ASNR assessments by area of activity THE MEDICAL SECTOR The medical sector encompasses a wide range of activities and issues in terms of the doses delivered or administered to patients, workers’ occupational exposure, the layout of premises, the nature of ionising radiation sources and the production of waste and effluent contaminated by radionuclides. On the basis of the inspections carried out in 2025 and an analysis over the period enabling the entire base of facilities with safety implications to be covered, ASNR considers that the state of radiation protection in the medical sector is being maintained at a satisfactory level, relatively comparable from one year to the next. However, this finding needs to be qualified in view of the recurring weaknesses observed in all areas, the degraded situations that led ASNR to issue two formal notices to healthcare facilities carrying out fluoroscopy-guided interventional practices, and the occurrence of ESRs reflecting a lack of radiation protection culture. This includes the persistence of errors (wrong-side or target errors in radiotherapy, particularly in the context of re-irradiations, incorrect calibration of activity meters in nuclear medicine, etc.), exceedances of dose limit values for interventional practitioners as well as several events, detected retrospectively, involving cohorts of patients, including paediatric cohorts, who received doses significantly higher than those expected in conventional and interventional radiology. In addition, these findings are part of a context of persistent signals which led to the identification of a deterioration in radiation protection culture, and which were also identified in 2025 as a contributing factor in the occurrence of ESRs, and were noted during inspections: ∙a finding that resources are on the whole shrinking, with pressure on radiographer (MERM), medical practitioner and medical physicist staffing levels; ∙in imaging, the use of insufficiently well-understood services to carry out the roles of Radiation Protection Expert-Officers (RPE-Os) and medical physicists, leading to shortcomings in the optimisation of patient radiation protection, or liable to lead to a loss of radiation protection expertise and a lack of flexibility in implementing regulation radiation protection requirements (training, verifications, etc.); ∙increasingly complex organisations, with sharing of resources across different structures and the risk of dilution of responsibilities, against a backdrop of healthcare authorisation reforms and restructuring of services. As far as services are concerned, the growing reliance on external organisations (Radiation Protection Organisations – RPOs) to perform the duties of radiation protection advisors or medical physicists, already observed in 2024, in all types of healthcare centres, even in those considered to be at the cutting edge of medical techniques, is weakening radiation protection culture via dilution of responsibilities, loss of in-house skills and a lack of understanding of radiation protection issues. This situation is a source of concern, as it involves an organisational shift that is difficult for healthcare centres to reverse. The RPO profession must urgently consolidate its skills and practices against a backdrop of rapid market growth and fierce competition, as well as pressure on staffing levels, which is conducive to a decline in service quality. This competitive market has also led some organisations to offer the services of radiation protection advisors without possessing any certification as a competent radiation protection organisation. ASNR has informed more than a hundred employers and nuclear activity managers of these practices. In addition, during an inspection, ASNR detected falsified certificates of conformity issued for non-genuine reasons. This case resulted in the individual involved being given a suspended prison sentence. In radiotherapy, the 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 risk profile management approaches are mature. However, difficulties persist in maintaining the Operating Experience Feedback (OEF) process, with fewer meetings of dedicated committees, less detailed analyses of ESRs, 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 persistence of target errors (particularly wrong-side, delineation or positioning errors), and the multiplication of simultaneous treatments of several locations or 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 brachytherapy, the inspections confirm that the radiation protection rules are well taken into account, and that progress is being made in the deployment of quality management systems. However, on the basis of feedback from ESRs notified to ASNR, departments must pay particular attention to the management and traceability procedures for brachytherapy applicators, which are not sufficiently well managed. Application of the requirements concerning the protection of highlevel sources against malicious acts is gradually improving, with the implementation of a source protection policy, the definition of measures to prevent unauthorised access to these sources, and the identification and control of sensitive information. However, some centres are still facing difficulties in cases in which major works are required to be carried out to ensure compliance. 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. Dosimetry monitoring also remains satisfactory, but requires particular attention in light of emerging new practices, as does the training of professionals. The inspections confirmed the need to reinforce compliance with effluent and waste management rules, particularly with the emergence of new radiopharmaceutical drugs and the observation of an increase in triggering of radiation portal monitors at waste treatment facilities. While dose optimisation and analysis of DRLs have improved, the implementation of quality management systems remains inconsistent. In addition, ESRs show persistent shortcomings in the preparation and administration of medicines, often linked to identity monitoring or incorrect use of activity meters, as well as the need to reinforce prevention of the risk of extravasation, particularly for Internal Targeted Radiotherapy (ITR) treatments involving the delivery of very significant radiological activity. They also highlight the importance of preventive management of effluent discharge incident situations by those responsible for nuclear activities and the regulatory obligation to have a discharge agreement in place between nuclear medicine departments and wastewater network operators. ABSTRACTS – ASNR Report on the state of nuclear safety and radiation protection in France in 2025 27
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