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John Croft (NRPB) Pascal Crouail (CEPN) John Wheatley (IAEA)

Review of the Development of Incidents Databases and Feedback Mechanisms: IRID, RELIR, EURAIDE and RADEV. John Croft (NRPB) Pascal Crouail (CEPN) John Wheatley (IAEA). Ionising Radiations Incident Database (IRID). Established in UK in 1996 Partnership

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John Croft (NRPB) Pascal Crouail (CEPN) John Wheatley (IAEA)

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  1. Review of the Development of Incidents Databases and Feedback Mechanisms:IRID, RELIR, EURAIDE and RADEV John Croft (NRPB) Pascal Crouail (CEPN) John Wheatley (IAEA)

  2. Ionising Radiations Incident Database (IRID) • Established in UK in 1996 • Partnership • National Radiological Protection Board ( NRPB) • Health and Safety Executive (HSE) • Environment Agency (EA)

  3. Ionising Radiations Incident Database (IRID) • Established in UK in 1996 • Partnership • National Radiological Protection Board ( NRPB) • Health and Safety Executive (HSE) • Environment Agency (EA) • Objectives • National focus on ionising radiation incidents • Feedback to prevent or limit future incidents • Analysis to inform priorities in resource allocation

  4. IRID: Scope and Confidentiality • Broad definition of an “incident” • includes “near misses” • Included: non-nuclear sector • industry, medicine, research and teaching • Excluded • nuclear, transport and patient exposure

  5. IRID: Scope and Confidentiality • Broad definition of an “incident” • includes “near misses” • Included: non-nuclear sector • industry, medicine, research and teaching • Excluded • nuclear, transport and patient exposure • Confidentiality • major issue with potential contributors • data is anonymous • pledges by NRPB, HSE & EA

  6. IRID: Format 23 fields categorising the accidents 1 text field : anonymous descriptions of accident what happened causes doses and other consequences lessons learned Published first 100 cases in 1999

  7. IRID

  8. Usage % Radiography  - site 15  - facility 14 X - site 2 X - facility 8 39 Other Density / Moisture gauges 12 Processing of ore / scrap 10 IRID: First Analysis

  9. IRID: Lessons • Need for • Good management • Correct use of radiation monitors • Security of radiation sources • Appropriate training • Availability / use of contingency plans

  10. RELIR • Retours d’Expériences sur Les Incidents Radiologigues • = • Feedback Experience on • Radiological incidents

  11. RELIR: Creation • Qualified Expert Group of French Radiological Protection Society (SFRP) • In collaboration with • Research and Safety National Institute (INRS) • Office of Protection against Ionising Radiations (OPRI) • National Institute of Nuclear Sciences &Techneques (INSTN) • Curie Institute • CEPN • Reporting networks • Qualified Experts in Industrial and Medical fields • Medical Physicians

  12. RELIR: Objectives • to learn from feedback to avoid new incidents • to provide training material from examples of incidents • to encourage exchanges between HP & RP professionals and non-professionals

  13. RELIR : Operation analyse Moderator dialogue validation questionnaire Workers INCIDENT Expert Occupational Physicians Committee Competent persons, etc. diffusion training Publication material Internet

  14. RELIR: Fields Covered • Sector Activities • Medical and Veterinary 9 • Industry 10 • Research and Teaching 2 • Other 4 • ~ 20 Moderators

  15. RELIR: Next Steps • WEBSITE (http://RELIR.cepn.asso.fr/) • still in construction (available October 2001) • BY THE END OF THE YEAR • about 40 cases with lessons to be learned • LATER ON • about 10 cases per year ?

  16. EURAIDE • Recommendation from 2nd EAN Workshop 1998 • Pilot Study • European Union Radiation Accident and • Incident Data Exchange • encourage establishment and compatibility of databases • establishing network to exchange feedback • summary reports for RP training programmes • involve and integrate EU Applicant Countries

  17. EURAIDE: Pilot Study • NRPB (UK) • CEPN (France) BfS (Germany) • CSN (Spain) • existing national mechanisms for capturing data • selection criteria for incident feedback • making available in national languages • identification of relevant national organisations • structure of Steering committee

  18. EURAIDE: Development • Pilot Study output • Specifications for EURAIDE and its management • Completion: June 2002 • Development • 1st Workshop: present results and discus • Dialogue with EC • 2nd Workshop to consider revised proposals

  19. RADiation Event (RADEV)Reporting System • Purpose • To help prevent accidents or mitigate their consequences • To help Member States, IAEA and other organisations to identify priorities in their radiation safety programmes and to facilitate efficient allocation of resources

  20. RADiation Event (RADEV)Reporting System • Purpose • To help prevent accidents or mitigate their consequences • To help Member States, IAEA and other organisations to identify priorities in their radiation safety programmes and to facilitate efficient allocation of resources • Objective • Collect and disseminate information on radiation events • identification of causes • feedback lessons learned

  21. RADEV: Scope • Events with actual/potentially significant radiation protection consequences and from which lessons can be learned: • accidents • near misses • any other unusual* events • (*eg: malicious acts, deliberate acts)

  22. RADEV: Scope • Include • Worker / public exposure • Loss of control of sources - lost, found, stolen, illegally transported or sold • Patientexposure significantly different than intended Exclude • Nuclear power plants, fuel cycle and weapons • Transport • Illicit trafficking of nuclear materials

  23. Data collection/dissemination:-Electronically to/from MS RADEV National IAEA RADEV National RADEV International

  24. Dissemination of Information Internet IAEA IAEA RADEV Annual Report RADEV International Professional Journals

  25. Implementation plan • Test database in-house • Finalise TECDOC • Prepare instruction manual • Limited international test & evaluation • Incorporation of feed-back • Identify & establish formal contact points & data suppliers • Launch at international workshops (2001)

  26. IAEA’s RADiation EVents Database ( RADEV )Industrial Events Involving Workers / Public 24 orphaned sources 205 persons exposed below dose limits 44 exceeded dose limits Research Unknown 11% Industrial 50% 14* cases of ‘radiation burns’ 8* amputations 5* deaths * non-medical Medical 37% Total events recorded to date = 179

  27. IAEA’s RADiation EVents Database ( RADEV )Industrial Events Involving Workers / Public - Specific Practice NORM Unknown, 11% Laboratory uses Research accelerators Gauging Industrial radiography Adventitious x-rays Security inspection Industrial irradiators Medical, 37% Waste conditioning 0 10 20 30 Industrial, 50%

  28. IAEA’s RADiation EVents Database ( RADEV )Direct / Contributory Causes of Industrial Events Deliberate / malicious act Unknown, 11% Design / testing deficiency Equipment / facility failure Human effects Maintenance problems Procedure deficiency Radiation survey deficiency Source security ineffective Source storage deficiency Supervision inadequate Medical, 37% Training deficiency 0 10 20 30 40 Industrial, 50%

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