Equipment installation and commissioning: a critical stage in optimisation The installation and commissioning of new radiology equipment is a critical stage. A medical device must be “properly supplied, correctly installed, maintained and used in accordance with its intended purpose” according to Article R. 5211-17 of the Public Health Code, and “accompanied by the information necessary to ensure it can be used correctly and safely, taking into account the training and knowledge of potential users”. In several cases, users(3) were trained in the use of the device when the equipment was installed, but the high turnover in radiology teams meant that users’ knowledge of the machines’ functions (collimation, filtration, etc.) could not be maintained over time. The lack of formally established protocols for the equipment in question contributed to this loss of knowledge, since the basic documents needed to build the skills of new arrivals and implement best practice were non-existent. ASNR points out that training – including qualification of personnel in the use of medical devices – and the establishment of formalised practices are essential safety barriers. In addition, optimisation of the doses delivered by the equipment at the time of its installation, taking into account the various procedures for which it is intended, must be carried out in consultation with the various professionals involved: doctors, radiographers, medical physicists and the supplier’s application engineer. The involvement of the medical physicist and the doctors at this stage is not always observed, even though the optimisation process must be implemented on a collaborative basis in order to achieve the best compromise between the doses delivered and the desired image quality. ASNR calls for a stronger radiation protection culture in the field of conventional radiology Optimisation on commissioning of equipment must be supplemented by a regular optimisation process based on analysis of quality controls, regular collection of doses delivered to patients, implementation of regular dosimetry assessments, analysis of the results of these assessments, and comparison of the latter with the DRLs, where they exist. All these elements constitute barriers enabling teams to be rapidly alerted with respect to any malfunctions or misuse. The significant events that occurred in 2025 highlight the importance of connecting radiology equipment to a Dose Archiving and Communication System (DACS) to facilitate analysis of the doses delivered. In this respect, ASNR considers that it would be appropriate to strengthen the regulatory obligations for activities for which these systems are not currently required. In addition, key information for patient monitoring, including the dose received, must be recorded in the procedure report by the person carrying out the imaging procedure. 3. See the guide entitled ‘Recommendations on training in the use of medical devices emitting ionising radiation’ on the ASNR website. ASNR points out that the primary guarantee of a high level of radiation protection lies in a robust radiation protection culture, fostered by trained professionals equipped with appropriate resources and tools. Based on Operating Experience Feedback (OEF) from significant events, ASNR will undertake several initiatives over the coming months and years: ∙It will step up its controls by carrying out a campaign of paediatric radiology inspections in 2026, during which it will provide professionals with a self-assessment tool so that they can assess their regulatory compliance with radiation protection requirements and ensure that good radiation protection practices are implemented. ∙As these events have highlighted the difficulties in communicating with both the general public and patients, ASNR will begin work on these subjects in collaboration with the Professional Radiology Council (G4) in particular. To date, there is no communication scale for radiology and nuclear medicine activities similar to the ASN-SFRO scale, developed for radiotherapy, which facilities understanding of the severity of notified events. ∙As part of the ongoing revision of ASN resolution 2019-DC- 0667 of 18 April 2019 setting DRL values, OEF from these significant events will be used to encourage analysis and feedback for paediatric procedures. Diagnostic Reference Levels (DRLs), a tool for optimisation The principle of optimising exposure to ionising radiation, established by Article L. 1333-2 of the Public Health Code and specified in R. 1333-61 of the same Code, has led to the introduction of the concept of “Diagnostic Reference Levels” (DRLs) in the area of medical imaging using ionising radiation. These DRLs, which must not be considered “dose limits”, are established according to the type of examination, and differ between adults and children. DRLs are thus dosimetric indicators used to assess the quality of practices. They are only meaningful when assessing average practice (based on groups of patients) and should not be compared with an individual patient’s exposure. Therefore, the comparison of a DRL value with a dose received during an individual examination is not relevant for a given individual, because in certain situations the conditions of the examination can justify a higher value (to take into account the patient’s morphology for example, or other factors that do not call into question the benefit/risk ratio of the procedure). ABSTRACTS – ASNR Report on the state of nuclear safety and radiation protection in France in 2025 15
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