LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT certain patients. Among these events, one case of a peak dose to the skin estimated at more than 9 Gy was notified following a complex and prolonged interventional procedure, exposing the patient to a high risk of tissue reaction and necessitating the implementation of reinforced clinical and dermatological monitoring. In addition, ASNR was notified of an ESR highlighting shortcomings in the optimisation of uterine fibroid embolisation protocols, for which exposure levels were found to exceed the reference values expected for this type of procedure. In 2025, ASNR was informed of several events concerning the exposure of professionals to ionising radiation during radioguided examinations. Two events were classified as level 1 on the INES scale: in one case, practitioners were exposed to hand doses close to or slightly above regulatory limits, and in another, a radiologist received a dose to the lens of the eye slightly above the annual limit. As a result, protocols have been revised, radiation protection support has been stepped up and greater vigilance has been exercised over dosimeter management and exposure monitoring. ASNR also received several event reports, as early as January 2025, concerning defects in a large number of AMRAY brand Personal Protective Equipment (PPE). ASNR informed the General Directorate for Labour, which is responsible for the conformity of protective equipment, and published an incident notification on the subject. ASNR reiterates the importance of the radiation protection culture and compliance with its rules, in particular the providing of all the tools allowing the optimisation of practices, the use of personal and collective protective equipment, and compliance with the rules concerning the wearing of passive and active dosimeters, including their stowage on the panels provided for this purpose, for exposure monitoring and reactive alert in the event of abnormal exposure. Lastly, events were notified concerning accidental exposures of the foetus of pregnant women unaware of their pregnancy, who underwent a therapeutic procedure in the pelvic region. A “Patient Safety” newsletter entitled Ionising Radiation: Limiting the Exposure of Women Unaware of Their Pregnancy, published in 2021, addressed the lessons learned from OEF specifically from this type of event, which remains relevant today. The doses received by patients remain very low and no clinical consequences are expected. The hospital, in conjunction with the health authorities, informed the 703 patients affected by this overexposure. In addition to suspending operations until the full investigations have been completed, the hospital has taken corrective action: • definition of overdose alert thresholds in the Dose Archiving and Communication System (DACS); • reinforcement of good practice for checking exposure parameters and image quality, together with revision of staff authorisation procedures; • reinforcement of the training of temporary MERM; • revision of procedures for managing equipment failures and interventions, together with the creation of a quick-reference guide for managing faults and breakdowns. This event also resulted in a medical device vigilance report being submitted to ANSM. This ESR shows the need: • to follow the recommendations published by the ANSM when installing new radiology equipment “Acceptance testing of medical devices used for fluoroscopy-guided interventional practices (2018) - [Healthcare professionals]” and, in particular, recommendations 3 to 7. For example, for departments equipped with the Calypso DR imaging system, the consistency between the DAP values displayed and the measured dose values should be checked; • to optimise equipment from installation and throughout its operational lifetime, and to ensure that the professionals using it are appropriately trained and authorised, particularly in contexts of high staff turnover; • to implement the optimisation process by drawing on the expertise of medical physicists, as required under Article R. 1333-68 of the Public Health Code (Article R. 1333-68); • to assess delivered doses regularly and analyse procedures in accordance with the optimisation principle set out in Article R. 1333-61 of the Public Health Code. ASNR points out that it is a regulatory requirement under the Decree of 22 September 2006 for the person performing the imaging procedure to report the dose in the procedure report; This event also highlights the importance of connecting radiology equipment to a Dose Archiving and Communication System (DACS), with optimum configuration to facilitate dose analysis. Summary In the field of FGIPs, inspections carried out in 2025, viewed in the light of those conducted during the 2021–2024 period, which together covered all facilities considered to present radiation protection risks, show an overall improvement in 2025 compared with previous years, with the situation still remaining better in interventional imaging departments than in operating theatres. However, there are still areas of weakness. In most facilities, bringing premises into compliance with the technical design requirements remains a slow process, even though these modifications are essential for preventing occupational risks. While the designation of radiation protection advisors, the delimiting of regulated areas, and the performance of technical verifications and quality controls of medical devices are considered satisfactory, regulatory deviations are still frequently identified, both in relation to patient and occupational radiation protection. Although improvements have been observed, shortcomings remain with regard to training in patient and occupational radiation protection and to the coordination of preventive measures during co-activity, particularly where self-employed practitioners are involved. The inspections of employer private practitioners highlighted nonconformities with regard to the occupational radiation protection obligations and the fact that they were poorly aware of their responsibility, as employers, with respect to the protection of themselves and their employees. ASNR also noted that several medical centres were using medical devices without registration, and reminded the RNAs of their obligations to hold an administrative document from ASNR for these medical activities. ASNR observes that the trend noted since 2023 is continuing and that centres are increasingly relying on RPOs, either as specialised service providers supporting an internal RPE-O, or as the RPA itself. Where not properly controlled, this outsourcing leads to a dilution of the responsibilities of the RNAs and to reduced assimilation, or even a deterioration, of radiation protection. This observation also applies to outsourced medical physics services. In both cases, ASNR considers that such outsourcing should be approached with caution and organised rigorously. Indeed, while in some cases this enables the RNA to add to the pool of skills available for radiation protection, it can also lead them to reduce the resources they allocate to it, a choice that subsequently proves difficult to reverse. Although the use of medical physicists and formalising of the POPMs is gaining ground, further progress must be made in the implementation of the optimisation procedure, particularly in the operating theatres where doses are still insufficiently analysed and inappropriate or non-existent protocols are still observed. The reporting culture, however, has been spreading in the past five years, with the deployment of events recording systems. Extensive work to raise the awareness of all the medical, paramedical and ASNR Report on the state of nuclear safety and radiation protection in France in 2025 219 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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