LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT In a persistent context of medical staff shortages, organisational changes due to the reform of the healthcare licences or healthcare facility restructuring, ASNR continues to urge the decision makers, RNAs and medical professionals to be vigilant regarding the need to assess the impact of these changes insofar as these projects demand significant investment on the part of the personnel, adding to their existing workload. The results of the inspections carried out in 2025 also reveal major disparities between the medical and paramedical professions in terms of competency sign-off for new personnel or when changing jobs. On the whole, the competency sign-off procedures are well formalised and in place for MERM and physicists/dosimetrists (65% and 72% of cases respectively), whereas they are deemed to be compliant in only 41% of cases for radiation oncologists. The use of subcontractors and external medical physics personnel can also be a risky situation if it is not controlled. This is particularly the case where the commissioning centre does not have sufficient availability to supervise and monitor the service provided, where the personnel carrying out the work do not have sufficient time to perform it, where the outside contractor’s skills and/or experience are not appropriate, where the local practices and those of the contractor are not aligned, or where no joint risk analysis has been carried out by the two parties. In early 2026, based on the results of a survey conducted by IRSN in 2020, ASNR will publish a “Principles and Practices” document entitled Subcontracting and use of external medical physics personnel in external-beam radiotherapy: current situation, recommendations and avenues for consideration. This is an operational document to support external beam radiotherapy teams and outside contractors involved in subcontracting medical physics activities in external beam radiotherapy. More specifically, its aim is to help centres define (where necessary) their outsourcing strategy 8. Delineation, or contouring, is a stage in the management of a radiotherapy patient which consists of delineating the organs to be treated and the organs at risk to be protected during treatment sessions. for medical physics activities in external beam radiotherapy, and to prepare and supervise the service. It includes a self-assessment grid setting out the main considerations and actions to be taken when subcontracting medical physics services in external beam radiotherapy, so that centres can assess their practices and the conditions under which they carry out this subcontracting (see Highlight No. 2). The purpose of this selfassessment grid is to provide an internal tool for professionals to improve their practices. It sets out the main considerations and actions to be taken in the context of outsourcing, as described in this document. It is not exhaustive and may be adapted to the local context of the service and its nature, and added to as and when feedback is received from centres. 2.1.3.3 Significant events in external-beam radiotherapy In 2025, 108 ESRs were reported in radiotherapy. The majority of the events concern patient radiation protection, with 95 ESRs reported under criterion 2.1 (exposure of patients for therapeutic purposes). Most of the events have no expected clinical consequences. Of these events concerning patient radiation protection, 7 were classified as level 2 on the ASN-SFRO scale (7% of patient ESRs), 58 as level 1 (61%), and 28 as level 0 (29%) on the same scale. The level 2 ESRs declared in 2025 concern: ∙Four target errors that occurred at the delineation stage(8). Three cases involved a number of sessions of 1, 5 and 24 respectively (out of 28 planned) with, in the third case, the occurrence of radiodermatitis. In the last case, which occurred in the context of re-irradiation, the error was detected several months after the end of radiotherapy, which took place in 2024, during the MRI supervisory examination carried out in June 2025 (see Highlight No. 3). ∙A laterality error at the delineation stage. The subsequent stages, including the various validation steps carried out during treatment planning and delivery, did not allow the error to be detected. ∙An error involving the unjustified irradiation of a breast when a second tumour location was identified as suspicious. The incident resulted from the start of radiotherapy before the diagnosis had been confirmed. ∙Finally, one error concerned the irradiation treatment of a vertebra, which was initiated before the second histopathology review had been received and validated, in a context of severe pain for the patient and delays in obtaining the histopathology results. In addition, four ESRs classified at level 1 on the ASN-SFRO scale (see Highlight No. 6) concern cohorts of patients with no expected clinical consequences: ∙a calibration error involving the use of an incorrect correction coefficient (input error) on an accelerator, affecting 150 patients; ∙an error in the automatic contouring, resulting in anatomical volumes to be protected at the junction between the spinal cord and the brain stem not being taken into account in the dose calculation, concerning a cohort of 143 patients; ∙a software parameterisation error led to a reversal of the respiratory phases during radiotherapy. The irradiation was delivered outside the respiratory phases initially planned and concerned 11 patients; ∙an error due to a malfunction in the automatic repositioning system for the treatment table of three external radiotherapy accelerators, affecting 6 patients. The events reported in 2025 and in previous years highlight organisational weaknesses in the following areas: ∙patient record management, which should provide both an overall view of the patient’s case and timely access to the information required. The earlier an error occurs in the care pathway (for example, a laterality error), particularly during the initial consultation and HIGHLIGHT No. 3 Significant radiation protection event relating to a target error in a re-irradiation context during external-beam radiotherapy The significant radiation protection event, classified as level 2 on the ASN-SFRO scale, was reported to ASNR on 23 June 2025 in connection with a target error that occurred in June 2024 during a cerebral re-irradiation treatment delivered using external-beam radiotherapy. This error led to a different brain lesion being irradiated than the one initially prescribed. The origin of the error lies in the treatment preparation stage, called contouring, where an old right occipital lesion (treated in 2020) was delineated instead of the right parietal lesion that required treatment. None of the subsequent checks detected this error before or during processing. The error was not discovered until June 2025, several months after the end of the radiotherapy (which took place in 2024), following a surveillance MRI scan which revealed an unexpected aspect of the right parietal lesion. The patient was informed and offered a new treatment plan to treat the area initially targeted. Given the erroneous irradiation of an area that should not have been treated, ASNR classified this event as level 2 on the ASN-SFRO scale of radiotherapy events, which corresponds to an incident causing or likely to cause moderate damage to an organ or function. The centre sent ASNR a significant event report detailing the analysis of the causes and the corrective actions planned. ASNR reminds radiotherapy professionals of the need to assess the robustness of their safety barriers, particularly in the context of the increasing frequency of re-irradiation procedures, which require heightened vigilance. 202 ASNR Report on the state of nuclear safety and radiation protection in France in 2025
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