of these clinical peer reviews. The review grids have been finalised and the recruitment and training of reviewers (physicians, medical physicists and radiographers) has been completed, as has the identification of volunteer centres to test the process. The pilot phase for testing the review process as a whole (organisation, documentation, etc.), and the appropriateness of the said grids for the two areas was initiated late 2023. The assessment conducted at the end of 2024 on about ten volunteer radiotherapy centres is broadly positive as regards review preparation on the part of the reviewers, the reviewed centres and the subjects addressed during the reviews, such as justification of the procedure (patient radiation protection). Deployment of the pilot phase in radiotherapy will continue in 2025. In radio- logy, some thirty imaging facilities out of the 70 candidacies received by National Professional Council (CNP) for radiology had been reviewed by the end of July 2024. The medical imaging reviews held in the first year of operation will undergo an assessment. The reviews will continue on a voluntary basis in 2025. At the end of these experimental phases, a national assessment will be carried out by the Ministry responsible for health in order to extend these clinical reviews to the national scale, with conditions of performance and the frequency of the reviews being specified in an Order. ASN encourages the deployment of these reviews in the sectors with high radiation protection risks which are not covered at present, namely radiosurgery and therapeutic nuclear medicine and, in particular, it encourages the professional organisations to start working on the review baseline requirements as of now. Training in patient radiation protection The obligations for continuous training in patient radiation protection are set in Articles L. 1333‑19, R. 1333‑68 and R. 1333‑69 of the Public Health Code. The system as a whole was revised in ASN resolution 2019-DC-0669 of 11 June 2019 amending resolution 2017-DC-0585 of 8 January 2015, further to discussions with all the CNPs concerned. This resolution aims to clarify and enhance the teaching objectives concerning justification, to integrate new actors and to foster interfacing with the other continuous training systems. Pursuant to this resolution, 18 professional guides have been produced by the professional organisations, validated by ASN and put on line on asn.fr((5). To monitor the practical implementation of this new regulatory framework, 5. asn.fr/espace-professionnels/activites-medicales/guides-professionnels-de-formation-continue-a-la-radioprotection a qualitative and quantitative assessment involving all the professions was carried out in 2022. An inventory of the training offerings has been drawn up to identify the main players (health facilities, professional organisations, continuous training organisations). For the guide for radiotherapy professionals and the guide for radiographers working in imaging, a specific assessment has been conducted by the Centre of Studies on the Evaluation of Protection in the Nuclear Field (CEPN) at the request of ASN, on the number and content of these two training courses. This assessment focused on compliance with the regulations, the organisation of the training courses, their teaching methods and the level of satisfaction of the professionals who have followed the courses. The first results show that the training guides are broadly followed by the training organisations (whether public or private). This work was presented in 2023 to the committee that monitors the national plan for controlling imaging doses and to the Advisory Committee of Experts for Radiation Protection – GPRP (see chapter 2) and continued in 2024 with, in particular, a presentation of the results to the organisations providing training in patient radiation protection. 1.4 The risks and oversight priorities In order to establish its oversight priorities, ASN has classified the nuclear-based medical activities according to the risks for the patients, the personnel, the public and the environment. This classification takes particular account of the doses delivered or administered to the patients, individually or collectively, the fitting out of the premises and the conditions of use of sources of ionising radiation by the medical professionals, the production of waste and effluents contaminated by radionuclides, the source security risks (high activity sealed sources), lessons learned from significant events notified to ASN and the radiation protection situation in the institutions exercising these activities. On the basis of this classification (see point 1.3.3, Table 1), ASN considers that its inspection priorities must focus in priority on external-beam radiotherapy – including radiosurgery, brachytherapy, nuclear medicine and FGIPs. The inspection frequencies, based on an approach graded according to the radiation protection risks (see Table 2), enable all the safety- significant activities to be inspected over a period of three to five years, depending on the sectors. These frequencies are increased when vulnerabilities that could have an impact on radiation protection are identified (difficulties linked to human resources, technical or organisational changes, quality management or insufficient control of risks – lateness in formalising practises, absence of risk assessments, lack of risk culture –, particular risks associated with certain techniques, etc.). This can lead ASN to place certain centres under tightened surveillance, when significant persistent malfunctions have been found, and to inspect them at least annually (see chapter 3). The inspection frequency for FGIPs can be reduced by ASN depending on the knowledge of the radiation protection situation of the facilities, on the basis in particular of the inspections carried out when issuing a registration. In 2018, ASN defined a list of systematic inspection points concerning the radiation protection of workers, patients and the public, the management of sources, waste and effluents, and the security of sources. These inspections, associated with indicators, enable regional and national assessments to be carried out and the developments to be measured over time. Some indicators are common to all the inspected activities, such as the organisation of radiation protection and of medical physics, and training in radiation protection of workers and patients. Others are specific to a given activity, such as the management of waste and effluents in nuclear medicine or the security of sources in brachytherapy. These indicators serve in particular as the basis for assessing the radiation protection situation in the medical sector (see point 2). These systematic checks are complemented by investigations on specific themes defined in an annual or multi-annual framework and adapted to the particular situations encountered in the inspections. The main themes chosen in 2024 were: ∙in radiotherapy – including radiosurgery, and brachytherapy: risk management and in particular learning lessons from ESRs, management of skills and training, mastery of the equipment and more particularly the accelerator calibration process and the security of high-activity sealed sources; ∙in nuclear medicine: the management of adverse events relating to the administration of RPDs, implementation of the verifications to ensure there is no surface or atmospheric contamination; ∙in FGIPs: implementation of the optimisation approach and training practitioners in patient radiation protection. 216 ASN Report on the state of nuclear safety and radiation protection in France in 2024 Medical uses of ionising radiation
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