LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT HDR brachytherapy. As the doses delivered at each brachytherapy session are about 4 to 10 Gy, errors in treatment delivery can have serious consequences for the health of the patient. 2.2.3.6 Significant events notified in brachytherapy In 2025, 7 ESRs were reported in brachytherapy, 6 of which were under criterion 2.1 (exposure of patients for therapeutic purposes). Five are rated level 1 and one rated level 0 on the ASN-SFRO scale. Five brachytherapy ESRs were classified as level 1 on the ASNSFRO scale in 2025, two of which concerned an error related to the diameter of an applicator. The first ESR concerns a patient undergoing treatment for gynaecological brachytherapy, for whom an applicator with a different diameter from that prescribed was implanted. The treatment consisted of four fractions of 8 Gy each, giving a total dose of 32 Gy. The dose delivered to part of the vagina was higher than planned. The second ESR concerns a second HDR vaginal vault brachytherapy session following radiotherapy. An applicator with a diameter of 30 mm was used for the second session, whereas a diameter of 35 mm had been used for the first session. The volume irradiated in the patient with the 30 mm applicator was greater than the volume planned in the dosimetry for the 35 mm applicator. The full prescribed dose was delivered. At the end of the session, the radiographer completed the treatment record and identified the error at that point. Summary In brachytherapy, inspections carried out in 2025 in almost a quarter of departments, viewed in the light of those conducted during the 2022–2025 period, confirm that radiation protection requirements are generally being addressed satisfactorily. In particular, inspections show progress in 2025 in the implementation of the quality and risk management system (reporting culture and organisation for managing notifications, analysis and definition of corrective actions and the use of lessons learned, and assessment of the effectiveness of corrective actions). ASNR observes in 2025 that the gradual deployment of the requirements relative to the protection of high-activity sources against malicious acts is continuing, particularly as regards putting in place a protection policy, measures for preventing unauthorised access to these sources and the identification and control of sensitive information. The situation is gradually improving although it cannot yet be considered to be compliant. Some centres are still faced with difficulties when bringing into compliance necessitates major works. However, the ESRs reported show that procedures for the management and traceability of brachytherapy applicators are not always properly controlled. Finally, maintaining a brachytherapy activity remains a challenge for the years ahead, given the resources and expertise required and the recruitment difficulties faced by centres. 2.3 Nuclear medicine Nuclear medicine is a medical discipline that uses radionuclides in unsealed sources for diagnostic purposes (functional imaging in vivo or medical biology in vitro) or therapeutic purposes (ITR). Thanks to the increase in new radionuclides and vectors, nuclear medicine has evolved considerably over the last few years, for diagnostic and therapeutic purposes alike. Furthermore, the reform of healthcare licences (see point 1.3.3) has introduced two licensing “levels” for nuclear medicine (levels A and B) in application of Decree 2021-1930 concerning the conditions of installation of nuclear medicine departments. Level A concerns the diagnostic or therapeutic activities other than the treatment of cancerous pathologies, carried out by administering RadioPharmaceutical Drugs (RPDs) that are ready to use or are prepared using an aseptic process in a closed system. Level B is attributed when the activity includes, in addition to the procedures covered by level A, the following procedures: ∙procedures with the administration of an RPD prepared using an aseptic process in an open environment; ∙diagnostic procedures carried out for explorations of cellular marking (labelling) of the formed elements of the blood by one or more radionuclides; ∙therapeutic procedures carried by the administration of active implantable MDs; ∙therapeutic procedures for cancerous pathologies performed by administering RPDs. The healthcare activity licence for nuclear medicine is now granted by geographical site on condition that the provisions concerning the number of Single Photon Emission Computed Tomography (SPECT) and Positron Emitting Tomography (PET) devices are observed (see point 2.3.1). The facilities will have to regularise their situation and submit applications to install new devices in already authorised sites or for the creation of new sites with the ARS. The licenses to possess and use a radioactive source or a device emitting ionising radiation issued by ASNR shall be updated according to the nature of these changes (new holders, site change, devices, sharing of devices, etc.). Nuclear medicine is included in ASNR’s inspection priorities. The main radiation protection risks are linked to the use of unsealed sources, which generate radioactive waste and effluents and can lead to contaminations of premises. Nuclear medicine is moreover the main contributor to doses at the extremities of professionals in the nuclear sector (see point 1.2.1). During inspections, particular attention is focused on management of the sources, waste and effluents, occupational radiation protection, control of drug dispensing, through quality assurance obligations and the OEF process. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Reporting culture and organisation Analysis, defining corrective actions, building on lessons learned HDR validation procedure existing and tracked Assessment of corrective action effectiveness 31 87 83 67 80 80 90 100 100 100 92 90 78 69 90 91 50 77 70 90 2024 2025 2023 2022 2021 GRAPH 4 Change in the percentage of conformity of brachytherapy facilities in the management of events giving rise to corrective actions over the 2021-2025 period 206 ASNR Report on the state of nuclear safety and radiation protection in France in 2025
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