation principles. Each year, ASN conducts about twenty inspections in computed tomography, adopting a graded approach by targeting the Accident & Emergency (A&E) departments (most often shared with the radiology department) and the paediatric CT scanners because of the vulnerability of children. Numerous ESRs occur in CT examinations in the A&E departments and are caused by poor communication or organisation between the A&E staff and radiology. The inspections conducted by ASN focus in particular on the verification of proper application of the requirements defined by the abovementioned ASN resolution 2019-DC-0660 of 15 January 2019, especially the justification of the examinations and optimisation of the procedures. ASN carried out 24 inspections in departments equipped with CT scanners in 2024. Half of the inspections revealed shortcomings in personnel training in both occupational radiation protection and patient radiation protection. These inspections highlight the departments’ difficulties in implementing the specific work tasks qualification relating to use of the CT scanner. The qualification procedure is often initiated for the paramedical staff with the ongoing deployment of matrices, but is often incomplete for the medical staff. Continued efforts are required in the application of the principle of optimising CT procedures. The methods of recording and analysing the doses with regard to the DRLs are not always formalised in the quality management system for the most common and the most irradiating procedures in order to define local reference levels, and the same goes for procedures for vulnerable people (pregnant women and paediatric activities). A tendency to declassify certain personnel categories (radiographers, radiologists, private practice radiologists, stretcher- bearers) working with the scanner and likely to have access to the delimited areas is noted. The computed tomography inspections reveal cases where non-classified workers have not been issued authorisations to access the delimited areas, and the need to improve their radiological monitoring. The use of teleradiology is continuing to increase, and in 2025 ASN will publish the results of a study it has initiated on this subject in order to identify the radiation protection risks. The inspections of the centres have revealed difficulties in appointing a coordinating radiologist physician in centres that no longer have salaried radiologists. Efforts must be maintained in the drawing up and validating of teleradiology examination protocols and subjecting them to strict quality assurance procedures. ASN notes moreover that 31 ESRs out of the 253 ESRs notified in computed tomography (about 13.8%) occur in a teleradiology context and are linked to communication problems between the on-site and the remote medical professionals. 2.5.4 Significant events notified in medical and dental radiodiagnosis In 2024, 365 ESRs were notified in medical and dental radiodiagnosis (+13 % compared with 2023): ∙112 in conventional radiology, of which 26 concerned women unaware of their pregnancy; ∙253 in computed tomography, of which 87 concerned women unaware of their pregnancy; ∙no ESR in dental radiology. 240 ASN Report on the state of nuclear safety and radiation protection in France in 2024 Medical uses of ionising radiation
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