LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT radiology. The inspections conducted by ASNR focus in particular on the verification of proper application of the requirements defined by the above-mentioned ASN resolution 2019-DC-0660 of 15 January, especially the justification of the examinations and optimisation of the procedures. In CT scanning, inspections conducted in 2025 show good compliance by those responsible for nuclear activities with radiation protection requirements for both workers and patients, supported by strong and dynamic involvement of teams and key stakeholders. Overall, facilities have established a radiation protection organisation that is considered robust and broadly satisfactory in terms of dedicated resources. The main regulatory requirements, in particular risk assessment, radiological zoning and equipment checks, are complied with. In terms of patient radiation protection, paramedical personnel are more likely than medical personnel to comply with regulatory training at the required intervals. The implementation of optimised procedure protocols, including for paediatrics, is deemed satisfactory in terms of DRLs. Application of the justification principle is also satisfactory, with systematic traceability of examination requests and interactions with requesting departments. Finally, in complex organisational settings such as Economic Interest Groupings (EIGs), the establishment of a Service Competent in Radiation Protection (SCR) provides resources and a structure conducive to continuity of the mission. The discrepancies and weaknesses observed mainly concern the lack of formalisation and completeness of documentation, as well as the need to complete or update individual assessments of occupational exposure by including projected doses, and to ensure that these are communicated to workers and the occupational health physician. The specific work tasks qualification process is often incomplete or not finalised for all personnel, including radiologists, and requires a better description of the assessment and traceability procedures and criteria. Shortcomings have been noted in the organisation of radiation protection for self-employed professionals, particularly regarding the designation of a radiation protection adviser, enhanced medical monitoring and the establishment of prevention plans required for co-activity. Management of regulatory verifications also remains an area of weakness. Verification programmes are often imprecise or incomplete, failing to specify the scope, method or frequency of the verifications, and periodic verifications of workplaces (performed quarterly) are not always carried out or properly documented. Finally, the quality management system required by ASN resolution 2019-DC-660, although initiated, is often still being deployed and requires the formalisation of OEF processes and systematic criteria for analysing adverse events (including patient misidentification) in order to foster a stronger reporting culture. 2.5.3.2 Dental radiology The increasing use of Cone Beam Computed Tomography (CBCT) in dental surgery, while providing essential 3D diagnostic capabilities, raises radiation protection concerns because patient exposure to X-rays is higher than with conventional radiography. As part of the revision of the DRL resolution, ASNR identified shortcomings in patient dose optimisation for dental procedures involving CBCT, which were attributed to an imperfect understanding and application of the many technical parameters by dental surgeons. In this context, ASNR conducted an inspection campaign in 2025 among CBCT users to assess, in particular, how effectively they used the features available for dose optimisation and to examine how the main radiation protection requirements were being implemented. At the same time, in order to facilitate assimilation of the regulations by dental surgeons, ASNR developed a self-assessment grid enabling them to verify compliance with radiation protection requirements. This grid was drawn up with representatives of the Dental Surgery Profession HIGHLIGHT No. 8 Initial findings from the dental surgery inspection campaign ASNR has highlighted shortcomings in patient dose optimisation procedures for dental procedures using Cone Beam Computed Tomography (CBCT). To investigate these issues, it conducted an inspection campaign in 2025 with CBCT operators, focusing in particular on their command of the functionalities used for dose optimisation and on the implementation of the main radiation protection requirements. At the same time, in order to facilitate assimilation of the regulations by dental surgeons, ASNR developed a self-assessment grid enabling them to verify compliance with radiation protection requirements. This grid was drawn up in conjunction with representatives of the Dental Surgery Profession (Agence dentaire française – ADF). It also enables practitioners to test their knowledge, particularly in the area of justifying and optimising patient doses when using CBCT. The 956 usable responses to the self-assessment grid, supplemented by the inspections carried out in 2025, provide a relatively reliable overview of the state of radiation protection in these facilities. With regard to patient radiation protection, the results show that there is a good understanding of the basic requirements: 83% of respondents confirm that they are up to date with patient radiation protection training, and 90% are aware of the need for greater optimisation for vulnerable patients, such as children and pregnant women. In addition, practitioners generally demonstrate a good understanding of the classification of examinations according to the dose delivered (79% correct answers). However, implementation has revealed significant weaknesses in the traceability of procedures and dose optimisation. Only 57% of practitioners systematically write a report for each CBCT procedure, and the rate of non-compliance with the regulatory content of these reports (in particular the absence of justification and dosimetric information) is as high as 70%. In terms of optimisation, only 34% of dentists have mastered the combination of the two key parameters (size of the Field of Exploration – FOV – and selection of voxel size) used to optimise the dose. In addition, the evaluation of dosimetric readings is inadequate, since only 39% of respondents communicate the Diagnostic Reference Level (DRL) value for dental panoramic imaging, which is a hindrance to the establishment of future DRLs specific to CBCT. When it comes to occupational radiation protection, practitioners are well aware of the regulatory requirements and apply them: 93% of respondents have appointed a Radiation Protection Advisor (RPA), and high rates of correct response are observed for risk assessment (89%), the delimitation of restricted areas (92%) and individual exposure assessment (88%). Once the classification of workers has been established, the associated regulatory requirements are 95% complied with. However, inspections and self-assessment results reveal shortcomings in formalisation and traceability. Less than half (49%) of practitioners claim to have had the initial verification of their equipment carried out by an accredited body before it was commissioned, a recurring discrepancy noted in the field. Similarly, only 53% have formalised, dated and signed prevention plans with outside contractors working in zoned areas. Despite 87% of practitioners believing their facilities to be compliant, inspections frequently reveal non-compliant premises and signage (non-functional warning lights or incorrectly positioned zoning displays). ASNR inspections, coupled with the results of the analysis of the self-assessment grids, highlight the need to systematise the drafting of procedure reports, ensuring that all the regulatory information is included for all dental CBCTs, i.e. the justification for the procedure and dosimetric information. In addition, ASNR stresses the need for practitioner training to improve mastery of the technical parameters for optimisation, an essential condition for optimising doses, and also reiterates the obligation to send details of the dosimetric records, without which the DRLs cannot be drawn up. ASNR is therefore calling on practitioners to send in their dosimetry records. Lastly, particular attention must be paid to systematically carrying out initial checks on equipment before it is used for the first time, and to formalising written procedures for each type of procedure. ASNR Report on the state of nuclear safety and radiation protection in France in 2025 223 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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