LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT have implemented such an approach and update and assess it regularly). Deployment of the competency sign-off process is continuing, even if this year ASNR still observed disparities between the medical and paramedical personnel, given that it is applied mostly for the paramedical personnel. Of the departments audited for nuclear medicine therapy, 62% have formalised competency sign-off procedures for new arrivals, and only 51% are up to date with regard to competency sign-off for a change of post or the implementation of a new medical practice. In the context of the anticipated expansion of ITR, these findings, although based on a smaller sample (22 departments), show that further efforts are required in view of the issues at stake for patients receiving higher administered activities. Although the events notification culture exists in a large proportion of the departments inspected, it must be improved and even reinforced, particularly regarding the analysis of events. ASNR once again observed this year that ESRs had not been notified by some centres. The organisational arrangements put in place to support the involvement of a medical physicist, together with the identification of their responsibilities and the quantification of their time on site, remain at a stable level, with 80% of the departments inspected in 2025 having a comprehensive organisational framework in place (see Graph 7). This organisation can still be improved however in some departments where the Medical Physics Organisation Plan (POPM) is incomplete and the medical physics organisation described in the POPM is considered inadequate. 2.3.3.3 Protection of the public and the environment A large majority of the departments inspected have a dedicated and secure delivery room that complies with the requirements of ASN resolution 2014-DC-0463 of 23 October 2014 (93% in 2025 and 91% on average over the period 2020-2024), and 86% of the departments inspected in 2025 have no particular difficulties in complying with the statutory effluent discharge limits (10 becquerels per litre – Bq/L – for contaminated effluents after interim storage, or 100 Bq/L for effluents from the rooms of patients treated with iodine-131) set for the activity concentration of effluents discharged after radioactive decay (see Graph 8). In departments carrying out remote activities within the meaning of resolution 2014-DC-0463 (excluding hospitalisation in an ITR room), non-contamination checks at the end of procedures are carried out in 91% of cases. However, over the period 2020–2024, only 80% of departments performed these checks satisfactorily. On the other hand, verification of leak detectors for storage tanks located within the retention basin remains an area for improvement, with 80% of the departments inspected in 2025 demonstrating compliance (the same average level as that observed across all departments inspected during the period 2020–2024). Once again in 2025, it was observed that, while deferred alarm management arrangements are generally appropriate outside working hours, alarms are not always handled adequately in accordance with a formalised procedure. Inspections also revealed that Effluent and Waste Management Plans (PGEDs) do not always contain all the required elements and that discharge agreements are often slow to be concluded with the operator of the public wastewater network. ASNR also notes that the RNAs have difficulties in implementing the new regulations concerning the verifications to be carried out under the Public Health Code which are applicable since 1 January 2023. The main difficulty is linked to the definition of the requirements (scope of the verification action) of the regulation, for the approved organisations and healthcare centres alike. 2.3.3.4 Significant events notified in nuclear medicine Out of the 75 departments inspected in 2025, most of them have a system for recording adverse events. For the majority of events notified to ASNR, the proposed action plan is appropriate but shortcomings are sometimes observed in the notification and especially in the analysis of their root causes. On the other hand, several inspected departments had not notified certain ESRs to ASNR, primarily due to the personnel’s lack of awareness of events notification. The number of ESRs notified in 2025 was 304, down on 2024 but still up on previous years (2024 was a special year because a nuclear medicine department wanted to report internal events that did not meet the criteria for notifying to the authorities). The number of ESRs notified in nuclear medicine in 2025 was therefore higher than in 2023 (201), and the average number of ESRs notified over the period 2015-2024 (175 – see point 2.7). This upward trend results from an increase in the number of procedures in nuclear medicine, a discipline that developing strongly, whether for diagnostic purposes – with PET scans in particular – to therapeutic purposes, but also due to greater adoption of the quality assurance approach by the centres, which integrates the notification of ESRs. This trend must not mask the fact that failures to notify events are still observed occasionally. As in the preceding years, the majority of the notified events (69%) concern patients (see Graph 9). Significant events concerning patients (217 ESRs, i.e. 70% of the notified ESRs) The large majority of ESRs concerning nuclear medicine patients occur in the course of diagnostic procedures (93%). Most of these ESRs have no expected clinical consequences, in view of the activities injected. They result mainly from drug preparation or administration errors leading to injection of the wrong RPD or an inappropriate RPD activity (50% of the ESRs concerning patients, a figure that is stable compared with 2024). They result from organisational and human malfunctions, generally in periods of high activity or staffing shortages. The other ESRs occurring in the context of diagnostic procedures are most often linked to errors in examination requests, medical prescriptions or the processing thereof (12%), to errors in patient management, including treating one patient instead of another (10%), or to problems occurring during image acquisition (10%) (equipment failure, incorrect protocol, etc.). The latter situation was encountered in two of the four ESRs involving children, all of which occurred during diagnostic procedures. An ESR involving six patients was the subject of an incident notification published on the ASNR website. It involved the delivery of higherthan-planned doses in scintigraphy examinations due to incorrect utilisation of the dose calibrator used to measure the activities to be injected into the patients. In 2025, 15 events that occurred during therapeutic procedures were notified, 13 linked to complications associated with either the use of yttrium-90 microspheres (6 ESRs), or cases of 5 % Public 71% Patients In red: average of the number of ESRs notified during the 10 preceding years. 7% 4% 9% 12% 68% 5 % Workers 16% Sources, waste, effluents 3% Others GRAPH 9 Breakdown (in %) of ESRs in nuclear medicine in 2025 ASNR Report on the state of nuclear safety and radiation protection in France in 2025 211 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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