bones, ENT). This activity presents radiation protection risks and requires skills of a high standard and greater control of the doses delivered. It also takes up more medical and medical physics time and requires work organisation adaptations. Furthermore, the reform of care authorisations (see point 1.3.3) is likely to lead to changes in the porting of nuclear activity authorisations (for radiosurgery for example), and organisational changes. ASN is extremely attentive to the impact of these changes on radiation protection, and in particular to the adequacy of the planned resources for implementing treatments of this type. The safety of radiotherapy treatments has been a priority area of ASN oversight since 2007 on account of the high doses delivered to the patient. Since 2019, the fouryearly inspection programmes have placed the emphasis on the ability of the centres to deploy a risk management approach. Skills management, the implementation of new techniques or practices and the mastery of the equipment are also examined in depth, depending on the centres. ASN has continued its graded inspection approach: ∙by reducing, in the light of the progress made in the control of treatment safety, the average frequency of inspections, which since 2020 has been reduced to once every four years (instead of the previous threeyearly frequency), enabling all the centres to be inspected every four years; ∙by maintaining a higher frequency for the centres presenting vulnerabilities or risks, particularly for some centres having necessitated tightened inspections. ASN conducted 66 inspections in 2024, representing 39% of the French centres. These 66 inspections include the routine inspections, commissioning inspections, inspections further to ESRs and unannounced inspections if any (one in 2024). In 2024, ASN again observed difficulties in recruiting radiographers, medical physicists and radiation oncologists, irrespective of the region. This lack of personnel has impacts on the activity, the organisational set-ups and the working conditions of the medical staff (reduction in treatment slots, overstretched personnel, tensions in the teams, etc.). Holding interviews with the medical and paramedical teams and medical physicists during the inspections brings to light situations of tension and malfunctioning, which are sources of risks for the patients despite a highly formalised reference framework. Holding interviews with senior management enables these risk situations to be discussed with a view to helping the department identify technical, human and organisational lines for improvement. These inspections focusing on Human and Organisational Factors (HOFs) are conducted regularly by ASN in the area of radiotherapy; they sometimes detect situations representing a risk for patient safety that would not be found during a conventional inspection. 2.1.3.1 Radiation protection of external-beam radiotherapy professionals When the radiotherapy facilities are designed in accordance with the rules in force, the radiation protection risks for the medical staff are limited due to the protection provided by the facility. The results of the inspections conducted in 2024 reveal no difficulties in this sector: Radiation Protection Experts (RPEs) have been effectively appointed in all the inspected centres; the technical radiation protection verifications have all been carried out at the required statutory frequency. 2.1.3.2 Radiation protection of external-beam radiotherapy patients The assessment of the radiation protection of radiotherapy patients is based on the inspections focusing on implementation of the treatment QSMS, made compulsory by ASN resolution 2021-DC-0708 of 6 April 2021. Since 2016, in the course of its inspections ASN verifies the adequacy of the human resources, particularly in medical physics. Emphasis is also placed on the internal organisation methods to guarantee a culture of reporting significant event (or near miss), ensuring their follow-up and systematically analysing them when necessary. ASN notes that the requirements concerning the medical physics organisation and the presence of a medical physicist during the treatments are satisfied in all the centres, even if there may be personnel shortages from time to time. The ASN inspectors observe that deployment of the authorisation process is continuing, still with disparities between the medical and paramedical personnel given that it is applied mostly for the paramedical staff. Furthermore, the analysis of compliance with regulatory requirements concerning the management of events over the 2020‑2024 period shows a constant proportion of departments complying with the regulations, with significant disparities depending on the requirements concerned (see Graph 2): ∙The detection of adverse events, their reporting (internally or to ASN) and their recording are deemed satisfactory on the whole, with rates varying between 74% and 91% over the period in question, with better results observed in 2024 (79%) compared with 2023 (74%). ∙The analysis of these adverse events, the defining of corrective actions and building on the lessons learned, after an initial phase of progress followed by stabilisation in 2021 and 2022 at around 75%, is dropping in 2023 and 2024 with about 60% of the inspected centres carrying out these steps satisfactorily. ∙The improvement in practices resulting from Incident Learning Systems (ILS) and assessing the effectiveness of the corrective actions still represent the weak spot of these events analysis procedures, with the situation being deemed satisfactory in only 30% (2021) and 49% (2023 and 2024) GRAPH 2 Change in the percentage of conformity of external-beam radiotherapy facilities in the management of events giving rise to corrective actions over the 2020-2024 period 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2024 2023 2022 2021 2020 Reporting culture and organisation Analysis, defining corrective actions, building on lessons learned Assessment of corrective action effectiveness 91 75 30 81 74 74 60 49 79 61 49 76 38 36 85 220 ASN Report on the state of nuclear safety and radiation protection in France in 2024 Medical uses of ionising radiation
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