LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT (Association dentaire française – ADF). It also enables practitioners to test their knowledge, particularly with regard to the justification principle and optimisation of patient doses when using CBCT. A review of the 15 inspections carried out in dental practices, together with an analysis of the 956 self-assessment grids received, highlighted several common findings (see Highlight No. 8). Most dental surgeons have a good theoretical understanding of regulatory requirements, the dose-related issues associated with the various examinations performed in their practices, and the obligation to optimise doses for patients at greatest risk. However, the main weaknesses lie in the difficulty of translating regulatory requirements into formalised processes that are applied on a day-to-day basis. The most common finding is the limited deployment of the quality management system, reflected in the absence of written procedures for each type of procedure, the limited number of procedure records, and the lack of quality control and maintenance records. Significantly, there is a lack of dose traceability and optimisation control, with no dosimetric assessment compared to the DRL and imperfect knowledge and expertise in the choice of combined parameters influencing dose. In addition, external quality controls and initial equipment verifications, including for older equipment, are frequently not carried out. Finally, inspections identified deviations relating to premises (warning signals and signage), sometimes contradicting the results of practitioners’ self-assessment grids. This suggests that dental surgeons may have only a limited understanding of the actual compliance status of their facilities if they rely solely on selfassessments and may overestimate the results of those assessments. ASNR also found that some RPOs were offering RPA services without holding certification as a competent radiation protection organisation. ASNR informed more than one hundred employers and RNAs who may be affected by these practices. 2.5.4 – Significant events notified in medical and dental radiodiagnosis In 2025, 430 ESRs were notified in medical and dental radiodiagnosis (+18% compared with 2024): ∙112 in conventional radiology, of which 19 concerned women unaware of their pregnancy; ∙317 in computed tomography, of which 91 concerned women unaware of their pregnancy; ∙Only 1 ESR in dental radiology. The increase in the number of ESRs is mainly attributable to the increase in the number of CT examinations (+25% between 2024 and 2025). Just under one third of the ESRs notified for CT examinations concerned pregnant women who were unaware of their pregnancy at the time of the examination (29%). This figure remained stable between 2024 and 2025. In addition, ESRs notified in the context of teleradiology contributed significantly to the overall number (+69% between 2024 and 2025). This finding echoes the report on teleradiology published by ASNR (see Highlight No. 7). Among the ESRs notified in 2025, three were particularly significant in terms of the size of the patient cohorts involved, comprising both paediatric and adult patients, and one because of the duration of the event period (see Highlight No. 6). They reveal shortcomings in the rigorous application of the optimisation principle in certain facilities, as required by Article R. 1333-68 of the Public Health Code. They highlight the need to optimise equipment from the moment it is installed and throughout its use, and to train and authorise the competency sign-off the professionals who will be using it. Analysis of quality controls, regular collection of data on doses delivered to patients, implementation of regular dosimetry assessments, analysis of the results of these assessments and comparison of the latter with DRLs, where they exist, are all barriers enabling teams to be rapidly alerted to malfunctions or inappropriate use. The value of connecting radiology equipment to a DACS to facilitate dose analysis is another lesson learned from the OEF from these ESRs. Summary In 2025, ASNR carried out 31 inspections in CT scanning and 15 inspections in dental radiology (CBCT). It has also made available a regulatory compliance self-assessment grid for dentists performing procedures with CBCT. In CT scanning, patient and worker radiation protection requirements are generally well taken into account. Inspections confirmed the existence of robust organisational arrangements and effective implementation of the justification principle, with systematic traceability of examination request validation. The same applies to the process of optimising protocols, with detailed dosimetric readings that are satisfactory in relation to national DRLs, including for paediatric procedures. The main challenge now lies in the implementation, on the one hand, of the quality management system required by ASN resolution 2019-DC-660, including the formalisation of essential documentation (individual exposure traceability and competency sign-off processes), and, on the other hand, of a reporting culture based on a systematic approach to OEF and the analysis of adverse events, particularly those involving identity monitoring. In dental radiology (CBCT), practitioners have a good theoretical understanding of dosimetric issues and regulatory obligations. However, ASNR notes a gap between this knowledge and its translation into formalised, documented and traceable processes, as well as shortcomings in compliance with certain essential regulatory requirements. Accordingly, implementation of the quality management system remains the principal weakness, together with shortcomings in optimisation practices (absence of assessments against DRLs) and dose traceability. Regulatory deviations are also identified with regard to essential safety requirements relating to premises and equipment safety (failure to perform External Quality Controls and non-compliance of premises). Lastly, the ESRs notified in radiology and involving cohorts of patients, particularly paediatric patients, although of no clinical consequence for patients, show a poor radiation protection culture and, in particular, a lack of understanding of the principle of optimisation, traceability and dose monitoring. 224 ASNR Report on the state of nuclear safety and radiation protection in France in 2025
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