LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT ASNR encourages the deployment of these reviews in the sectors with high radiation protection risks which are not covered at present, namely radiosurgery and therapeutic nuclear medicine and, in particular, it encourages the professional organisations to start working together on the review of audit baseline requirements. It considers that the feasibility of external audits should encourage the implementation of internal audits within each imaging facility, which external audits will take into account in order to ensure the application of the principles of justification and optimisation. Training in patient radiation protection – The obligations for continuous training in patient radiation protection are set in Articles L. 1333‑19, R. 1333‑68 and R. 1333‑69 of the Public Health Code. The system as a whole was revised in ASN resolution 2019-DC-0669 of 11 June 2019 amending resolution 2017-DC-0585 of 8 January 2015, further to discussions with all the National Professional Councils (CNP) concerned. This resolution aims to clarify and enhance the teaching objectives concerning justification, to integrate new actors and to foster interfacing with the other continuous training systems. Pursuant to this resolution, 18 professional guides have been produced by the professional organisations, validated by ASNR and published online on asnr.fr(5). To monitor the practical implementation of this new regulatory framework, a qualitative and quantitative assessment involving all the professions was carried out in 2022. An inventory of the training offerings has been drawn up to identify the main stakeholders (health facilities, professional organisations, continuous training organisations). For the guide for radiotherapy professionals and the guide for radiographers working in imaging, a specific assessment has been conducted by the Centre of Studies on the Evaluation of Protection in the Nuclear Field (CEPN) at the request of ASN, on the number and content of these two training courses. This assessment focused on compliance with the regulations, the organisation of the training courses, their teaching methods and the level of satisfaction of the professionals who have followed the courses. The first results show that the training guides are broadly followed by the training organisations (whether public or private). This work was presented in 2023 to the committee that monitors the national plan for controlling imaging doses and to the Advisory Committee of Experts for Radiation Protection – GPRP (see chapter 2). It was also presented to the organisations providing continuing training in patient radiation protection in October 2024, before the survey summary was published on the ASN website in November 2024. In 2025, the recommendations concerning the clarification of the status of professionals who may be involved in the delivery of the dose (other than radiographers, physicians and dental surgeons) with regard to continuing education in patient radiation protection contributed to the work of the monitoring committee for the National Imaging Dose Management Plan (see chapter 1, point 3.3). 1.4 The risks and oversight priorities In order to establish its oversight priorities, ASNR has classified the nuclear-based medical activities according to the risks for the patients, the personnel, the public and the environment. This classification takes particular account of the doses delivered or administered to the patients, individually or collectively, the fitting out of the premises and the conditions for use of ionising radiation sources by medical professionals, the production of waste and effluents contaminated by radionuclides, the source security risks (high activity sealed sources), lessons learned from significant events reported to ASNR and the radiation protection situation in the institutions conducting these activities. On the basis of this classification (see point 1.3.3, Table 1), ASNR considers that its inspection priorities must focus in priority on external-beam radiotherapy, including radiosurgery, brachytherapy, 5. https://reglementation-controle.asnr.fr/espace-professionnels/activites-medicales nuclear medicine and fluoroscopy-guided interventional practices (FGIPs). The inspection frequencies, based on an approach graded according to the radiation protection risks (see Table 2), enable all the safety-significant activities to be inspected over a period of three to five years, depending on the sectors. These frequencies are increased when vulnerabilities that could have an impact on radiation protection are identified (difficulties linked to human resources, technical or organisational changes, quality management or insufficient control of risks – lateness in formalising practises, absence of risk assessments, lack of risk culture , particular risks associated with certain techniques, etc.). This may lead ASNR to step up its monitoring of certain centres where significant and persistent malfunctions have been observed, by carrying out more frequent inspections (see chapter 3). The inspection frequency for FGIPs can be reduced by ASNR depending on the knowledge of the radiation protection situation of the facilities, on the basis in particular of the inspections carried out when issuing a registration. In addition to these inspection priorities, annual priorities are defined on the basis of OEF from inspections and ESRs. In 2025, for example, ASNR launched an inspection campaign focusing on dentists who use Cone Beam Computed Tomography (CBCT), providing them with a self-assessment grid to evaluate their regulatory compliance (see Highlight No. 8). In 2026, ASNR will launch a campaign on conventional paediatric radiology (see point 3). In 2018, ASN defined a list of systematic inspection points concerning the radiation protection of workers, patients and the public, the management of sources, waste and effluents, and the security of sources. These inspections, associated with indicators, enable regional and national assessments to be carried out and the developments to be measured over time. Some indicators are common to all the inspected activities, such as the organisation of radiation protection and of medical physics, and training in radiation protection of workers and patients. Others are specific to a given activity, such as the management of waste and effluents in nuclear medicine or the security of sources in brachytherapy. These indicators serve in particular as the basis for assessing the radiation protection situation in the medical sector (see point 2). These systematic checks are complemented by investigations on specific themes defined in an annual or multi-annual framework and adapted to the particular situations encountered in the inspections. The main themes chosen in 2025 were: ∙for radiotherapy, including radiosurgery and brachytherapy: risk management and in particular learning lessons from ESRs, management of skills and training, mastery of the equipment and more particularly the accelerator calibration process and the security of high-activity sealed sources; ∙for nuclear medicine: the management of adverse events, particularly with regard to controlling the dispensing of RPDs, the implementation of the ASN circular letter of 12 June 2020 concerning changes to the licensing conditions applied by the ASN to nuclear medicine departments for the possession and use of lutetium-177, and the implementation of checks to ensure the absence of surface and airborne contamination; ∙for FGIPs: implementation of the optimisation approach and training practitioners in patient radiation protection. With regard to radiotherapy, in 2024 ASNR conducted an internal review to define a new inspection programme for the period 20252028. This review was based in particular on the conclusions of the national seminar held by the ASN on 15 March 2023, which took stock of developments in quality-safety approaches in radiotherapy after more than 15 years of implementation and their contribution to making treatment delivery safer. Although the fundamentals of safety have now been established in radiotherapy departments and the qualitysafety culture has improved significantly since 2008, challenges remain, in particular the need to make these approaches sustainable and avoid them becoming routine. Inspections will continue to assess organisational processes and risk control measures, taking into 196 ASNR Report on the state of nuclear safety and radiation protection in France in 2025
RkJQdWJsaXNoZXIy NjQ0NzU=