LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT ever-more efficient and sophisticated medical devices. “Hybrid” operating room facilities, which combine the characteristics of a conventional operating theatre with those of an interventional imaging room, are continuing to develop. These operating rooms contain fixed or mobile C-arm units and fixed or mobile scanners. This combination enables the surgeon to perform “mini-invasive” surgery with 2D and 3D imaging. Given that the delivered dose levels are higher than in other interventional procedures, practices must be optimised in order to reduce the exposure doses for the patients and the operators, who often work in the immediate proximity of the patient. ASNR also observes the use of CBCT devices in the departments performing FGIPs. 2.4.2 – Technical rules for the fitting out of medical rooms The rooms in which FGIPS are carried out, operating theatres and interventional imaging rooms, must be organised in accordance with the provisions of ASN resolution 2017-DC-0591 of 13 June 2017 laying down the technical design rules that must be fulfilled by rooms in which electrical devices emitting X-rays are used. The design rules for the rooms, set by the above resolution, aim to protect the workers by limiting their exposure to ionising radiation. The arrangements must make it possible for any member of personnel entering a room in which an electrical device emitting X-rays is present and used, to assess the risk in order to take appropriate radiation protection measures on entering or when inside the room. With regard to signalling systems, they are obligatory at the point of access to the operating rooms and inside the rooms when a device is present and to signal the emission of radiation. It is important to point out that many medical and nonmedical personnel members intervene in the operating theatre. Simple and practicable instructions must be favoured in a context of multiple risks and a complex environment. The signalling systems moreover count among the most effective prevention measures, as does the wearing of appropriate personal protective equipment and dosimeters by each operator, from the moment a restricted area is delimited due to the risk of exposure to ionising radiation. Some centres are equipped with operating halls that constitute technical platforms allowing procedures to be performed simultaneously with the sharing of certain members of personnel. Compliance with the regulatory requirements, particularly those concerning signalling, can be more complicated to implement in these halls. 2.4.3 – Radiation protection situation in fluoroscopy-guided interventional practices For some years now ASNR has been receiving regular reports on ESRs in the area of FGIPs, but their number remains low for the number of procedures performed. In the course of its inspections, ASNR still finds that the medical professionals lack knowledge of the criteria for notifying significant events, even though the doses administered in some centres are high and sometimes exceed the dose thresholds beyond which tissue damage occurs (radiodermatitis, necrosis) in patients having undergone particularly long and complex interventional practices. In addition to these events, which underline the major radiation exposure risks for the patients, are those concerning professionals, whose exposure can lead to the exceeding of regulatory dose limits, particularly at the extremities (fingers) and the lens of the eye. Ever more efficient and sophisticated techniques are developing in environments with little experience of the radiological risk. In this context, it is essential to optimises the doses, as much for the patients as for the personnel. This is why ASNR’s inspections focus in particular on the rules for the fitting out of premises, the delimiting and signalling of restricted areas, dosimetric and medical monitoring of the personnel, the provision of Personal Protective Equipment (PPE). Concerning patients, particular attention is paid to the optimisation of doses delivered to the patient (putting in place DRLs and dose analysis), personnel training in patient radiation protection and the use of the MDs. Application of ASN resolution 2019-DC-0660 of 15 January 2019 laying down the quality assurance obligations in medical imaging using ionising radiation helps the centres manage the risks arising from ionising radiation. As FGIPs are numerous, varied, and performed in many different departments (neuroradiology, interventional cardiology, interventional radiology and operating theatres) within a given centre, the inspection programme is established so that all the departments performing radiation-risk procedures are inspected every five years. Nevertheless, the progress made in certain centres, the checks carried out when examining the FGIP registration applications, and the need to focus inspections more on the departments that are falling seriously behind in fulfilling the regulatory radiation protection obligations have led ASNR to adjust the inspection frequency. Inspection prioritisation is based on the number of procedures performed within a centre, the nature of the procedures which determine the radiation protection risks for the patients and medical personnel, the condition of the facilities, (compliance with Intracranial FGIP FGIP on the spine FGIP in cardio-coronary FGIP in cardio-rhythmology FGIP in vascular domain FGIP in visceral or digestive system FGIP in urology FGIP on the musculoskeletal system Other FGIPs 0 100 200 300 400 500 600 700 800 900 1,000 89 207 314 416 611 570 627 978 409 GRAPH 10 Breakdown of the number of registrations by category of fluoroscopy-guided interventional practices in 2025 214 ASNR Report on the state of nuclear safety and radiation protection in France in 2025
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