LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT extravasation(10) with lutetium-177 (7 ESRs). The last two ESRs concern therapeutic procedures using iodine-131 (failure to carry out identity monitoring when taking charge of a patient to administer a capsule). Two “Experience Feedback” factsheets have recently been published on these subjects. The first concerns complications during liver cancer treatment by radioembolisation using yttrium-90 and presents good practices for limiting the frequency of occurrence of such events. The second, published in 2025, concerns an extravasation during a course of lutetium-177 treatment and highlights the systematic detection of extravasation at the end of the injection as a key factor that enabled appropriate management of the patient. The 11th event involved an error in patient management resulting from a patient identity verification error, which led to the administration of an under-dosed activity to a patient during iodine-131 treatment. Significant events concerning medical professionals (15 ESRs, i.e. 5% of the notified ESRs) These 15 events result from contaminations that led to internal or external exposures (surface contaminations as a result of handling errors or reception of a broken vial). None of these ESRs led to exceeding of the regulatory dose limit for the workers concerned, but three were rated level 1 on the INES scale because they led to exposure exceeding, on a one-off basis, a quarter of the regulatory limit for exposure to the extremities. These ESRs were the subject of incident notifications published on the ASNR website. Significant events concerning the public (14 ESRs, i.e. 4% of the notified ESRs) These ESRs result from the exposure of foetuses of women who were unaware of their pregnancy, although in most cases the department has a procedure in place to prevent this risk. The doses received had no consequences for the unborn child. A “Patient safety” newsletter published in 2021 was devoted to this type of event. Significant events concerning radioactive sources, waste and effluents (48 ESRs, i.e. 16% of the notified ESRs) These ESRs are mostly related to source losses/discoveries, the dispersion of radionuclides (resulting from overflows of radioactive effluent tanks or leaks in the effluent evacuation circuit), deliveries that do not comply with the licenses and unauthorised 10. Extravasation is the accidental, inappropriate and unintentional injection or leakage of drugs into the perivascular or subcutaneous tissues rather than into the target vascular compartment. discharges of effluents into the environment (emptying of tanks, etc.). On 12 March 2025, ASNR was informed of an incidental release of radioactive effluent from a nuclear medicine department. The contents of a tank of liquid effluent were discharged into the sewer system, without following the radioactive decay procedure (see Highlight No. 4). Difficulties have recently emerged in the management of the solid waste produced in the ITR treatments of certain prostate cancers with RPDs using lutetium-177, leading notably to the triggering of radiation portal monitors in the sorting centres for waste coming from hospitals or private individuals. The patient is given instructions on leaving the nuclear medicine department regarding the management of the waste produced at home (sanitary protections, for example) in the days following treatment, including storage of their waste in the home for several weeks. At present these instructions are not harmonised nationally. Storage of this type of waste in the home can be difficult (lack of space or a suitable area). Consequently, it can happen that waste arrives at the waste treatment facilities before the time indicated in the patient’s discharge instructions has lapsed, triggering the radiation portal monitors. ASNR, in collaboration with the DGPR, carried out a survey of waste treatment centres in 2025, which confirmed the increase in the number of radiation portal detectors triggered at the entrance to waste treatment centres for waste containing lutetium-177. ASNR is continuing the work begun in 2024, building in particular on the work of the GPRP (currently preparing recommendations on patient instructions and guidance for patients leaving nuclear medicine departments) and of a working group comprising representatives of the French Society of Nuclear Medicine and Molecular Imaging (SFMN), DGS, DGOS, ANSM, DGPR and the French Departmental Fire and Emergency Services (SDIS). This work aims to identify practical, sustainable solutions for improving the management of these situations and to propose information measures to improve communication, particularly with professionals involved in waste management. The initial avenues identified include improving the instructions provided to patients and informing waste treatment facilities about new RPDs and identification procedures following the triggering of radiation portal monitors. HIGHLIGHT No 4 Accidental release from a decay tank in a nuclear medicine department On 12 March 2025, ASNR was informed by a cancer hospital in the Ile-de-France region of an incidental release of radioactive effluents from the hospital’s nuclear medicine department. In accordance with article 20 of ASN resolution 2008-DC-0095 of 29 January 2008, “contaminated liquid effluents are directed to a system of storage tanks prior to their discharge to a sewer system, or to any arrangement preventing direct discharge into the sewer system [...]. The contents of the contaminated liquid effluents storage tanks or containers may only be discharged into the sewer system after ensuring that the activity concentration is below a limit of 10 Bq/L. This limit is set at 100 Bq/L for liquid effluents originating from rooms occupied by patients treated with iodine-131.” In this event, the contents of one liquid effluent tank were mistakenly discharged into the sewerage network instead of another tank, without compliance with the radioactive decay procedure. On 13 March 2025, wastewater samples were collected by the Central Laboratory of the Paris Police Prefecture (LCPP), the Paris Fire Brigade (BSPP) and ASNR, acting on behalf of the l Prefect of the département, immediately upstream of the three wastewater treatment plants potentially affected by the discharge, as identified by the sewerage network operators. The various field and laboratory analyses, together with the radiological measurements, showed that the samples did not exhibit radioactivity above normal natural background levels, despite the presence of very small quantities of medical radionuclides. ASNR carried out an assessment of the health consequences of the incident, on the basis of information provided by the hospital’s radiation protection advisor and by the network managers, and taking into account assumptions about the flow of effluent in the sewage networks. The results of this assessment indicate that the exposure of wastewater treatment plant and sewer network workers was below a few microsieverts (µSv). This exposure remains well below the regulatory annual public exposure limit of 1 mSv/year (i.e. 1,000 µSv/year or 1 mSv/year). Although very rare, such an event highlights the importance of preventive management of effluent release incidents by those responsible for nuclear activities using unsealed sources. This ESR also serves as a reminder of the regulatory requirement for nuclear medicine departments to submit an application for authorisation to discharge wastewater, which must be authorised by the authorities responsible for wastewater collection (Article L. 1331-10 of the Public Health Code) and the fact that many discharge authorisations are still not in place. Finally, it highlights the need for close coordination between all stakeholders involved in post-incident management, particularly in the context of the continued development of innovative therapies in nuclear medicine. 212 ASNR Report on the state of nuclear safety and radiation protection in France in 2025
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