Abstract
Covid-19 pandemic imposes crucial social distancing rules and restriction measures; therefore, the access to facilities and sites, in order to perform on-site inspections, became difficult or not feasible. Greek Atomic Energy Commission (EEAE) adopted remote virtual inspections (RVIs) of facilities and practices applying ionising radiation and magnetic resonance imaging installations, in order to continue discharging its regulatory duty of inspection, effectively. This study presents the experience gained and lessons learnt from the implementation of the RVIs and explores the RVIs perception by the stakeholders. Moreover, the effectiveness and the capability of RVIs to identify 'findings', is assessed by comparing the on-site and the remote inspections outcomes. The presented study showed that RVIs could not replace the on-site inspections, entirely; however, they could support and contribute to the inspection activities and program, in certain circumstances. RVIs were proven to be a valuable tool for the inspection of procedures, documents and records as well as the design and operational conditions of the facilities. The performance of remote verification tests and measurements, although feasible, was challenging, due to the technical issues needed to be resolved in advance. The comparison between remote and on-site inspections outcomes showed that both inspection options had similar capability to identify 'findings', indicating the validity of the RVIs as an inspection methodology in certain inspection thematic areas. The perception of the RVIs was positive and the added value and usefulness was acknowledged by the inspected facilities' personnel and the EEAE's inspectors, although the latter mainly considered RVIs as complementary and supportive to the on-site inspections.
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1. Introduction
The Covid-19 pandemic imposed crucial social distancing rules and special precautions to prevent virus dispersion. The restriction measures posed difficulties in the implementation of on-site inspections in facilities and sites. Thus, authorities and organisations rapidly considered adopting remote virtual inspections (RVIs) in their effort to continue discharging their duties. RVI, also called e-inspection, distant or hybrid inspection, is the process of conducting inspections for the review and assessment of practices and operational conditions of a facility, remotely and virtually, with the use of e- tools, without the physical presence of the inspectors at the sites being inspected [1]. To facilitate RVIs, several authorities and organisations have developed procedures and guidelines for the RVI implementation [1–5].
RVIs are not a new concept; for many years they have been implemented in nuclear industry, health care sector and other areas such as fire protection, industry, finance [6–10]. The main scope of the RVIs is to facilitate the effective and timely implementation of the inspection program and the verification and improvement of safety and security, especially in cases that the facilities are located at far distant areas. RVIs may also aim to the efficient use of the inspection authority's human resources and to improved management of the respective workload.
A recent International Atomic Energy Agency survey of regulatory bodies in 127 countries [11] revealed that national regulators are using innovative methods, including remote inspections, during the Covid-19 pandemic, to ensure that radiation safety is not compromised. Among others, the survey identified challenges and opportunities for the regulators considering to adopt remote inspections in their activities and addressed the need for developing guidance for the RVIs establishment and implementation.
In the field of ionising radiation applications and nuclear industry, there are activities that are conducted remotely for safety and security reasons (e.g. manipulating a high activity radioactive source, maintenance or repair works in a nuclear power plant) or other practical reasons (e.g. restricted access to an area or location). Furthermore, dosimetry audits in radiotherapy are often performed remotely, where the dosimeters are sent to the radiotherapy centres by post [12]. However, such remote monitoring activities and audits should not be confused with the RVIs.
The Greek Atomic Energy Commission (EEAE) is the national regulatory authority, competent for the control, regulation and supervision in the fields of nuclear energy, nuclear technology, radiological and nuclear safety and radiation protection in the country. Among its duties, EEAE conducts inspections, based on the graded approach, to all facilities performing ionising radiation practices and medical magnetic resonance imaging (MRI), in order to verify the compliance with the regulatory requirements and the authorisation terms. It is noted that no nuclear power plants operate in the country. The Licensing and Inspection Department (LID) of EEAE, that is in charge for the inspections, implements a management system according to ISO/IEC 17020:2012 standard (Type A—Inspection Body), which is accredited by the HellenicAccreditation System. LID consists of 13 inspectors holding postgraduate degrees (PhD or MSc) in medical–radiation physics.
The inspectors use inspection forms, as guidance, which are developed based on the ionising radiation regulatory provisions [13]. The thematic areas and topics assessed during inspections are presented in figure 1. Each topic (boxes in figure 1) includes several elements that assist the inspector to observe, investigate and assess. In terms of verification, the inspectors seek proof that includes visual inspection of records, facility design, equipment and inventories and may perform tests and measurements. The inspection report contains the inspection findings, as well as recommendations and timeframes. A follow-up inspection is conducted, when the identified non-compliances could pose significant impact to occupational, medical and public exposures.
Figure 1. The thematic areas, topics and sub-topics (boxes in blue, green and yellow, respectively) investigated and assessed during inspections (on-site and remote). The inspection forms, used by the inspectors, include several elements and questions for each thematic area and topic. The symbols for microphone, camera and meter-reading stand for verbal interview, visual inspection and verification tests performance, respectively. RP: radiation protection, QC: quality control, DRL: diagnostic reference levels.
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Standard image High-resolution imageOn annual base, EEAE performs several 100 inspections (∼400) at facilities and practices (figure 2). It is obvious that the inspections conducted in 2020 were significantly decreased compared to the previous years, due to the Covid-19 restriction measures (311 in 2019–131 in 2020) [14].
Figure 2. The number of inspections performed by the LID/EEAE at facilities and practices utilising ionising radiation and medical MRI installations in the period 2015–2020. Inspections of other practices (e.g. dental, veterinary, transport, radioactive waste, etc) are not presented.
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Standard image High-resolution imageThis fact triggered EEAE to consider implementing RVIs, initially adopted as a pilot study, in order to continue discharging its regulatory duty of inspection, effectively.
The aim of this work is: (a) to present the needs, requirements and specificities of the RVI and identify their strength and weaknesses, opportunities, challenges and threats and (b) to report the perception of the RVIs by the personnel of the facilities and the EEAE's inspectors. Moreover, the possibility to continue the RVIs after the Covid-19 pandemic and their incorporation within EEAE's inspection program is investigated. In this context, a comparison was carried out between the on-site and remote approaches, to support the decision making.
2. Material and methods
2.1. Implementation of the RVIs
2.1.1. Setting up RVIs.
As a first step, an LID internal guide was developed to describe the RVIs performance framework, mainly based on information from literature [1–3, 11]. It addressed practical issues, as: the criteria for RVI implementation; the beforehand contact with the facility to be inspected, the use of e-communication platforms and relevant equipment (internet, WiFi, wireless local area network, PC, laptops, smart phones, tablets) and the arrangements necessary for remotely conducting verification tests and measurements; the communication means that could be used for specific element assessment, i.e. verbal interviews, visual assessments and remote verification tests, as noted in figure 1 by the symbols of a 'microphone', 'camera' and 'meter-reading' respectively; the procedures for results evaluation and the preparation of the inspection report.
As a general rule, RVIs recording and screen shots acquisition were prohibited, unless consent was given by both parts (EEAE and operator).
2.1.2. RVI performance.
Two EEAE inspectors participate in an RVI, as in on-site inspections, using separate communication equipment. The radiation protection officer (RPO), experts and other staff members participated, as appointed by the facility top management.
The inspection forms used for on-site inspections were followed; the thematic areas elements shown in figure 1 were assessed.
A virtual–visual tour was conducted at the facility premises with the use of a web-camera to verify the design, the use of each room, the classification of areas; shielding verification measurements were conducted, as appropriate. In facilities utilising unsealed radioactive sources, the RVI additionally assessed the means and procedures for prevention of contamination spread and management of radiopharmaceuticals and radioactive waste. Visual inspections of MRI installations also assessed the response to emergency situations such as quench, and the safe operation of the MRI system including the maintenance of regular cryogen levels.
The practical implementation of the procedures and arrangements, related to occupation exposure, medical exposure wherever applicable, and exposure of the public were inspected via interviews and review of documentation and records. The latter was taking place either by screen-sharing of the electronic documents or by viewing the hard copies via the web-camera.
If instructed by the EEAE inspectors, the facility staff conducted verification tests and measurements in certain thematic areas as shown in figure 1. The EEAE's inspectors observed the procedures and the instrument readings with the web-camera. Relevant documents (e.g. calibration certificates, manuals) would be available to the EEAE's inspectors, for the assessment of the results. Outdated calibration certificates were noted as an inspection 'finding'. Operators make use of the calibration services provided by the Greek secondary standard dosimetry laboratory or other calibration laboratories abroad that ensure traceability to international standards.
Table 1 summarises the verification tests and measurements performed remotely.
Table 1. Verification tests and measurements performed remotely.
| Field | Task | Instrument/Method |
|---|---|---|
| Radiation protection a | Verification measurement of dose rates at points and areas in workplaces, indoors and outdoors. | Operator's staff used their own portable survey meter. Exposure conditions and measurement locations were indicated by the EEAE's inspectors. |
| Diagnostic radiology | Verification of medical x-ray equipment performance and typical patient doses and DRL. | Operator's staff used their own test tools, phantoms, devices (multi-meters) and followed the facility's methodology for the tests. |
| Radiotherapy | Verification of radiation beam output and dose delivery through the % differences of the stated (by the hospital) to the measured (during RVI) doses. | Operator's staff used EEAE's phantoms and dosimetry equipment (sent to the operator in advance); EEAE's methodology and protocols were applied [15]. |
| MRI | Verification of 0.5 mT and 3 mT contours indoors and outdoors areas. | Operator's staff used their own magnetometer. Areas were indicated by the EEAE's inspectors. |
a Applied to diagnostic radiology, nuclear medicine, radiotherapy and industrial facilities and practices.
The installed security systems were visually inspected and tested by challenging the existing interlocks and observing the operation of alarms and the staff response. The facilities staff was interviewed by the inspectors in order to verify to which extent they were informed, aware and familiar with the security measures and means.
2.1.3. Comparison of RVIs with the on-site inspections.
A key question for the RVIs concerns the effectiveness and capability to identify 'findings'. In an effort to evaluate this, the remote and the on-site inspections outcomes were compared for the period January 2020 to August 2021. The number of inspections per type of facility or practice is presented in table 2.
Table 2. Number of inspections of facilities and practices performed in 2020–mid 2021.
| On-site inspections | RVI | |
|---|---|---|
| Diagnostic radiology | 49 | 17 |
| Nuclear medicine | 10 (a) | 6 |
| Radiotherapy | 15 | 8 |
| Industrial | 52 | 8 |
| MRI | 7 | 3 |
| Total | 133 | 42 |
It is evident that the number of the RVIs is low compared to the on-site inspections. However, the size of the facilities and type of practices inspected on-site and remotely were very similar. Indicatively, the percentages of the large-size hospitals and private clinics, industrial radiography and private/state owned facilities were similar in both the on-site and remote inspections samples. Since the purpose of this comparison was the qualitative, rather than quantitative, analysis of inspection outcomes, the inspected samples can be considered appropriate and reliable.
The inspection outcomes were grouped in the thematic areas presented in figure 1, i.e. (a) roles and responsibilities of staff; (b) radiation workers; (c) facility design characteristics; (d) optimisation of practices; (e) quality assurance program; (f) radioactive sources; (g) justification of (medical) practices. The topics concerning the external workers and emergency and preparedness response were not included in the comparison, due to the limited data.
The number of identified 'findings' from the on-site and the remote inspections for each thematic area were recorded. The term 'finding' is used in this work to denote an inspection observation that indicates that there is room for improvement in the performance of the operator; a 'finding' is not necessarily a non-compliance. Since the number of the non-compliances was very low, it was considered appropriate to use the 'findings' for this comparison. The percentages of the 'findings' (i.e. ratio of the number of 'findings' to the number of the assessed elements) identified during the on-site and remote inspections were compared.
2.2. RVI perception
The RVI perception was investigated using questionnaires, in order to collect and analyse the stakeholders' views and the strengths, weaknesses, opportunities and threats of the RVIs. One questionnaire was distributed to the EEAE's inspectors and a second one to the facilities, where RVIs were recently performed. Both questionnaires had questions (multiple choice or checkboxes) and free text areas for comments.
3. Results
3.1. Implementation of the RVIs
3.1.1. RVI performance.
All 42 RVIs (table 2) were performed successfully. In only one case, in a diagnostic radiology facility, the RVI was terminated and postponed, due to the weak internet signal and sound low quality, as well as due to the fact that the facility's RPO was not participating.
The assessment of all elements regarding the thematic areas 'human resources', 'optimisation of practices' and 'justification of practices' (figure 1) was smoothly completed. The interviews with the RPOs, experts and other facility's personnel were open and comprehensive. The inspection of documentation and records was implemented without problems. RVIs identified a few 'findings' in respect to the radiation workers training and staff roles and responsibilities, as summarised in table 3. In nuclear medicine and radiology facilities, the 'findings' identified, were mainly related to the calibration program frequency, the practical implementation of dose constraints for carers and comforters and the revision of dose constraints established for workers in order to consider the professional specialty, e.g. physician, technologist.
Table 3. Element assessments in facilities and practices with on-site inspections and RVIs in the period 2020–mid 2021 a .
| On-site inspections | RVIs | |||
|---|---|---|---|---|
| Thematic area | Total number | 'Findings' b | Total number | 'Findings' b |
| Roles and responsibilities | 463 | 14% | 194 | 21% |
| Facility design characteristics | 273 | 4% | 96 | 6% |
| Optimisation of practices | 383 | 10% | 144 | 11% |
| Quality assurance (QA) program | 515 | 24% | 188 | 16% |
| Justification of medical exposures | 78 | 6% | 30 | 5% |
| Shielding verification tests | 105 | 10% | 31 | 3% |
| Patient dosimetry in radiology | 45 | 9% | 16 | 13% |
a For nuclear medicine facilities, the on-site inspection outcomes refer to Q4 of 2019. b The term 'findings' is defined in the text.
The 'findings' relating to the 'facility design characteristic' were mainly the lack of labels in two new irradiation rooms (nuclear medicine and brachytherapy) and dose rate measurements, as presented below. In one case of a newly constructed nuclear medicine facility, the RVI revealed that some design characteristics were not in full agreement with the information and documentation submitted to EEAE in the context of the authorisation process. A remote inspection to an MRI facility identified weaknesses in the access control to areas close to quench pipe exhaust point and lack of appropriate warning signs for potential harm in the event of quench.
The performance of verification tests and measurements virtually was challenging. In some cases, the WiFi signal was weak at locations where the tests were conducted, as indicatively basements or behind heavily shielded walls (e.g. in radiotherapy), affecting the communication.
The virtual dose rate monitoring at locations around irradiation rooms was feasible, once the communication equipment and internet connection were appropriate. Remote shielding checks were performed at 31 facilities (table 3). A few 'findings', from both on-site and remote inspections, relevant to higher than the expected instantaneous dose rates were identified at certain locations, as indicatively doors frames, loose doors or due to unshielded or poorly shielded radiopharmaceuticals. Nevertheless, it worth mentioning that none of these cases exceeded the respective dose limits.
Remote assessment of the fixed security systems installed at radioactive sources premises (e.g. access interlocks, motion detectors) was feasible and performed successfully. However, the evaluation of the practical implementation of security procedures, such as access control or functional vulnerability, was challenging during the RVIs.
3.1.2. Comparison with the on-site inspections.
Table 3 presents the comparison of the identified 'findings' between the remote and on-site inspections conducted in facilities with diagnostic radiology, nuclear medicine, radiotherapy and industrial practices. The total number of the assessed elements for each thematic area and the percentages of the identified 'findings' are presented, as well as, the results from shielding verification measurements and typical patient doses. Shielding tests were performed in the majority of the inspected facilities (136 out of 173) and typical patient doses at almost all diagnostic radiology facilities (61 out of 66).
The verification tests for dose delivery in radiotherapy are summarised in figure 3. The differences, as percentages, of the stated, by the radiotherapy centre, dose to the measured dose are presented for the on-site inspections and the RVIs. The results distributions from the on-site and the remote inspections appear similar (p = 0.68), indicating that it is feasible to perform remote dose delivery assessments.
Figure 3. Results of radiation beam output and dose delivery verification in radiotherapy during on-site and remote inspections.
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Standard image High-resolution imageThe RVIs performed in industrial facilities utilising radioactive sources were less than the on-site inspections (8 and 52, respectively, table 2). The virtual assessment of the elements regarding the 'human resources', 'optimisation of practices', 'QA program' was feasible. However, the assessment of some elements related to the radioactive sources, like accountability, supervision and transport, as well as the storage of disused radioactive sources, proved difficult to be remotely performed, mainly because of the nature of the practice, i.e. the radioactive sources are at several locations or used in the field, where the internet access and the web-cameras function may be problematic. Furthermore, the remote evaluation of security procedures was challenging.
Regarding the MRI facilities, the completeness, clarity and accuracy of information obtained from the RVIs were similar to those obtained from on-site inspections. A common weakness identified in most MRI facilities was the weak or absence of WiFi signal, due to the nature of the MRI installations (shielding).
3.2. RVI perception
The questionnaire distributed to the operators inspected remotely, was responded by 56 facilities staff members. Moreover, 10 EEAE inspectors (out of 13) responded to the second questionnaire.
The operators' responses showed that 85% of them strongly believed that EEAE's inspections, either on-site or remote, are useful and contribute to the radiation protection of the facility; 78% believed that inspections are important for assessing the safety, including radioactive source security and radiation protection of the facilities and 55% that inspections promote the radiation protection, in general, countrywide. Moreover, 15% of the facilities staff members preferred the remote inspections, 11% preferred the on-site inspections and 74% did not express any preference stating that both types of inspection were equivalent.
Figure 4 summarises the responses concerning the feasibility and usefulness of the RVIs and the remote verification tests and measurements, as well as the continuation of the RVIs after the Covid-19 pandemic.
Figure 4. Views of facilities' staff and EEAE's inspectors on (a) the continuation of RVIs after Covid-19 pandemic (b) the usefulness of RVI as a tool for inspections during the Covid-19 pandemic and (c) the feasibility of conducting verification tests and measurements remotely with the use of e-tools. The x-axis refers to the percentages (%) of the responding to the questionnaires staff members.
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Standard image High-resolution imageFigure 5 presents the most significant pros and cons of the implementation of RVIs at the facilities and practices, as assessed from the analysis of the questionnaires responses.
Figure 5. Most important pros and cons of the RVIs as identified by the facilities staff members and EEAE inspectors, based on the questionnaires responses. The x-axis refers to the percentages (%) of the responding to the questionnaires staff members.
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Standard image High-resolution imageThe rating for the RVIs given by the facility personnel and the EEAE inspectors in a 1–5 scale is presented in figure 6 (1 corresponds to low and 5 to high rating). The presented rates are the averages of all answers provided for each question.
Figure 6. Rating of the RVIs in a 1–5 scale; the score of 1 corresponds to low rating and the score of 5 to high rating. The operators' staff scored the RVI they recently experienced; EEAE's inspectors stated the average score of all RVIs in which they participated.
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4. Discussion
The Covid-19 pandemic significantly challenged the implementation of the EEAE inspection program, mainly due to the travel restrictions and the remote working. RVIs were a useful tool for continuing to discharge the regulatory duty of inspection and implementing the inspection program.
An overall conclusion from this work is that the remote inspections could not fully replace the on-site inspections. This is in agreement with reported conclusions from other inspection authorities and organisations [1, 16–18]. However, RVIs could support and contribute to the inspection program, in certain circumstances. Table 4 presents the criteria for RVIs performance as established based on the EEAE feasibility study, the experience gained from the RVIs, and from the EEAE's inspectors' questionnaire responses.
Table 4. Criteria for the RVIs implementation.
| RVIs may be conducted at: |
|
| RVIs should not be conducted at: |
|
a 'High' risk practices: operation of high activity radioactive sources, particle accelerators or x-ray systems with voltage higher than 500 kV, radiotherapy and brachytherapy practices, administration of isotopes to patients, computed tomography and interventional radiology procedures.
The RVIs must be well prepared from both sides, i.e. operator and inspectors, in advance. Therefore, 'unannounced' remote inspections are not feasible. Reactive remote inspections, which should be conducted without delay upon complaints, events, allegations, or evidence for radiation protection regulation violations, might not be efficient, considering that practical facts or operational elements may need to be investigated in depth.
Several published articles provide information on available advanced communication technologies to be used in virtual inspections [17], as indicatively 360° automatically movable cameras, virtual reality devices, 3D technology mapping and dedicated software. Such technology is anticipated to ensure high quality and security of the virtual communication. Nevertheless, it may not be readily available to operators. In the presented study, the communication was conducted with Webex or Zoom platforms with the use of web-cameras on laptops, tablets or mobile phones. Even with such broadly available tools, the RVIs were conducted with no particular problems in most cases.
The protection of sensitive data need to be thoroughly considered in advance. According to the questionnaires responses and the scores in figure 6, the majority of the facilities and practices (61%) would not refuse the RVIs performance because of this. However, a limited number of operators' staff members appeared reluctant to participate in an RVI, mainly due to concerns relating to potential cyber-security gaps.
The analysis of the inspections outcomes themselves and the origin of the relevant 'findings' is out of the scope of this work. The presented study aims to investigate the efficiency of the RVIs and their capability to identify 'findings'. As shown in table 3, no significant differences are observed among the percentages of the identified 'findings' from the remote and on-site inspections. Minor differences were observed, which apart from their statistical origin, are discussed below.
For the thematic areas of 'Roles and responsibilities' and 'Patient dosimetry, DRLs', the RVIs detected slightly more 'findings' (as percentages) than the on-site ones, possibly resulting from the increased available inspection time allocated to procedures, documents and records review and assessment. On the other hand, RVIs detected less 'findings', in the thematic areas of 'QA program' and 'Shielding verification tests' assessments, possibly due to the limitations in the performance of virtual verification tests and measurements. Despite these small differences, the general agreement observed in 'findings' detected from remote and on-site inspections supports the validity of the RVIs as an inspection methodology and indicates that the assessments performed are not jeopardised by the remotely implemented inspection procedures.
No particular difficulty was encountered during the RVIs with the staff interviews and the review of documentation and records.
In the field of remote verifications tests and measurements, the presented study showed that beforehand preparation and communication with the facility or the practice operator is necessary to ensure that any technical issues are resolved and the staff becomes familiar with the purpose and the methodology of the tests. The use of facility's QA/QC tests instruments during the RVI, may reveal 'errors' and discrepancies due to insufficient performance, which however, the inspectors could overcome by requesting and reviewing the respective calibration certificates and QC records.
Moreover, the presented study identified a significant weakness of RVIs in evaluating the practical implementation of the security procedures and arrangements for radioactive sources, as well as, in assessing the entire set of elements related to radioactive sources. In these cases, the physical presence of inspectors on site seems necessary for inspection, assessment and verification purposes.
The perception of the RVIs by the operators' staff appears highly positive, as shown in figure 6. The limited disruption in the operation and workload of the facility or practice seems to be noted by the staff as a strength of the RVIs. More than 90% of the staff recognised the added value and the usefulness of the RVIs, for both operators and EEAE, and acknowledged that the conducted remote inspection was complete and comprehensive. The EEAE inspectors appeared cautious about the RVIs and noted that more topics should be assessed.
Most of inspectors (eight out of ten) believed that the virtual performance of verification tests and measurements had difficulties and technical problems and therefore, it is preferable to be conducted on-site. It worth mentioning that, in contrary, 75% of the operators' staff did not encounter particular difficulties with the remote performance of verifications tests and measurements.
All inspectors foresee the continuation of RVIs after Covid-19 restriction measures termination, as complement and supportive to the on-site inspections. A high percentage of operators' staff (63%) consider RVIs as effective as the on-site inspections and 74% of them foresee the continuation of the RVIs after the Covid-19 pandemic.
Concerns that RVIs could limit the interaction between facilities staff and inspectors and the subsequent decline in the exchange of information, knowledge and expertise, were also noted. This threat could be significant for inspections of advanced technologies, practices newly introduced in the country and new facilities; the in-person interaction of inspectors and facilities—practices staff promotes proficiency and expertise.
Finally, a key question is whether RVIs could lead to misinterpretation and jeopardise the quality of the assessments conducted. The presented study noted that RVIs had similar potential for misinterpretation as the on-site inspections, if the preparation, the context and the implementation procedures of the RVI were well designed and communicated to the operators to be inspected. The inspectors also need to be aware of the relevant procedures and properly prepared. A weak point is the performance of remote verification tests and measurements that should be performed with caution, in order to maintain their validity and added value.
5. Conclusion
EEAE adopted RVIs to facilities and practices applying ionising radiation and MRI installations to efficiently implement the inspection program during the Covid-19 pandemic.
RVIs are not anticipated to fully replace the on-site inspections; however, they could support and contribute to the inspection program, in certain circumstances.
RVIs proved a valuable tool for the inspection of procedures, documents and records as well as the design and operational conditions of the facilities. The performance of verification tests and measurements remotely, although feasible, was challenging, due to the practical problems needed to be addressed in advance. The lack of in-person communication between inspectors and facilities personnel threatens the opportunities for improving and exchanging expertise and knowledge. The good preparation and the establishment of appropriate communication channels are important for the effective and successful implementation of RVIs. Finally, the perception of the RVIs is highly positive and their added value and usefulness is acknowledged.