LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT 2.1.3.1 Radiation protection of external-beam radiotherapy professionals When the radiotherapy facilities are designed in accordance with the rules in force, the inherent radiation protection risks for the medical personnel are limited due to the protection provided by the facility. The RPAs have been appointed and the technical radiation protection audits are all carried out at the required regulatory frequency. 2.1.3.2 Radiation protection of external-beam radiotherapy patients The assessment of the radiation protection of radiotherapy patients is based on the inspections focusing on implementation of the treatment QSMS, made compulsory by ASN resolution 2021- DC-0708 of 6 April 2021. Since 2016, in the course of its inspections ASNR verifies the adequacy of the human resources, particularly in medical physics. Emphasis is also placed on the internal organisation methods to guarantee a culture of notifying significant events or near misses, ensuring their follow-up and systematically analysing them when necessary. ASNR notes that the regulatory requirements for event management over the period 2022-2025 were met overall, with the results for the departments inspected in 2025 comparable to those in 2024. However, there are significant disparities between the requirements concerned (see Graph 2): ∙The detection of adverse events, their reporting (internally or to ASNR) and their recording are deemed satisfactory on the whole, with rates varying between 74% and 85% over the period in question, with stable results observed in 2025 (81%) compared with 2024 (79%). ∙The analysis of these undesirable events, the definition of corrective actions and the process of building on lessons learned, have remained broadly stable since 2023, with around 60% of the centres inspected carrying out these steps satisfactorily (60% in 2023, 61% in 2024 and 65% in 2025). However, this level is lower than the levels observed in 2021-2022, which were around 75%. ∙The improvement of practices through OEF and assessment of the effectiveness of corrective actions increased over the period under consideration: from 30% (2021) to 49% (2023 and 2024) and 61% in 2025 of the centres inspected for which the situation is deemed satisfactory (see Graph 2). ASNR also observes an increase in the participation of radiotherapists in these procedures in the inspected centres over the last three years. Furthermore, regular assessment of the corrective actions implemented and updating of the prospective risks analysis on the basis of the lessons learned from the events reported internally, which is obligatory pursuant to the above-mentioned ASN resolution 2021-DC-0708 of 6 April 2021, are vital in order to improve treatment quality and safety. With regard to the assessment of a centre’s ability to implement a risk management approach, which is the focus of ASNR inspections, it emerged that in 2025: ∙The risk management approach was coordinated satisfactorily in 77% of the centres inspected, compared with just 59% in 2024. This concerns the centres in which management is involved in the approach and has defined a policy with shared, assessable and assessed operational objectives, and has allocated the necessary resources, in particular to the operational quality manager and communicated on the results of this policy. Conversely, these procedures stand still or regress when senior management does not sustainably grant sufficient means to the operational quality manager or when the latter does not have sufficient authority to deploy them. ∙The rate of compliance with the requirements for ex ante risk analysis is on the decline (58% of centres have updated their analysis, compared with 63% in 2024), with variations still persisting from one centre to another. The situations considered to be unsatisfactory concern the departments whose prospective risk analyses have not taken into account the OEF from internal or external events (those from other centres for example, disseminated by the ASNR publications such as the “Patient safety” bulletins and “Learning from experience” sheets, the deployment of new practices or organisational changes when the technical platforms evolve. The impact of an organisational or technical change on the operators’ activity is effectively not always analysed, yet these changes are potential sources of disruption, particularly in the organisation of treatments and work practices and can weaken the existing lines of defence. The procedures to formalise the change management process are being increasingly deployed. They are considered satisfactory in 60% of centres inspected in 2025, stable compared with 2024 (53%). ASNR nevertheless notes an improvement over the period 2022-2025. To help them to better adopt material and/or technical changes, IRSN has published, in partnership with the radiotherapy professionals a Guide to the adoption of a technical or equipmentrelated change in radiotherapy. HIGHLIGHT No. 2 ASNR’s new “Principles and Practices” collection, the first part of which is devoted to subcontracting and the use of external medical physics personnel in external-beam radiotherapy At the beginning of 2026, ASNR will publish a document entitled: “Outsourcing and use of external medical physics personnel in external-beam radiotherapy: the current situation, recommendations and avenues for further study”. This document is intended for use by external-beam radiotherapy teams and outside contractors to ensure the safe use of subcontractors or external medical physics personnel. In 2020, an IRSN survey identified potentially risky situations associated with outsourcing, including lack of availability of the Commissioning Centre (CDO), time constraints, insufficient expertise on the part of the outside contractor, misalignment of practices, and the absence of a shared risk assessment. To maintain treatment safety when outsourcing activities and to promote good practice, ASNR is publishing the first document in the “Principles and Practices” series, developed with experts in radiotherapy and the human and social sciences. Its purpose is to provide the stakeholders concerned with practical guidance to help them plan ahead for risks and ensure the safe management of outsourced activities. This document presents: • a summary of the findings of the IRSN survey (2020) and insights from the human and social sciences on the subject; • recommendations based on the lessons learned, together with questions designed to support their implementation; • a self-assessment grid to identify areas for improvement. The document stresses the importance of involving the centre’s medical physics team throughout the subcontracting process and proposes more specific elements, in the form of focus points, to support the centre’s discussions on the following topics: • defining an outsourcing strategy (defining the scope, assessing the benefits/risks, considering in-house as an alternative), • formulating the terms and conditions for implementing the service (clarifying expectations, tasks, responsibilities and resources in the contract), • skills management (ensuring the outside contractor has the necessary expertise and that the CDO has the capacity to supervise and take ownership of the service provided), • the investment required from the CDO in terms of the workload involved in preparing, monitoring and coordinating the stakeholders, • risk management, • assimilation needs (facilitating the integration of local practices by the outside contractor and the assimilation of results by the CDO). ASNR Report on the state of nuclear safety and radiation protection in France in 2025 201 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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