Many accidents in radiotherapy have been reported in France over the last years. This is due to the recent legal obligation to declare to the national safety authorities any significant incident relative to the use of ionising radiation including medical applications. The causes and consequences of the most serious events in radiotherapy are presented in this paper. Lessons can be learned from possible technical dysfunctions, from human errors or organisational weaknesses as to how such events can be prevented. The technical aspects are addressed here: in particular, dosimetric issues.
A national survey of patient doses from 'whole-body PET-CT' examinations was conducted within all French nuclear medicine departments in 2011. Data related to injected [(18)F]-fluorodeoxyglucose (FDG) activity and to computerised tomography (CT) parameters were received from 56 positron emission tomography (PET)-CT units (answer rate: ∼60 %). The average specific injected FDG activity was equal to 4.3 MBq kg(-1), in agreement with European recommendations. The new 'time-of-flight' technology enabled to decreasing the specific activity down to 3.5 MBq kg(-1). The results have shown that current diagnostic reference levels (DRLs) for the diagnostic trunk CT are too high for CT combined with PET, only performed in France for attenuation correction and localisation, and not for diagnostic purpose. Despite wide variations between PET-CT units (4-fold factor in CTDI(vol)), DRLs equal to 8 mGy (CTDI(vol)) and 750 mGy cm (dose-length product) could be proposed for whole-body PET-CT. The average effective dose related to whole-body PET-CT examination in France has been assessed to ∼14 mSv.
• Delivered dose in interventional radiology depends on procedure, practice and patient. • National RLs are proposed for 15 interventional procedures. • Reference levels (RLs) are useful to benchmark practices and optimize protocols. • RLs are proposed for kerma area product, air kerma, fluoroscopy time and number of images. • RLs should be adapted to the procedure complexity and updated regularly.
Based on these findings, IRSN recommends to update DRL regulation with current and relevant examination lists, dosimetric quantities and numerical values. In addition, this study shows that technology and generation of equipment, such as detector type in radiography or image reconstruction algorithm in CT, take an important place in the dose optimisation process, enabling significant patient exposure reduction when it is associated with protocols optimisation.
The Nuclear Safety and Radiation Protection French Institute (IRSN) presents its latest assessment from up-to-date diagnostic reference levels (DRL) national data in nuclear medicine (NM). NM departments annually send data to IRSN to estimate the representativeness of current DRLs. Complementary analyses of the data have been performed to evaluate the influence of equipment evolution on practice and patient radiation exposure. Based on data from almost 90% of the French NM departments, some DRL update are proposed. The analysis of positron emission tomography data show that the more the time of flight technology is available on equipment, the lower is the administered activity to the patient. IRSN recommends updating DRL regulation with current and relevant examination data. The influence of technology evolution appeared to be positive for patient exposure and the results showed an obvious involvement of professionals in the radiation dose optimisation process.
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