LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT The technologies developed over the last few years (such as multi‑energy photon-counting CT scanners) have made examinations easier and faster to perform, and have led to an increase in exploration possibilities (example of dynamic volume acquisitions) and in the indications(13). The placing of mobile CT systems on the market for intraoperative use is to be underlined, as is the increase in fluoroscopy-guided interventional CT procedures. On the other hand, these technological developments have led to an increase in the number of examinations, resulting in an increase in the doses delivered to patients and thus reinforcing the need for strict application of the principles of justification and optimisation (see point 1.3.4). Technological advances nevertheless allow a new mode of image reconstruction thanks to iterative reconstruction and deep learning of AI. Computed tomography can thus provide consistent image quality at reduced doses. Strict application of the principles of justification of the procedures and optimisation of the protocols remains as topical as ever. Teleradiology Teleradiology is a medical procedure in its own right defined in the Public Health Code, performed at a distance from the patient by a radiologist who performs the procedure at the request of a referring physician. Essentially two methods are used: ∙Telediagnosis, which is a remote radiological medical service for a patient when a radiologist is not present on site, either on a one-off basis in an emergency situation, or on a regular basis in 13. The term indication means a clinical sign, an illness or a situation affecting a patient which justifies the value of a medical treatment or a medical examination. non-emergency situations. The medical radiographer takes charge of the patient to perform the radiological or CT examination after receiving the instructions from the teleradiologist. At the end of the examination, the images are sent to the teleradiologist in order to formalise a results report in a manner comparable with what an on-site radiologist would have done. ∙Tele-expertise is defined as having recourse to a second opinion. The radiologist on the scene who performed and validated the examination, or a referring physician, asks for a second opinion on the images produced. Teleradiology is more than just a remote interpretation of images. Its development is becoming more widespread to allow continuity of out-of-hours service and to reduce the waiting times before receiving medical care. The organisation of the practice, the way it interfaces with the personnel on site and the many responsibilities are specified by contract between the healthcare facility and the teleradiology outside contractor. In May 2019 the HAS published a Guide to good practices concerning the quality and safety of tele-imaging procedures. Details are provided, with organisational, technical and operational recommendations. The French Professional Council of Radiology and Medical Imaging (G4) and the French Council of the Order of Physicians updated the teleradiology charter in January 2025, containing nine general recommendations. This latest version introduces requirements concerning the supervision of teleradiology platforms and HIGHLIGHT No. 7 ASNR publishes a study on teleradiology and sets out recommendations: prospects and challenges of radiation protection In view of the growing development of teleradiology and the marked increase in recent years in Significant Radiation Protection Events (ESRs) notified in this context, ASNR has conducted a study, with the support of CEPN, to examine the effects on radiation protection. Teleradiology, which enables imaging examinations to be interpreted remotely, has become an essential tool for ensuring continuity of care and rapid access to diagnosis, particularly in facilities facing significant shortages of radiologists. Initially focused on out-of-hours care (nights and weekends), the practice has progressively expanded to cover scheduled activity, including CT and conventional radiology, resulting in a structural transformation of the organisation of radiology services. The study highlights a number of organisational, technical and human weaknesses that are likely to have consequences for radiation protection and to increase the risk of errors when this method of teleradio- logy is deployed without sufficient preparation: • Firstly, remote working arrangements may weaken application of the fundamental principle of justification, as limited access to patients’ clinical histories and previous examinations can hinder assessment of the appropriateness of imaging requests. In addition, activity often picks up at night, when requests for imaging examinations are subject to less systematic scrutiny, contributing to an increase in the number of procedures performed. • Secondly, communication between professionals is affected by remote working, particularly because of limited interoperability between information systems (Radiology Information System – RIS, Picture Archiving and Communication System – PACS, platforms) and difficulties in contacting the teleradiologist. These coordination difficulties contribute to an increased risk of patient misidentification, which accounts for around 47% of ESRs notified in teleradiology, compared with 22% in other radiology activities. • Finally, this organisation can also lead to increased workloads and responsibilities for Radiographers (MERM) and administrative staff, resulting in professional isolation and a loss of meaning in work for some radiographers. Based on these findings, four specific challenges have been identified to guarantee safe teleradiology: • the need for better project management (often reduced to simple information without any real consultation or support for change); • reinforcing implementation of the principle of justification, which is weakened by limited access to electronic patient records and by differences in examination protocols; • improving communication between professionals, given that communication failures are a recognised contributor to ESRs; • implementing a structured risk-management approach capable of identifying and managing the new risks generated by this form of organisation. In light of these findings, ASNR has identified seven areas for improvement. The first two aim, respectively, to strengthen early consultation between all stakeholders (healthcare facilities and professionals) before projects are implemented, and to support the healthcare professionals concerned through the resulting changes. The third is to improve implementation of the justification principle by facilitating access to clinical histories and harmonising protocols. The fourth is to improve communication between professionals and Human-Machine interfaces to ensure better multidisciplinary collaboration. The fifth concerns the updating of good practices baselines for doctors and scan procedure guides. The sixth aims to enhance patient care by conducting and sharing prospective and retrospective risk analyses (OEF from ESRs) between healthcare facilities and operators. Finally, the last area concerns improving the understanding and assessment of teleradiology activity in order to ensure compliance with radiation protection requirements in light of the recommendations set out in the latest teleradiology charter. ASNR has forwarded the conclusions of this study and its recommendations to the healthcare agencies, professional organisations and teleradiology operators. The study has also been reviewed by the committee responsible for monitoring the national imaging dose control plan. In addition, as part of its efforts to promote the sharing of good practice, ASNR will present the study’s findings to its European counterparts. ASNR Report on the state of nuclear safety and radiation protection in France in 2025 221 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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