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Ionizing radiations are commonly used in interventional endoscopy, mainly during endoscopic retrograde cholangio-pancreatography (ERCP). These radiations are not without short-, medium- and long-term side effects for both endoscopists and patients. Various authorities have defined specific procedures to limit the risks to patients and health-care workers from exposure to ionizing radiation. These procedures are based on well-justified procedures, optimizing procedures and monitoring dosimetry. Training in patient and health-care worker protections is mandatory for doctors performing such procedures. This article expresses the current view of the French Society of Digestive Endoscopy (SFED) about radiation protection for endoscopic procedures. [ABSTRACT FROM AUTHOR]

Introduction: interventional cardiology procedures have become complex and expensive in time with a higher risk of exposure to ionizing radiations. The purpose of our study was to assess radiation protection knowledge and practices among Tunisian cardiologists exposed to X-rays. Methods: we conducted a descriptive, analytical study in October 2019. An anonymous survey on the knowledge and practices regarding radiation protection was sent to all Tunisian cardiologists exposed to X-rays. Results: among 126 cardiologists exposed to X-rays and having received the survey, 58 physicians responded to the survey (48%), with a male predominance (72%, n=42). Thirty-eight physicians (65%) were public sector workers. Average years of working experience were 12.02 years (SD 6.88 years). Half of doctors had a knowledge score of less than 50%. The average practice score was 43.83 (SD 13.95%). Wearing a lead apron, thyroid shield, dosimeter, lead glasses, lead cap accounted for 100% (n=58), 86.2% (n=50), 30.7% (n=18), 12.1% (n=7) and 1.7% (n=1) respectively. There was no correlation between scores and doctor’s age as well as the length of working experience. There was no statistical differences between knowledge scores of males and females (p=0.06) or between public sector and private sector (p=0.9). Practice score was significantly higher among men (0.007) and interventional cardiologists compared to rhythmologists and pediatric cardiologists (p<0.001). Conclusion: the level of knowledge and practices among Tunisian cardiologists regarding radiation protection is generally insufficient. Then, health authorities should implement regular training programs. [ABSTRACT FROM AUTHOR]

Résumé La protonthérapie, en dépit du coût encore très élevé des installations et des questionnements toujours présents sur sa « vraie » place dans l’ensemble des modalités de radiothérapie, est toujours en pleine croissance dans le monde, avec près de 60 centres en opération aujourd’hui et plus de 30 projets déclarés ou en cours de construction ( http://www.ptcog.ch ) [1] . Devenue depuis un certain nombre d’années, une modalité technologiquement mature et fiable, la protonthérapie ne s’implante cependant pas comme toute autre modalité de radiothérapie et la mise en œuvre d’un projet constitue un changement d’échelle majeur au niveau d’une institution hospitalière, aux contraintes techniques, architecturales et financières beaucoup plus lourdes. Il convient d’en prendre toute la mesure avant de se lancer dans un projet. En effet, une installation maîtrisée est une condition nécessaire (mais non suffisante) d’un démarrage efficace de l’activité clinique et de la pérennité économique de l’ensemble. The number of protontherapy facilities is still increasing rapidly with more than 30 ongoing projects and close to 60 currently under operation. Although the technology is now validated and robust, a proton facility cannot be considered as a standard radiation therapy equipment: its constraints in terms of building, services, project management are of paramount impact at the level of the hospital. Therefore, a protontherapy project must be carefully considered and prepared, which is mandatory for further fluid and efficient clinical operation. [ABSTRACT FROM AUTHOR]

Résumé: Le recours à la tomodensitométrie (TDM) thoracique augmente en pédiatrie. L’objectif de notre travail était double : évaluer ses indications et son impact en pneumologie pédiatrique, et apprécier l’irradiation induite selon la sensibilisation des radiologues à la radioprotection. Patients et méthodes: Il s’est agi d’une observationnelle, prospective réalisée entre novembre 2009 et avril 2010. Tous les enfants, dont la TDM thoracique avait été présentée en réunion de radio-pneumologie pédiatrique du centre hospitalier régional universitaire (CHRU) de Lille, ont été inclus. Nous avons relevé les caractéristiques démographiques, les indications, l’irradiation (produit dose longueur [PDL] et dose efficace [DE]) et les résultats. Le PDL et la DE ont été comparés selon le lieu de réalisation (TDM double source ou 64 barrettes du CHRU, ou extérieur). Résultats: Cent trente-cinq patients ont été inclus (âge moyen 6,4ans). Les TDM diagnostiques (61 %), avaient eu un impact diagnostique pour 48 % et thérapeutique direct pour 24 %. Celles de suivi de maladies chroniques (39 %) avaient eu un impact diagnostique pour 38 % et thérapeutique pour 19 %. L’irradiation avait été significativement inférieure pour les TDM réalisées au CHRU, a fortiori avec la TDM 128 barrettes (DE double source : 0,61mSv±0,32 ; DE 64 barrettes : 1,24mSv±0,97 ; DE extérieurs : 2,56mSv±1,98). Conclusion: La facilité d’accès aux TDM et leur qualité, y compris chez les jeunes enfants, ont augmenté leurs indications, ne dispensant pas de certaines précautions. Notre étude montre que la sensibilisation des radiologues aux risques pédiatriques, les progrès techniques et la collaboration avec les cliniciens réduisent l’irradiation induite. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons le cas clinique d’un patient de 72ans, adressé en janvier 2009 par son dermatologue pour « brûlure » du dos. L’anamnèse retrouvait la réalisation d’une coronarographie et de deux coronaroplasties entre septembre et octobre 2005, ce qui nous a permis d’évoquer le diagnostic de radiodermite chronique du dos après coronaroplastie, à partir des données de la littérature. La survenue de radiodermites chroniques du dos et de la région axillaire après cathétérisme cardiaque a été observée dans de nombreux pays ; il s’agit presque toujours de cas ayant subi des manœuvres difficiles et prolongées, exposant à une dose élevée de radiation. Il n’y a pas toujours de radiodermite aiguë, les lésions apparaissant entre trois et 30 mois voire plus après l’exposition. Il s’agit de zones quadrangulaires bien limitées de plusieurs centimètres de côté, caractérisées au minimum par une radiodystrophie, au maximum par une ulcération de type radionécrose tardive nécessitant un geste de couverture chirurgicale. [ABSTRACT FROM AUTHOR]

With the goal of obtaining the decommissioning of the LURE nuclear facility, three of its accelerators were dismantled and another was modified to be below the threshold of "Installation Nucléaire de Base" status. Operations were carried out with the strategy of mechanical dismantling with no cutting process. As the civil engineering radioactivity level was low, a great majority of it has been left in place with no processing, but compensatory measures have been taken for public and environmental protection. The overall result of these operations is a gain in both cost and operating time. They also contribute to a significant decrease in the risks, including radiological ones. The radiological impact after decommissioning remains acceptable. [ABSTRACT FROM AUTHOR]

Résumé: L’optimisation de la sécurité des patients, du personnel et du public et de la gestion des risques reste une préoccupation majeure. C’est le cas pour la curiethérapie dont la technique s’est profondément améliorée mais est devenue plus complexe. Les différents aspects de la curiethérapie sont abordés aussi bien pour le patient que pour le personnel. Pour tous, il faut minimiser les risques tout en réalisant un traitement de qualité et établir une liste la plus exhaustive possible des risques, a priori quelle que soit la technique utilisée (bas et haut débits, débit pulsé). Il faut évaluer leur importance en s’aidant de leur criticité. Pour la radioprotection du personnel et du public, il faut tenir compte des nombreux textes réglementaires existants. Quatre axes ont été définis pour décliner la gestion des risques pour les patients : organisation, préparation, planification et réalisation du traitement. Pour chaque axe, une revue des risques est présentée. Pour le personnel et le public, les dispositions administratives, techniques et médicales sont présentées. [ABSTRACT FROM AUTHOR]

Pregnancy and radiation risks in radiology: users' knowledge at the University Hospital of Yopougon (Abidjan, Côte d'Ivoire). Objectives: to assess the knowledge of users and health professionals about the risks of irradiation of the pregnant woman in the course of radiological examinations and the application of rules of radiation protection to pregnant women by X-ray users. Materials and Methods: our prospective study, conducted at the University Hospital of Yopougon, lasted 6 months. We interviewed 60 women who were pregnant or likely to be, 30 non-radiologist prescribing physicians, 29 medical imaging technicians and 21 healthcare aides on radiation risk and protective measures for pregnant women before and during the implementation of a radiological examination using X-rays. Results: 73.7% of prescribing physicians have no knowledge of radiation protection in women who are pregnant or of childbearing age. 93.1% of patients who are pregnant or of childbearing age were not aware of X-rays in diagnostic radiology and the harm they pose to a pregnant or potentially pregnant woman. 80% of radiology manipulators do not respect the basic rules of radiation protection. Conclusion: greater awareness of the users of X-ray radiation risks in pregnancy or women likely to be pregnant is required at the University Hospital of Yopougon. [ABSTRACT FROM AUTHOR]

Evaluating pediatric patient dose during computed tomography in two University Teaching Hospitals in Yaoundé - Cameroun. The practices related to patient radiation protection are poorly documented in sub- Saharan Africa because of the lack and/or weak enforcement of the related legislative and regulatory frameworks. This study investigates the justification and optimization of pediatric CT scans in two university teaching hospitals in Yaoundé in Cameroon. 171 CT scans in pediatric patients below 15 years of age performed during one trimester were surveyed. The data collection form was adapted from a dosimetric assessment sheet from the French Institut de radioprotection et de sureté nucléaire. The guidelines were those of the Société française de radiologie and the Société francophone d'imagerie pédiatrique et prénatale. Each CT scan was assessed and the CT dose index and dose length product were compared with the Diagnostic Reference Levels (DRLs) of the above-mentioned guidelines. While all the CT exams were justified, protocols were not readily available and varied amongst teams and units. The tension conformed in 87.7% of cases and 15.2% of DLPs were higher than the DRL for thoracic and abdominal CT scans performed under helical mode and brain CT scans performed sequentially. Readily available optimal CT protocols for children are urgent to improve upon the pediatric CT practices in these two units with a high turn-over rate of technologists and radiology residents. [ABSTRACT FROM AUTHOR]

Abstract: Since its introduction as a routine arterial route for interventional cardiology, the radial route has been associated with higher X-rays doses, either to the patient and the operator. There is less evidence for this association in recent studies, probably due to the learning curve for this approach, improvement in radiological equipments and in radiation protection techniques. Coronary angiography and percutaneous coronary interventions can be performed by radial route routinely with very low levels of exposure for the patient (<50% of the reference levels). However, for a fixed dose to patient, the operator''s exposure remains higher by radial route, compared to femoral route. Optimized individual radiation protection devices for operators are mandatory when procedures are performed by radial approach. [Copyright &y& Elsevier]

Pulse Dose Rate (PDR) brachytherapy presents the potential radiobiological advantages of low dose rate and the technical and radiation protection advantages of high dose rate remote afterloading technology. The different algorithms provided by the treatment planning systems allow dose rate and isodose shape optimization regarding the volumes defined by the radiologist and the radiation oncologist. The contribution of imaging together with these new optimization tools should improve brachytherapy practice and the therapeutic ratio. These new evolutions of brachytherapy will be presented here. [Copyright &y& Elsevier]

Introduction: The medical director of the pediatric intensive care unit (PICU) selected a collection of pediatric chest X-rays for a clinical audit. As an unrelated activity during the performance of this audit, the frequency of adult fingers visualized on the PICU chest X-rays was documented. Methods: A clinical audit of 439 PICU chest X-rays was performed. The visualization of adult fingers on the radiographs was categorized into those fingers directly in the X-ray beam and those seen only in the partially coned area of the images. Results: There were 43 instances (9.8%) in which adult fingers were directly exposed to the X-ray beam. Additionally, in 23 instances (5.2%), adult fingers were seen only in the partially coned area of the image. Discussion: Professional standards of practice and radiation biology publications support the need to avoid occupational radiation exposure. Occupational health and safety and radiation safety regulations stipulate that operators of an X-ray emitting device, or technologists assisting in the operation of an X-ray emitting device, must distance themselves from the primary beam (minimum of 3 metres) during X-ray exposure. All attempts must be made not to expose other individuals during the acquisition of clinical images. These policies and practice standards must be reinforced to minimize the exposure of medical radiation technologists and other medical staff to radiation. [ABSTRACT FROM AUTHOR]