LES ACTIVITÉS NUCLÉAIRES : RAYONNEMENTS IONISANTS ET RISQUES POUR LA SANTÉ ET L’ENVIRONNEMENT cohorts, who received doses significantly higher than those expected in conventional and interventional radiology. ASNR draws attention to the fact that the warning signs identified in recent years, as described below, point to a risk of deterioration in radiation protection culture. They are identified as a factor contributing to the occurrence of ESRs and are found during inspections to explain the decrease in regulatory compliance: ∙a finding that resources are on the whole shrinking, with pressure still observed on radiographer, medical practitioner and medical physicist staffing levels; ∙in imaging, recourse to outsourced services to perform the duties of RPE-Os and medical physicists, which could lead to a loss of radiation protection skills within the establishments and a lack of availability to implement the regulatory radiation protection requirements (training, verifications, etc.); ∙increasingly complex organisations, with sharing of resources and the risk of dilution of responsibilities, against a backdrop of health care authorisation reforms and restructuring of centres. These findings must also be viewed in the context of the significant acceleration of medical innovations involving ionising radiation and the development of new practices, such as teleradiology. The constant growth in teleradiology with technical and organisational constraints associated with this type of organisation that are under-estimated by the facilities (communication problems, software interface). In 2025, ASNR published the findings of a study it conducted on this subject. Internal Targeted Radiotherapy (ITR) is also expanding rapidly, particularly with the growth of clinical trials involving new radionuclides. Given the high levels of radiological activity involved, the stakes are particularly high for patients, workers and the environment. Radiotherapy is continuing to develop adaptive radiotherapy and is also exploring the FLASH effect, which promises much faster treatment but raises many questions; a Canpri opinion was submitted to ASNR at the end of 2025. The growing diversity of fluoroscopy-guided interventional practices illustrates the complexity of the techniques involved. Finally, the use of AI is progressing across all medical applications involving ionising radiation, without these new tools always being properly understood, controlled or validated. This momentum in innovation offers considerable hope for patients and helps ensure continuity of care, but it also represents a challenge for radiation protection, requiring additional knowledge, data and appropriate infrastructures. For this reason, ASNR reiterates the need to assess the impact of these developments on organisations and on the work of professionals, and to define clearly the roles and responsibilities of all stakeholders so that radiation protection requirements are met. The ESRs notified in 2025 involving cohorts of patients, including paediatric patients, in conventional and interventional radiology, constitute a significant event for the year 2025 (see Significant Events in the introduction to this report). They reveal shortcomings in dose traceability and monitoring, as well as insufficient assimilation of the optimisation principle, beginning as early as the equipment installation phase. They highlight the need for better training of professionals, particularly through competency sign-off processes, and for greater rigour in the analysis of medical device quality control results. Finally, the OEF learned from these ESRs highlights the importance of connecting radiology equipment to a Dose Archiving and Communication System (DACS) to facilitate the use and analysis of dose data, and to examine the need to reinforce regulatory obligations for activities where such systems are not currently required. In radiotherapy, in a context of increasing complexity and rapid innovation, ASNR updated its inspection guidance and launched a new four-year inspection programme for the period 2025–2028. Inspections carried out by ASNR in 2025 confirm that the main fundamentals of safety in radiotherapy are in place (organisation of medical physics, equipment checks, training) and that quality management and risk management processes are mature. However, difficulties persist in maintaining the OEF process, with fewer meetings of dedicated committees, less detailed ESR analyses and shortcomings in assessing the effectiveness of corrective actions. Furthermore, it is still the case that preliminary risk assessments are often not sufficiently updated, either prior to organisational or technical changes, or following OEF from events. The number of events classified as level 2 on the ASN-SFRO scale is also increasing, although it is not yet possible to draw any conclusions regarding changes in the overall state of radiation protection. Lastly, the persistence of target errors (particularly laterality, delineation or positioning errors), the multiplication of simultaneous treatments of several locations, and treatments in the context of re-irradiations, underline the need for centres to regularly assess the barriers in place, making greater use of national OEF. In the face of increasingly rapid innovation, particularly in the field of AI, ASNR stresses the need to anticipate the deployment of new techniques, as they raise technical, human and organisational challenges and may weaken existing safety arrangements or render them obsolete. In 2026, ASNR will examine Canpri’s opinion on FLASH therapy, which was submitted in December 2025. In brachytherapy, the inspections carried out in 2025 in nearly a quarter of the departments, considered alongside those carried out over the 2022-2025 period, enabling all the departments to be covered, confirm that the radiation protection rules are properly applied. In particular, the inspections carried out in 2025 showed progress in the adoption and assimilation of quality management systems. However, the ESRs notified highlight the need for better control of applicator management and traceability procedures in brachytherapy. The requirements concerning the protection of high-level sources against malicious acts are gradually improving, in particular through implementing a protection policy, measures to prevent unauthorised access to these sources and the identification and control of sensitive information. Some centres are still faced with difficulties when bringing into compliance necessitates major works. Finally, maintaining brachytherapy services themselves represents a major challenge for the years ahead because of the specialist resources and skills required, together with the persistent recruitment difficulties faced by centres, highlighting the need for collective action to preserve this essential expertise. In nuclear medicine, the inspections carried out in 2025 show a satisfactory, albeit mixed, picture. Worker radiation protection is generally well managed, but there are still weaknesses in equipment verifications and management of interventions by external personnel. Dosimetric monitoring also remains satisfactory and warrants particular attention in view of the emergence of new practices, as does the competency sign-off of professionals, which still requires improvement. The inspections confirm the need to reinforce compliance with effluent and waste management rules, particularly with the emergence of new RPDs that may trigger radiation portal monitors at waste treatment facilities when waste management is not properly controlled. On the patient side, dose optimisation and analysis of DRLs have improved, but the implementation of quality management systems remains inconsistent. The notified events (ESRs) reveal persistent shortcomings in the preparation and administration of medicines, often involving identity monitoring failures or the incorrect use of dose calibrators, highlighting the need for regular training and assessment. Measures to prevent the risk of extravasation must also be strengthened, particularly for ITR treatments. The increase in clinical trials using new radionuclides raises specific issues of radiation protection, not only for patients and their families, but also for professionals, the public and the environment. This underlines the need to have an overall view of these issues and to support these developments. The commitment and collaboration of all stakeholders: healthcare regulatory agencies, manufacturers, ASNR Report on the state of nuclear safety and radiation protection in France in 2025 227 01 05 02 03 04 09 06 10 07 11 13 08 12 A / Z
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