LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Reporting culture and organisation Analysis, defining corrective actions, building on lessons learned Assessment of corrective action effectiveness 30 75 85 81 74 79 81 74 60 61 65 36 49 49 61 2024 2025 2023 2022 2021 GRAPH 2 Percentage change in compliance of external-beam radiotherapy facilities in relation to the management of events giving rise to the implementation of corrective actions over the period 2021-2025 with fewer architectural constraints (no bunker) and is likely to respond more directly to the healthcare needs of certain regions. In its opinion 2024-AV-0447 of 22 October 2024, ASN recommends that medical-economic studies by carried out to confirm the justification of this MD compared with the other existing devices used in France. Furthermore, the conditions of installation and use of this platform should enable the level of ionising radiation exposure of the personnel working on this platform and in adjacent rooms to be optimised. ASNR considers that the ionising radiation exposure levels of these professionals should not be higher than those found at present when using medical particle accelerators installed in bunkers. In addition, a set of safety systems informs the operator of the machine operating status (exposure in progress or not) and switches off the beam in an emergency or if the door to the irradiation room is opened. The protection of the premises, in particular the treatment room, must be determined in order to respect the annual exposure limits for the workers and/or the public around the premises. The current conditions of design of these rooms were reviewed in 2019. A specific study must be carried out for each installation by the machine supplier, together with the medical physicist and the Radiation Protection Advisor (RPA). This study defines the thicknesses and nature of the various protections required, which are determined according to the conditions of use of the device, the characteristics of the radiation beam and the use of the adjacent rooms, including those vertically above or below the treatment room. This study must be included in the file submitted to ASNR to support the application for a license to maintain and use a radiotherapy installation. 2.1.3 – Radiation protection situation in external-beam radiotherapy The installed base of external-beam radiotherapy facilities in 2025 comprises 592 particle accelerators in operation (+2.5% compared with 2024), distributed among 174 radiotherapy centres subject to ASNR licensing (see Graph 1). More than 231,000 patients(7) are treated each year, which represents 4.16 million radiation sessions (in 2024). The French radiotherapy observatory (French National Cancer Institute – INCa), lists 974 radiation oncologists in 2024 and 835 medical physicists. Although fewer licenses were issued in 2025 compared to 2024 (98 compared with 112, a decrease of 14.3%), ASNR notes that radiotherapy centres are modernising and expanding (moving, new bunkers, changing accelerators, restructuring, etc.), due to an ageing fleet of accelerators and the arrival of new technologies. Furthermore, the rise in the number of stereotactic treatments in radiotherapy departments across the country is continuing, with an increase in extra-cranial stereotactic indications (lung, liver, spine, bones, head and neck). This activity presents radiation protection risks and requires skills of a high standard and greater control of the doses delivered. It also takes up more medical and medical physics time and requires work organisation adaptations. Furthermore, the reform of care authorisations (see point 1.3.3) is likely to lead to changes in the holding of nuclear activity licenses (for radiosurgery for example), and organisational changes. ASNR is closely monitoring the impact of these changes and, in particular, the adequacy of the resources allocated to setting up new organisational structures or rolling out new treatment techniques, as these may have an impact on radiation protection. The safety of radiotherapy treatments has been a priority area of ASNR oversight since 2007 on account of the high doses delivered 7. In 2024, 230,956 cancer patients were treated by radiotherapy with 4,162,457 treatment sessions (source: INCa national radiotherapy observatory 2025 - 2024 data). to the patient. Since 2019, the four-yearly inspection programmes have placed the emphasis on the ability of the centres to deploy a risk management approach. Skills management, the implementation of new techniques or practices and the mastery of the equipment are also examined in depth, depending on the centres. ASNR has continued its graded inspection approach: ∙by reducing, in the light of the progress made in the control of treatment safety, the average frequency of inspections, which since 2020 has been reduced to once every four years (instead of the previous three-yearly frequency), enabling all the centres to be inspected every four years; ∙by maintaining a higher frequency for the centres presenting vulnerabilities or risks, particularly for some centres having necessitated tightened inspections. In 2025, 77 inspections in 74 departments were carried out by ASNR, representing 43% of radiotherapy departments. These inspections include the routine inspections, commissioning inspections, inspections further to ESRs and unannounced inspections if any (one in 2025). In 2025, ASNR again observed difficulties in recruiting and retaining radiographers, medical physicists and radiation oncologists, irrespective of the region. This lack of personnel has impacts on the activity, the organisational set-ups and the working conditions of the medical personnel (reduction in treatment slots, overstretched personnel, tensions in the teams, etc.). Holding interviews with the medical and paramedical teams and medical physicists during the inspections brings to light situations of tension with the personnel and malfunctioning, which are potential sources of risks for the patients despite a highly formalised reference framework. Holding interviews with senior management enables these risk situations to be discussed with a view to helping the department identify technical, human and organisational lines for improvement. Lastly, ASNR carried out specific inspections in departments experiencing conflict situations where these were likely to have an impact on the organisation or operation of radiation protection. These inspections, which focus on Human and Organisational Factors (HOFs), are regularly carried out by ASNR in the field of radiotherapy. 200 ASNR Report on the state of nuclear safety and radiation protection in France in 2025
RkJQdWJsaXNoZXIy NjQ0NzU=