Lessons learned from the recent overexposures of patients in interventional radiology in France

Abstract

Introduction Although interventional radiology (IR) is nowadays a widespread and well-known technique, it is associated to a potential deterministic risk for the patients, particularly for the most complex procedures (cardiology, neurology, vascular surgery). Since 2007, six patient overexposures declared to the French Authory (ASN) have needed a technical and radiobiological expertise from the Institut de radioprotection et de Surete nucleaire (IRSN). Analysis of the recent patient overexposures in IR in France Although these incidents occurred in different fields (cardiology, neurology, vascular surgery), their analysis has shown some recurrent causes: – Lack of basic knowledge, within the interventionists, in the optimization capacity of their radiological equipments. – Poor awareness of the level of delivered dose and of potential for radiation injuries to patients. – No medical physicist involved in IR department. – Procedures (and doses) not optimized. – No alert values (DAP and fluoro time) for each different procedure. – No procedure for appropriate patient follow-up. Conclusion Lessons to be learned for the future ICRP published in 2000 its publication 85 dedicated to IR. Today, IR procedures are even more frequent and complex. Nevertheless, radiation protection (RP) principles are not enough implemented in the routine practice. To improve this situation, IRSN has published recommendations, among them: – Improve the education and training in RP of interventionists, especially those who have the weakest knowledge in RP, like cardiologists and surgeons. – Make sure that medical physicists are enlisted by the departments to take part in the optimization actions. – Require departments to assess their practice, through patient dose collection and establishment of local dose reference levels. – Establish alert values and patient follow up procedures. – Establish national dose reference levels for the most standardized procedures. – Harmonize units of DAP indicators between the different equipment manufacturers. The presentation will review the different actions in progress at national and European level to implement these recommendations.