LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT nuclear medicine), by anatomical region examined, by age and by gender. The main conclusions are as follows (see chapter 3, Highlight No. 3): ∙The frequency of procedures fell from 1,181 to 1,083 per 1,000 beneficiaries between 2017 and 2022, representing a reduction of 8%. This overall fall was mainly due to a reduction of around 19% in conventional radiology procedures. The frequencies of CT examinations and diagnostic nuclear medicine procedures increased by approximately 11% and 22%, respectively. ∙The average annual effective dose per beneficiary increased very slightly between 2017 and 2022 (+2.6%), from 1.53 mSv to 1.57 mSv. This increase is essentially linked to CT scans and nuclear medicine procedures, which involve higher doses, and for which the proportion increased over the period compared to conventional radiology. ∙By 2022, almost 43% of the population had undergone one or more diagnostic procedures. The proportion of women exposed is significantly higher than that of men: 47.3% versus 37.8%. The proportion of exposed individuals in the population depends heavily on age, from around 15% for the youngest children to just under 70% for women aged 65 to 74 and around 55% for men aged 65 to 84. ∙This effectively exposed population received an average of 2.54 procedures during 2022. This number varies according to age: children under 10 have had an average of less than 2 procedures per year, while adults over 75 have had around 3.4. ∙The cumulative individual effective dose for this exposed population in 2022 was an average of 3.7 mSv. The distribution of this dose is extremely heterogeneous: half the patients received a dose of less than or equal to 0.1 mSv, 75% received a dose of less than 1.9 mSv, while the 5% most exposed received a dose of more than 18.6 mSv. 1.2.3 – Exposure of the public The impact of medical applications of ionising radiation is likely to concern: ∙carers and comforters of patients having received therapeutic nuclear medicine treatment and healthy volunteers participating in biomedical research involving exposure to ionising radiation. The regulatory obligations applicable to these exposures are those that apply to medical exposures. These exposures are therefore not subject to the dose limits for the public but must comply with dose constraints (see below and point 1.3.4); ∙embryos or foetuses exposed in utero when pregnant women are exposed for medical purposes; ∙members of the public who live near facilities that emit ionising radiation and the persons working in these facilities who are not workers classified in application of the Labour Code with regard to the radiological risk; ∙the personnel of the sewage networks and wastewater treatment plants who could be exposed to effluents produced by nuclear medicine departments and radioimmunoassay laboratories, and in the event of non‑compliance with waste management procedures, the personnel working in waste collection and waste treatment facilities who could be exposed to waste produced by nuclear medicine departments or generated at home by patients having received therapeutic nuclear medicine treatment. The estimated doses for the public (people external to the health facility) resulting from discharges from nuclear medicine departments are a few tens of microsieverts (µSv) per year for the most exposed people, primarily the personnel working in sewage networks and wastewater treatment plants (IRSN studies, 2005 and 2014). In 2015, IRSN developed a support tool called CIDRRE (French acronym for “Calculation of the impact of radioactive discharges into wastewater networks”). This aid enables nuclear medicine departments to estimate, with reasonably penalising assumptions, 3. ICRP Publication 84. Ann. ICRP 30. ICRP Supporting Guidance 2. Ann. ICRP 31. ICRP Publication 90. Ann. ICRP 33. ICRP Publication 103. Ann. ICRP 37, ICRP Publication 105. Ann. ICRP 37 (2005). conservative dose values for the sewage system workers based on the activities they administer to patients or use in their research work. Situations of occupational exposure of waste treatment personnel associated with the handing of radioactive waste from nuclear medicine departments or healthcare services or produced by patients at home are exceptional and of very limited scale, even if radiation portal monitors do get activated from time to time at the entrance to waste treatment facilities, in which case complex operations are required (sorting, characterisation, etc. – see point 2.3.3.4). The number of exposures of pregnant women unaware of their pregnant state reported to ASNR decreased by 12% in 2025 compared with 2024. These exposures accounted for 15% of Significant Radiation Protection Event (ESR) notifications in 2025 (see point 2.7), compared with an average of 25% over the previous 10 years. Although this figure fluctuates regularly, it has been on a downward trend since 2021. However, the decrease in the number of ESRs involving accidental exposure of embryos or foetuses has not been observed in CT scanning (see point 2.5.4). The fact that they occur so frequently means that there is still a need to develop the systematic use of pregnancy tests in these imaging centres. At the end of 2021, ASN published a “Patient Safety” bulletin on its website entitled Ionising radiation: limiting the exposure of women unaware of their pregnancy, which is gradually bearing fruit in areas other than CT scanning. The doses delivered to the uterus by imaging examinations are usually less than 100 milligrays (mGy), a value below which no increase in malformations or reduction in intellectual quotient has been detected to date in comparison with spontaneous risks (estimated at 3%)(3). The exposure of pregnant women who were unaware of their pregnant state during therapeutic treatments using ionising radiation could, given the higher doses than in diagnostic imaging, exceed 100 mGy depending on the zone treated. The exposure of a foetus to more than 100 mSv may lead the patient to decide to have an abortion. In nuclear medicine the administration of a RadioPharmaceutical Drug (RPD) also exposes the medical professionals who are involved in dispensing and/or monitoring the treatment (who are subject to monitoring as mentioned earlier in point 1.2.1) and can potentially expose the patient’s family and comforters. The regulations have introduced the notion of “dose constraints” for the patient’s family circle in order to control such exposure. To verify compliance with these dose constraints with respect to the patient’s family circle, ambient dose equivalent rate measurements can be taken before discharging a patient who has undergone a nuclear medicine procedure. In clinical practice, nuclear medicine departments HIGHLIGHT No. 1 The FEDORA study of foetal exposure to ionising radiation in utero FEDORA (FEtal DOse in RAdiotherapy) is a study conducted by ASNR in collaboration with external-beam radiotherapy centres. Although the foetus is at a distance from the treatment area, it is still exposed to various sources of ionising radiation, in particular leakage from the accelerator head and scattered radiation from interactions of the incident beam with the patient’s tissues. The study seeks to address two major objectives: providing optimal treatment for the mother while protecting the foetus from ionising radiation. Launched in 2022, the FEDORA study combines a national survey, the development of realistic anatomical phantoms using 3D printing, the optimisation of technical treatment parameters, and methods for estimating foetal dose, including in vivo on the patient. It also draws on the European SONORA project (PIANOFORTE), which studies foetal exposure for different types of medical exposure and enables international comparisons. The aim is to produce practical recommendations adapted to the equipment and techniques currently used in clinical practice (calculation software, detectors and treatment machines). 192 ASNR Report on the state of nuclear safety and radiation protection in France in 2025
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