LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT significant shortcomings in patient radiation protection. Inspections carried out in 2024 and 2025 highlighted, in certain facilities, the absence of complete dosimetric analyses, the lack of systematic assessment of doses, and shortcomings in protocol optimisation and the post-exposure follow-up of patients. These shortcomings, although central to the responsibilities of medical physics, reflect inadequate organisational oversight, insufficient time devoted to the service, or inadequate monitoring of outsourced services. Given the frequency and seriousness of certain findings, ASNR has taken enforcement action to ensure patient protection. Accordingly, in 2025 two healthcare facilities were formally required to comply with the regulations applicable to fluoroscopy-guided interventional practices (see Highlight No. 5). Training of doctors in patient radiation protection remains a recurring weakness: only around 19% of operating theatres have trained all their doctors. Training levels among medical staff are higher in interventional imaging departments, with 40% of medical personnel trained, compared with 23% in 2021. Over the last five years, 60% of the interventional imaging departments on average have collected, analysed and optimised the doses. ASNR notes a broadly stable situation in 2025, with 70% of the interventional imaging departments meeting these obligations compared with 65% of those inspected in 2024 (65%). On the other hand, only 47% of the operating theatres satisfied these optimisation requirements in 2025. ASNR finds the same weakness in the application of the optimisation principle in setting machine parameters and optimising the protocols used. The training time for the medical personnel is insufficient and the recurrent shortage of paramedical personnel does not facilitate the scheduling and following of training courses. Nevertheless, reference levels for the most common examinations are being developed locally more and more often. This approach makes it possible, among other things, to set alert levels for triggering appropriate medical monitoring of the patient according to the dose levels delivered to the patient. Patient dose archiving and analysis systems are also deployed and facilitate the development of these reference levels and the programming (or adaptation) of local alert levels per machine and by type of procedure. These systems are an asset for tracking the doses previously received by the patient and for patient monitoring, and they contribute to the optimisation of the dose delivered. ASNR is also regularly questioned about the scopes of intervention and the patient radiation protection training obligations of State-Registered Operating Theatre Nurses (SROTNs) and State-Registered Nurses (SRNs). ASNR reiterates that devices emitting ionising radiation may only be operated by radiographers whose training in patient radiation protection is current and under the responsibility of a physician. With regard to SROTNs, they now have new prerogatives and can, under the responsibility of a surgeon, assist in certain interventional practices (performed under mobile C-arm unit in the operating theatre, not requiring a protocol adjustment and delivering a dose of less than 10 grays per square centimetre (Gy/cm2) (Dose Area Product – DAP – at end of procedure) without being authorised to operate or set the parameters of the medical device. They must also have a specific work tasks qualification and be current in their patient radiation protection training (ASN resolution approving the patient radiation protection continuous training guide for SROTNs). With regard to SRNs, they can only operate devices emitting ionising radiation under the responsibility of a physician in the context of a cooperation protocol approved by the ARS in accordance with the Article of Act 2019-774 of 24 July 2019 on the organisation and transformation of the health system or under the provisions of Decrees 2019-678 of 28 June 2019 and 2024-954 of 23 October 2024 relative to the conditions of performance of certain professional procedures by nurses in the operating theatre. Patient monitoring if the skin exposure threshold defined by the HAS(12) is exceeded is formalised to a greater extent in the interventional imaging departments (90%) inspected in 2025 than in 12. Improving patient monitoring in interventional radiology and fluoroscopy-guided practices – reducing the risk of deterministic effects of 21 May 2014. the operating theatres (73%); interventional imaging departments are more frequently concerned by procedures leading to such exposure levels than the operating theatres. With regard to non-conformities identified during external quality inspections of medical devices, ASNR found during inspections that they had been corrected or were in the process of being resolved. However, persistent staffing pressures continue to be reported within several external quality control organisations. These difficulties have led to significant delays in the quality controls, sometimes compromising their regularity and effectiveness. Given this context, ASNR calls for increased vigilance in order to guarantee the continuity and quality of these quality controls which are essential for patient safety and the correct functioning of the MDs. 2.4.3.3 Significant events notified in relation with fluoroscopy-guided interventional practices An events recording system is in place in more than 74% of the inspected sites performing FGIPs. In 2025, 49 significant events were notified (compared with 32 in 2024) and mostly concern: ∙overexposures of patients (16 ESRs); ∙exposures of medical personnel (15 ESRs); ∙exposure of foetuses in women unaware of their pregnancy at the time of the procedure (6 ESRs); ∙non-compliant personal protective equipment (7 events). ASNR emphasises that the reporting culture is developing in facilities carrying out fluoroscopy-guided interventional practices. This process highlights the importance of sharing experience, encourages collective analysis of the situations encountered and enables OEF factsheets to be drawn up. These initiatives contribute directly to the continuous improvement of practices, the reinforcement of radiation protection for patients and professionals, and the prevention of similar events in the future. Reporting is therefore an essential driver for progress and safer care. Despite inspection findings highlighting progress in meeting “patient radiation protection” requirements, significant radiation protection events were notified to ASNR concerning significant overexposure of HIGHLIGHT No. 5 ASNR issued formal notices to two healthcare facilities concerning patient radiation protection The two health care facilities were served with formal notices following significant shortcomings in the organisation and implementation of patient radiation protection arrangements. The findings highlighted deficiencies in dose analysis and optimisation, inadequate monitoring of dosimetric threshold exceedances, and insufficient oversight of medical physics activities, which were often outsourced. In the case of Hôpital Privé Paul d’Egine, the inspections revealed shortcomings in dose assessment, a lack of systematic analysis of excess doses, inadequate formalisation of procedures and failure to implement appropriate monitoring of patients affected by high doses. At Centre hospitalier de Laval, the findings included overdue quality controls, major inconsistencies in dosimetric data, deficiencies in the analysis of undesirable events, and structural weaknesses in the organisation of radiation protection for both patients and workers. ASNR required these facilities to implement a series of corrective actions, including updating and formalising procedures, carrying out and using dosimetric analyses, strengthening the follow-up of exposed patients, providing evidence that deviations identified through quality controls have been addressed, and updating the quality management system in conjunction with medical physics activities. These actions are aimed at ensuring regulatory compliance and making patient care safer. These decisions are a reminder that ASNR is fully exercising its role as a supervisory authority and that it takes coercive measures when breaches are observed that compromise radiation protection. ASNR Report on the state of nuclear safety and radiation protection in France in 2025 217 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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