Stakeholder Perception of Radiation Protection Controls in France's Health Sector

1. HOW STAKEHOLDERS IN THE HEALTH SECTOR PERCEIVE THE ORGANIZATION OF RADIATION PROTECTION CONTROLS IN FRANCE MENECHAL Ph. (SFRP) GAURON Ch.(INRS), FRABOULET P. (AFPPE), KALIFA G. (Saint-Vincent de Paul Hospital), DE WILDE P. (Pitié-Salpétrière Hospital)

2. EXTERNAL ACTORS ASN AFSSAPS Work inspectorate DGS Health care facility IRSN Registered organisms CRAM

3. INTERNAL ACTORS • Manager • CHSCT (Hygiene, Safety and Working Conditions Committee) • Occupational physicians • Radiation Protection Competent Person (PCRP) • Physicists • Radiologists, radiographers • Biomedical engineers...

4. OCCUPATIONAL PHYSICIAN • a central actor in the French occupational health system • advises directly the employer and the workers about occupational risk management • prevents any harm to workers’ health condition due to work

5. OCCUPATIONAL PHYSICIAN • Works in collaboration with experts (physicists, PCRP…) • Assesses and improves radiological risk management • Deals with most problems concerning practices, training, management, devices

6. HOW DOES THE OCCUPATIONAL PHYSICIAN PERCEIVE RADIOPROTECTION CONTROLS? • Relies on sources of information from external controls • Dosimetric results • Workstation studies • Architectural conformities • Carries out medical visits • Internal actors’ role is essential • training actions, procedure controls, advice, equipment • incident investigation, feedback

7. PCRP • The internal operational link of radiation protection system • Works in collaboration with: • occupational physician • CHSCT • managers... • Acts as an adviser and as an expert

8. PCRP • Analyses the workplaces • Improves level of occupational expositions • Carries out training and spreads information • Manages risky situations • Enforces regulation • Gives technical advice • Performs active dosimetry, makes sure external controls are performed • Checks working situations

9. HOW DOES THE PCRP PERCEIVE EXTERNAL CONTROLS? • As an assessment of his job • As supporting and comforting his advice • As a means to dialogue with authorities • Limits to these external controls: • patient exposures controls • assessment of procedures and training levels • Importance of external + internal controls

10. RADIOGRAPHER • he is the last safeguard • he has essential knowledge • only radiographers are allowed to perform acts with ionising radiation • he receives regular training

11. RADIOGRAPHER • no contact with external actors • controls take into account mainly the compliance of medical devices and facilities • the regulatory external controls should take into account the training level of radiographers • receive advice from internal actors (PCRP and occupational physician)

12. THE RADIOLOGIST • Meeting point between the medical indication and the physical requirements • Specific training • Overall view of the different imaging technique • Real partner of clinicians,manufacturers and administators • Knowledge of the risks • RESPECT OF THE EURATOM97/43

13. THE RADIOLOGIST • PATIENTS • CLINICIANS • RADIOGRAPHERS • ADMINISTRATORS and or BUSINESSMEN • EXTERNAL REGULATORY BODIES • these partners act also as «controllers» • the patient being the «supreme judge»

14. MANAGER • He is in charge of workers’ safety • Coercive role of external controls • He gets a real idea of compliance level of facilities • Legal guarantee • Advice from internal experts is necessary (PCRP, occupational physician)

15. Conclusion • CONTROLS ARE APPROVED BY EVERY INTERNAL ACTORS AS A WAY OF KNOWLEDGE • EXTERNAL INSPECTIONS ARE NOT SUFFICIENT TO IMPROVE RADIATION PROTECTION • TECHNICAL COMPLIANCE LEVEL MUST BE COMPLETED BY A CONTROL OF THE MEN