source management, appropriate measures to prevent unauthorised access to the sources, source inventory, protection against malicious acts and management of sensitive information). In 2024, 16 inspections were carried out on the theme of radiation protection, representing 28% of the licensed departments. 2.2.3.1 Management of sources The organisational set-ups enable the category of each source or batch of sources to be identified in 80% of the centres inspected, a level similar to that of industry and the findings of the previous years. This is the indicator that obtains the highest score of conformity and the number of sites that have not yet classified their sources is very small. The nominative authorisations delivered by the RNA to allow access to the sources, their carriage, or access to the information relating to the means or measures that protect them raise no comments in slightly less than half the situations. This result is also comparable with the industrial sector, even though it would in principle seem more difficult to comply on this point given the number of persons concerned and the nature of the medical facilities whose function is to receive the public. No critical situation (absence of license) was found in the medical sector. Half the inspections in 2024 concluded that the policy for protection against malicious acts was satisfactory, as were the measures implemented for the identification and control of sensitive information. This is a great improvement compared with the last three years. A substantial improvement is required in the identification of the barriers to protect, for which the indicator remains mediocre: in 2024, one inspected facility in four had correctly defined its barriers; the figure in 2023 was one in five. One third of the facilities inspected in 2024 has a maintenance plan for the technical protection systems that is correctly applied. Here too an improvement is necessary, as shortcomings had already been found in this respect in the preceding years. The results are detailed in chapter 8. ASN notes that progressive deployment of the new requirements relative to protecting access to high-activity sources is continuing. This situation is gradually improving but cannot yet be considered compliant. 2.2.3.2 Emergency situations and management of malfunctions The malfunctions of brachytherapy devices which can result in jams or incorrect positioning of the source can lead to overexposure of staff or patients, sometimes with serious consequences (radiation necrosis). Consequently, this type of event underlines the need to comply with the technical requirements concerning the use of these devices, and the obligations to provide training in emergency situation management and to conduct exercises. 2.2.3.3 Radiation protection of medical professionals The occupational radiation protection measures deployed in 2024 by the brachytherapy departments were considered satisfactory in three quarters of the departments compared with just half in 2023. Of the 16 centres possessing high-activity sources inspected in 2024, 80% have put in place enhanced training in emergency situations and have organised situational exercises, particularly for managing situations linked to source jamming whereas only 46% had done so in 2023. ASN thus finds that the situation is better in 2024, but reiterates the importance of providing radiation protection training for the professionals when high-activity sources are possessed in order to be capable of managing jammed source situations. 2.2.3.4 Radiation protection of patients As with external-beam radiotherapy, the radiation protection of brachytherapy patients is assessed from the inspections concerning the implementation of the treatment QSMS and the medical physics organisation. 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 inspected centres. 2.2.3.5 The treatment quality and safety management system The qualitative result of the inspections carried out in 2024 has shown that the majority of brachytherapy departments inspected have deployed a QSMS, with the support of the external-beam radiotherapy departments (see Graph 4). A review of the inspections carried out over the 2021‑2024 period and covering all the departments reveals the following trends: ∙The notification culture and the organisation for managing the reports are considered satisfactory for all the departments inspected in recent years, with ratings of 100% in 2021 and 2022, 92% in 2023 and 90% in 2024. ∙The analysis, defining of corrective actions and building on lessons learned are considered satisfactory in more than two-thirds of the departments, with a better situation in 2024 (90%). ∙The assessment of corrective action effectiveness has been progressing since 2021. Thus, while only a third of the departments assessed the effectiveness of corrective actions in 2021, 70% of the inspected centres did so in 2024. ∙Ninety percent (90%) of the departments inspected in 2024 have a validation procedure for HDR treatments, whereas the figures for the 2021-2024 period ranged from two thirds to 89%. ∙The authorisation process is being deployed, but there are still disparities between the medical and paramedical personnel, given that it is applied mostly for the paramedical staff. Maintenance and quality controls – The majority of the centres have an inventory of the MDs and a register for recording maintenance operations and quality controls. In the absence of regulatory baseline requirements for the quality controls of brachytherapy devices, the quality controls implemented are based on the recommendations of the manufacturers or professional organisations. Guide of the European Society for Radiation Oncology (ESTRO) – Booklet No. 81 and Guide No. 36 of the French Society of Medical Physics (SFPM). 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Reporting culture and organisation HDR validation procedure existing and tracked Analysis, defining of corrective actions, building on lessons learned Assessment of corrective action effectiveness 2024 2023 2022 2021 2020 70 65 60 100 31 100 50 92 69 80 77 90 70 89 83 87 45 67 78 GRAPH 4 Change in the percentage of conformity of brachytherapy facilities in the management of events giving rise to corrective actions over the 2020-2024 period ASN Report on the state of nuclear safety and radiation protection in France in 2024 225 Medical uses of ionising radiation 07 01 02 03 04 05 06 08 09 10 11 12 13 14 15 AP
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