LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT prescription stages, the less likely the laterality information is to be challenged at subsequent stages of patient management; it is therefore essential to test the safeguards implemented at these stages of the process; ∙the parameters to be verified during validation stages, which are not described with sufficient clarity (At what stage of the process? By which operator?); ∙the management of the patients’ medical file movements which, if not planned with dedicated time slots, creates constraints on the work activity of the medical personnel, fostering the weakening of certain control barriers. Finally, the root causes of these events are still insufficiently investigated, and insufficient account is taken of the lessons learned from the OEF associated with events reported at national level. In addition, the Working Group on Operational Experience Feedback in Radiotherapy, coordinated by ASNR, worked on the development of new factsheets entitled “safeguarding treatment delivery”. Two fact sheets detailing the best practices to be implemented to avoid 9. Seminar for radiotherapy stakeholders organised by the ASN in Montrouge on 15 March 2023: "Quality and safety in radiotherapy: What lessons can be learned after more than 15 years of implementation?" identity monitoring and laterality ESRs were published in 2025 and are available on the ASNR website. The number of ESRs declared to ASNR in 2025 rose slightly again after a long period of decline (see point 2.7, Graph 14). Although these trends should be interpreted with caution, the decline in ESRs observed since 2015 may be partly attributable to improved risk control measures, including the implementation of quality assurance systems, full digitalisation with the use of “record and verify” task lists, harmonisation of medical protocols, contouring assistance software, automatic application of dosimetry offsets, monitoring of preparation times, etc. However, in recent years the inspectors have noted a decrease in the number of undesirable events recorded and analysed internally, and fewer OEF committee meetings. The number of level 2 ESRs and systematic errors involving several patients reported each year, the increase in complex treatments with several locations to be treated and situations involving previous radiotherapy (one ESR was classified level 4 in 2024) mean that centres must remain vigilant to ensure that these OEF procedures do not lose momentum. Summary In a context of greater complexity, fewer resources, strong innovation and organisational change, ASNR published the guidelines for its new 2025-2028 radiotherapy inspection programme (see point 1.4). These priorities stem from an approach involving all radiotherapy stakeholders, including the organisation of a national seminar(9) in 2023, hearings held with the same stakeholders during 2024, and consideration of the lessons learned from a seminar held by HERCA (Heads of the European Radiological Protection Competent Authorities) in 2024 on inspection practices in radiotherapy. The inspections carried out by ASNR in 2025, put into perspective with those carried out during the period 2022-2024, covering the entire fleet, confirm that the fundamentals of safety are in place: organisation of medical physics, control of equipment, training in radiation protection for patients and deployment of quality assurance procedures. ASNR highlights the progress made in the field of clinical audits with the introduction of experiments whose pilot phases ended in 2025 (see point 1.3.4). ASNR encourages the continuation of these audits. Analysis of the 2022–2025 period confirms that departments are struggling to sustain their OEF processes, with fewer OEF committee meetings, insufficiently in-depth analyses of ESRs, and persistent difficulties in assessing the robustness of corrective actions. The number of ESRs reported to ASNR in 2025 is rising slightly again after a period of decline since 2015, but it is not possible at this stage to deduce any deterioration in radiation protection. However, the number of level 2 ESRs and systematic errors involving several patients reported each year, the increase in complex treatments with several locations to be treated, and the growing number of situations involving a history of radiotherapy, mean that centres must remain vigilant to ensure that these OEF procedures do not lose momentum. Furthermore, the occurrence of events such as errors in the delineation of organs at risk and/or target organs, laterality errors and positioning errors still reveals organisational weaknesses and the need to regularly assess practices. In addition, prospective risk analyses remain insufficiently updated ahead of organisational or technical changes, or following OEF from events. ASNR remains particularly attentive to the deployment of new techniques and practices in radiotherapy. After encouraging the assessment of adaptive radiotherapy, ASNR continued its work and referred the matter of FLASH radiotherapy to Canpri. The Canpri opinion was submitted at the end of December 2025, and ASNR will examine the action to be taken in 2026. 2.2 Brachytherapy Brachytherapy can be used to treat certain pathologies and cancerous tumours in particular either specifically or as a complement to another treatment technique. This technique consists in placing radionuclide sources, in the form of sealed sources, either in contact with or inside the solid tumours to be treated. The main radionuclides used in brachytherapy are iridium-192 and iodine-125. Brachytherapy uses three techniques (detailed below), which differ more specifically in the dose rate applied according to the indications. As with radiotherapy, the radiation protection issues are linked to the intensity of the dose delivered to the patient and, if applicable, the high dose rates and the mastery of the equipment. Furthermore, as high-activity sources are involved, the management of emergency situations in the event of source jamming, as illustrated by the OEF from events notified to ASNR, and the security of the sources, constitute specific risks of brachytherapy. That is why the ASNR checks focus on the management of source security in addition to those on external-beam radiotherapy. 2.2.1 – Description of the techniques The radiation protection risks in brachytherapy, apart from the problem of managing sealed sources, depend on the dose rate associated with the technique, the method of delivering the radiation to the tumour (permanent or temporary implantation, or temporary application). The use where necessary of source afterloaders means that the medical personnel do not have to handle the sources and allows the patient to be treated without irradiating the personnel. On the other hand, it is necessary to make provisions for accident situations associated with malfunctioning of the source afterloader and the high dose-rate delivered by the sources used. ASNR Report on the state of nuclear safety and radiation protection in France in 2025 203 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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