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Order Of 18 May 2004 On The Programmes Of Training On Radiation Protection Of Patients Exposed To Ionizing Radiation

Original Language Title: Arrêté du 18 mai 2004 relatif aux programmes de formation portant sur la radioprotection des patients exposés aux rayonnements ionisants

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SANTE , TRAINING PROGRAM , RADIATION PROTECTION , PATIENT , EXPOSURE , IONIZING RADIATION , SPECIFIC PROGRAM , DOCTOR RADIOLOGIST , NUCLEAR DECIN , SURGICAL PROCEDURE , PERSON SPECIALISING , MEDICALEMANIPULATOR RADIOPHYSICS , MEDICAL ELECTRORADIOLOGY

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JORF No. 141 of 19 June 2004 Page 11017
Text No. 26



Decree of 18 May 2004 on training programmes on radiation protection for patients exposed to ionising radiation

NOR: SANY0421830A ELI: https://www.legifrance.gouv.fr/eli/arrete/2004/5/18/SANY0421830A/jo/texte


The Minister of Health and Social Welfare,
In view of Council Directive 97-43 Euratom of 30 June 1997 on protection Health of persons against the dangers of ionizing radiation during medical exposures;
In view of the Public Health Code, and in particular Articles L. 1333-1, L. 1333-11 and R. 1333-74;
In view of the opinion of the Board of Governors Of public health of France as of 27 January 2004,
Stop:

Item 1 More about this Item ...


This Order defines, in accordance with Article R. 1333-74 of the Public Health Code, the conditions to be met by training programs in the field of radiation protection for patients Exposure to ionizing radiation. This training shall be directed to the professionals referred to in Article L. 1333-11 of the Public Health Code in practice on the date of publication of this Decree or at the beginning of the year when their initial training does not involve teaching on the Radiation protection for patients. In all cases, the updating of the knowledge must be done at least every ten years.

Item 2 More about this Item ...


The objectives and content of programs, both theoretical and practical, of radiation protection for patients exposed to ionizing radiation must, for all professions Comply with the conditions laid down in Annex I to this Order. This training shall be completed for each occupational category referred to in Article L. 1333-11 of the Health Code, in accordance with the objectives and programmes set out in Annex II to this Order.

Article 3 More about this Item ...


Upon completion of the training, the organization will issue to the person who has completed the training a document attesting to the validation of this training. These documents are made available to screening officers.

Item 4 More about this Item ...


The professionals referred to in Article L. 1333-11 of the Public Health Code must be able to benefit from the training on radiation protection of patients within five years of the date of the Publication of this Order.

Item 5 More about this Item ...


The Director General of Nuclear Safety and Radiation Protection and the Director General of Health shall each have responsibility for the execution of this Order, which shall be published in the Journal Official of the French Republic.

Appendix


A N N E X E I


MINIMUM OBJECTIVES AND PROGRAM CONTENT FROM THE RADIATION TRAINING OF COMMON PATIENTS TO THE SET OF PROFESSIONALS
Introductory teaching:
Origin and nature of ionizing radiation, interactions of ionizing radiation with matter, sizes and units in Radiation protection.
Comparison of natural and man-made activities and exhibitions.
Biological Effects of Ionizing Radiation:
Molecular, cellular, and tissue effects, DNA repair mechanisms. Deterministic and stochastic effects.
Effects of ionizing radiation on the body (carcinogenesis, hereditary effects, teratogenic effects).
Comparison of exposure and other medical risks.
System for Radiation protection: principles and implementation:
Objectives and principles of patient protection (justification, optimization, precautionary principle and its limitations, the approach "as low as reasonably possible [ALARA]").
Radiation protection organisation: international bodies, European legislation, French legislation and regulations.
Privacy Principles.
Diagnostic and therapeutic medical exposures, nature and order of Magnitude of doses received at exhibitions in medical practice, medical responsibility in the demand and execution of acts, patient information.
Practical measures for radiation protection in radiodiagnostics, nuclear medicine and Radiotherapy; special case of pregnant or nursing women.


A N N E X E I I
Appendix II-1


Objectives and contents of specific programs for radiologists.


Appendix II-2


Objectives and contents of specific programs for nuclear physicians.


Appendix II-3


Objectives and contents of specific programs For medical radiation therapists.


Appendix II-4


Objectives and contents of specific programs for dental surgeons.


Appendix II-5


Objectives and contents of specific programs for physicians using ionizing radiation for diagnostic purposes without being qualified in radiology, nuclear medicine and radiation therapy.


Appendix II-6


Objectives and contents of specific programs for physicians using ionizing radiation for therapeutic purposes (angioplasties) or surgical procedures, without being qualified in radiology, nuclear medicine, and Radiotherapy.


Appendix II-7


Objectives and contents of specific programs for medical radiophysics specialists.


Appendix II-8


Objectives and contents of specific programs for manipulators and manipulators in medical electroradiology.


A N N E X E I I-1
OBJECTIVES AND CONTENT OF SPECIFIC PROGRAMS
FOR RADIO PHYSICIANS


The following objectives complement the objectives and contents of the Schedule I programs:
Physical bases of ionizing radiation imaging useful for radiation protection:
Physical to understand the production of X-rays.
Radioactivity and radionuclides.
General properties of X-rays and gamma rays, attenuation, absorption, diffusion and their practical consequences.
Image Formation Radiological and scintigraphic design.
Notions concerning exposure to radionuclides (nuclear medicine, accidents and attacks).
Radiobiology and Radiation Protection:
Biological Effects of doses issued. Somatic and genetic effects of ionizing radiation.
The principle of dose optimization, including the different means of dose reduction with special consideration for pregnant women and children.
Measures of the Dose received during an exposure.
Control organizations.
X-ray imaging equipment:
Basic technological knowledge to select the hardware.
Factors influencing the emission of X-rays.
Anti-diffusion systems, automatic exhibiting.
The quantities and units used to estimate the dose from each radiographic examination.
Tomodensitometry. Image acquisition and reconstruction principles. Parameters affecting the delivered dose. Devices and software to reduce the dose. The quantities and units used to assess the dose given by each scanographic examination.
Radiological image:
Optimization of conventional and digital radiological images.
Identifying and correcting artifacts on a Image.
Radiological image quality. Quality improvement and quality control.
The digital image.
Protection for specially irradiated examinations:
Practice of the pediatric scanner: sedation, restraint, parameter optimization, and acquisition.
Patient Protection In interventional radiology. Base rules for using dedicated radiographic tables. Skin risk and monitoring after iterative procedures.
Operator protection in interventional radiology.


A N N E X E I I-2
OBJECTIVES AND CONTENT OF SPECIFIC PROGRAMS
FOR PHYSICIANS NUCLEARIES


The following objectives complement the objectives and contents of the Schedule I programs:
Physical bases of imaging by ionizing radiation useful for radiation protection:
Physical bases To understand the production of X-rays.
Radioactivity and radionuclides.
General properties of X-rays and gamma rays, attenuation, absorption, diffusion and their practical consequences.
Radiological image formation and Scintigraphic.
Notions concerning exposure to radionuclides (accidents and attacks).
Radiobiology and Radiation Protection:
Biological Effects of Ionizing Radiation and the Means of Reducing them.
The principle of The optimization of doses, including the different means of dose reduction with special consideration for pregnant women and children.
Dose measurements received at an exposure.
Control organizations.
Imaging and radiation protection equipment:
Technology bases for the selection of nuclear medicine equipment. Activimeter and contaminameter.
Internal radiotherapy:
Radionuclide exposures to internal radiotherapy.
Factors that vary the dose of radiation received by the patient, those around them. Factors for Environmental Impact Management.
Radiation protection in internal radiotherapy.
Protection of pregnant and lactating women during the administration of radionuclides.


A N N E X E I I-3
OBJECTIVES AND CONTENT OF SPECIFIC PROGRAMS
FOR RADIOTHERAPEUTIC MEDICINES


The following objectives complement the objectives and contents of the Schedule I programs:
Physical imaging bases By ionizing radiation and radiation therapy for radiation protection:
Physical bases for understanding the production of X-rays and gamma rays.
Radioactivity and radionuclides. Particulate emissions.
General properties of X-rays and gamma rays, attenuation, absorption, diffusion and their consequences.
Exposure to radionuclides (brachytherapy, accidents and attacks).
Radiobiology and Radiation Protection:
Effect of doses, means of reducing them. Somatic and genetic effects of ionizing radiation.
The principle of dose optimization, including the different means of dose reduction with a particular consideration for women and children.
Dose Measurements Received At an exhibition.
Practical means to decrease the dose received outside the target volumes of radiotherapy.
Control organizations.
Radiotherapy and brachytherapy equipment:
Choice of equipment and impact on protection Patients.


A N N E X E I I-4
OBJECTIVES AND CONTENT OF SPECIFIC PROGRAMS
FOR DENTISTS


The following objectives complement the objectives and contents of the programs Appendix I:
Physical bases of imaging by ionizing radiation useful for radiation protection:
Physical bases for understanding X-ray production.
Radioactivity and radionuclides.
General Properties X-rays and gamma rays, attenuation, absorption, diffusion and their practical consequences.
Radiological and scintigraphic image training.
Notions for radionuclide exposures.
Radiobiology and Radiation Protection:
Biological effects of doses issued. Somatic and genetic effects of ionizing radiation.
The principle of dose optimization, including the different means of dose reduction with special consideration for pregnant women and children.
Measures of the Dose received during an exposure.
Control organizations.
Ionizing radiation detection.
Patient's practical procedures for radiation protection in dental surgery.


A N N E X E I I-5


OBJECTIVES AND CONTENT OF SPECIFIC PROGRAMS FOR PHYSICIANS USING DIAGNOSTIC RADIATION REQUIREMENTS WITHOUT QUALIFIED IN RADIOLOGY, NUCLEAR MEDICINE AND RADIOTHERAPY
The following objectives complement the Objectives and contents of Schedule I programs:
Physical bases of imaging by ionizing radiation useful for radiation protection:
Physical bases for understanding X-ray production.
Radioactivity and Radionuclides.
General X-ray properties. Mitigation, absorption, dissemination and their practical consequences.
Notions concerning exposure to radionuclides (nuclear medicine, accidents and attacks).
Radiobiology and Radiation protection:
Biological effect of doses issued. Somatic and genetic effects of ionizing radiation.
The principle of dose optimization, including the different means of dose reduction with special consideration for pregnant women and children.
Measures of the Dose received during an exposure.
Control organizations.
X-ray imaging equipment:
Basic technological knowledge to select the hardware.
Anti-diffusion systems, automatic exhibiting.
The Principles of the scanner. The quantities and units used to assess the dose given by each radiographic and scanographic examination.
Radiological image:
Optimization of conventional and digital radiological images. Identification and correction of artifacts on an image. Sensors. Constitution, operation and sensitometric curve.
Radiological image quality. Quality improvement and quality control. The digital image.
Helical Tomodensitometry: image acquisition and reconstruction principles and their influence on the delivered dose.


A N N E X E I I-6


OBJECTIVES AND CONTENT OF SPECIFIC PROGRAMS FOR MEDICAL DEVICES FOR THÉRAPEUTIC PURPOSES OR CHIRURGICAL INSTRUMENTS WITHOUT QUALIFIED IN RADIOLOGY, NUCLEAR MEDICINE AND RADIOTHERAPY
The following objectives complement the Schedule I program objectives and contents:
Physical bases of ionizing radiation imaging and radiation therapy useful for radiation protection:
Physical bases for understanding X-ray production and Gamma.
Radioactivity and radionuclides. Particulate emissions.
General properties of X-rays and gamma rays, attenuation, absorption, diffusion and their consequences.
Exposure to radionuclides (brachytherapy, accidents and attacks).
Radiobiology and Radiation Protection:
Biological effect of doses issued. Somatic and genetic effects of ionizing radiation.
Deterministic (skin, ocular) risk in interventional procedures.
The principle of dose optimization, including the different means of dose reduction with a Special consideration for pregnant women and children.
Dose measurements received at an exposure.
Protection for specially irradiated acts:
Patient protection in interventional radiology. Basic rules for the use of dedicated radiographic tables: choice of parameters, use of dose reduction devices, use of dose measurement systems. Skin risk and monitoring after iterative procedures.
Protection of operators in interventional radiology:
Basic rules of individual protection, method of use of protective equipment, principles and means of Active dosimetry.


A N N E X E I I-7


OBJECTIVES AND CONTENT OF SPECIFIC PROGRAMS FOR MEDICAL RADIOPHYSICAL PERSONS SPECIALIZED The
objectives complete the objectives And contents of Schedule I programs:
Physical bases of imaging by ionizing radiation useful for radiation protection:
Physical bases for understanding X-ray production.
Radioactivity and Radionuclides.
General properties of X-rays and gamma rays, attenuation, absorption and diffusion and their practical consequences.
Radiological and scintigraphic image training.
Notions for Radionuclide Exposure (Nuclear medicine, accidents and attacks).
Radiobiology and Radiation Protection:
Effect of doses, means of reducing them. Somatic and genetic effects of ionizing radiation.
The principle of dose optimization, including the different means of dose reduction with a particular consideration for women and children.
Dose Measurements Received At an exhibition.
Practical ways to decrease the dose received by tissues not covered by radiotherapy.
Control organizations.
Ionizing Radiation and Radiation Therapy Equipment:
Knowledge Basic technology for the selection of equipment: basic principles of the X-ray tube with rotating anode.
Basic factors influencing the emission of X-rays. Antidiffusion, automatic exhibiting. The principles of the scanner.
Factors that vary the dose of radiation received by the patient, his or her entourage in nuclear medicine.
Environmental impact management factors. Waste, doses received at internal and external exhibitions by the entourage and the public.
Equipment selection factors in radiology, nuclear medicine and radiation therapy.
Dosimetry measurement techniques.
Dosimetric Evaluation In the patient after an act using ionizing radiation. Specific case of fetal assessment.


A N N E X E I I-8


OBJECTIVES AND CONTENT OF SPECIFIC PROGRAMS FOR MANIPULATORS AND MANIPULATORS FOR MEDICAL ELECTRORADIOLOGY
The following objectives complement the objectives and contents of the programmes of Annex I:
Physical bases of imaging by ionizing radiation useful for radiation protection, radiobiology and radiation protection:
Structure of the atom, Excitation, ionization.
Radioactivity: general, decay mechanism, natural radioactivity, artificial radioactivity.
Different types of radiation. Interaction with matter.
Radiological units and units.
Detection methods: physical principles, detection equipment.
Dosimetry and dosimeters.
Biological Effects of Radiation.
Imaging technology X-rays:
Radiogenic tube principles. Basic factors influencing x-ray emission.
Tomodensitometry. Image acquisition and reconstruction.
Optimization of conventional and digital radiological images. Technical artifacts on an image, screen types, films, sensitometry, radiological contrast. Quality control, ACAP principles. Psycho-physiology of vision. Rebuilds 2 D and 3 D.
Parameters affecting the dose delivered in CT. Hardware and software devices to reduce the dose in CT. The quantities and units used to assess the dose given by each scanographic examination.
Rationale, management and evaluation of a quality assurance program. Practical application in radiography, nuclear medicine and radiation therapy.
General principles of radiation protection and conduct to be kept in case of accidental exposure:
Rationale, optimization, reference levels, stress of Dose, target dose level.
Control organizations.
Adaptations of radiography, nuclear medicine and radiotherapy protocols:
Depending on the age and condition of patients and the evolution of science, and Techniques.
Adaptation of radiological and technical parameters to optimize doses dispensed.
Patient information about the dose received during a necessary exposure during major diagnostic tests.
Elaboration A quality assurance program.
Optimization of doses to patients, radiological parameters and doses dispensed, dose levels by examination:
Principles of protection against external exposure, photon attenuation, means Specific protection.
Principles of protection against internal exposure, contamination control.
Transport of radioactive sources, quality control of facilities, risk assessment.
Practical aspects:
Use of measuring equipment: dose, activity, surfacic contamination, spectrometry.
Protection against external exposure: time, screen, distance.
Internal exposure protection: control, decontamination.
Monitoring Quality of the material and the radiological chain.


Done at Paris, 18 May 2004.


Philippe Douste-Blazy



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