Graph 15 shows that the number of ESRs concerning the medical professionals or the environment has remained stable while the number of ESRs concerning patients has risen. The number of ESRs notified has been increasing in conventional radiology and computed tomography since 2010, and even more so in nuclear medicine, where it exceeds the number of ESRs in computed tomography. This is the first year since ESR notification became obligatory that the number of ESRs in nuclear medicine exceeds the number of ESRs notified in the other activities. The number of ESRs in external-beam radiotherapy in 2024 remains stable with respect to 2023 but is nevertheless tending to decrease. On the other hand it is stable for interventional practices with about thirty ESRs in 2024. Human factors are the cause of many significant events according to the notifiers. As a result, the training, the procedures, the working systems and the way in which they affect the performance of the personnel as regards decision making and execution of the key radiation protection measures are not sufficiently questioned. ASN also notes that the relevance and effectiveness of the corrective actions defined after reporting an ESR to prevent its recurrence are not sufficiently assessed. The organisation of training and information sessions, reminders of instructions and the addition of check points are measures that are frequently mentioned in the experience feedback reports sent to ASN by the centres. Despite this, similar ESRs are still notified in some of these centres, indicating that the measures have not been sufficiently effective to prevent recurrence of the events. ASN thus underlines the importance of taking account of the lessons learned from previous events, whether internal or external, and assessing the effectiveness of the corrective measures taken. ASN also points out that the investigations must be conducted with a systemic approach, including the examination of the HOFs involved such as the training, the procedures, the work methods and the way in which they affect the performance of the personnel as regards decision making and execution of the main radiation protection measures. This incident management approach should result in more effective corrective actions to prevent the recurrence of similar significant events in the future. In 2024, ASN informed the health professionals of two lessons learned from the analysis of ESRs which are of interest for patient radiation protection. It convened its “imaging experience feedback” WG to produce two experience feedback sheets in the following specialities: ∙one in conventional radiology: “Expe- rience feedback” sheet on the accidental modification of the exposure settings of a mobile radiology device (see box page 241); ∙the other in therapeutic nuclear medicine: “Experience feedback” sheet concerning extra-hepatic complications after using yttrium-90 microspheres to treat a liver cancer (see point 2.3.3.4). Within the framework of radiotherapy experience feedback WG, ASN also worked on the preparation of two “Experience feedback” sheets on the radiotherapy treatment safety: the first focuses on identity monitoring and the second on laterality error prevention. These two sheets will be published in early 2025. 3 Synthesis and prospects On the basis of the inspections carried out in 2024 and an analysis of the period enabling the entire installed base of facilities with risks to be covered, ASN considers that the state of radiation protection in the medical sector remains at a satisfactory level, relatively comparable from one year to the next, although with a number of persistent shortcomings. It notes that the experimental clinical review initiatives, which began at the end of 2023 exclusively in radiotherapy and radiology under the control of the Ministry responsible for health, are going well but need to be continued for longer before being put into widespread application. ASN encourages their extension to the highest-risk activities, prioritising radiosurgery and therapeutic nuclear medicine, and calls upon the CNPs to take action as of now to set up review matrices. ASN moreover also encourages radiotherapy departments to embrace procedures for assessing new practices, like the procedure put in place for adaptive radiotherapy. It also encourages the CNPs to take into account the need to update the radiation protection guides they have produced, using as a basis the results of the evaluation of the new system for training in patient radiation protection that ASN published in 2024. ASN draws attention to the fact that the signals identified in 2023 and reiterated below lead to a degradation of the radiation protection culture. They are identified as factors contributing to ESRs and noted in inspections as factors explaining poorer compliance with the regulations: ∙a widespread finding of diminished resources with strained staffing levels for radiographers, medical practitioners and medical physicists, with the development of temporary work and tasks being performed by personnel without the required qualifications; ∙in imaging, recourse to service providers (RPOs) over which the medical centres have insufficient control, to assist the RPE-Os and medical physicists, which could lead to a loss of radiation protection skills and a lack of the flexibility necessary for the implementation of the regulatory radiation protection requirements (training, verifications, etc.); ∙constant expansion of teleradiology with technical and organisational constraints linked to this method of organisation that are underestimated by the centres communication problem, software interfaces); ASNR will publish in 2025 the lessons learned from a study it has conducted on this subject; ∙the complexification of organisational structures, with resource sharing and the risk of diluting responsibilities, in a context of reforms in the healthcare authorisations and the buying out of centres. Consequently, ASN maintains its request that decision makers be attentive to the need to assess the impact of these changes on the organisational set-ups and the work of those involved and to precisely define their roles and responsibilities so that the radiation protection requirements are satisfied. In radiotherapy, although the safety fundamentals are in place, radiotherapy departments are struggling to maintain learning from experience procedures with fewer meetings of experience feedback committees, insufficiently detailed ESR analyses and persistent difficulties in assessing the robustness of corrective actions. The recurrence of wrong-target errors (laterality, delineation and positioning errors in particular), the multiplication of simultaneous treatments of several locations and re-irradiations, in a context where more and more patients are receiving several radiotherapy treatments in the course of their lifetime, underline the need firstly to regularly assess the barriers put in place by capitalising on national experience feedback, and secondly to update the prospective risks analyses on the basis of local and national experience feedback. These studies are still incompletely conducted prior to technical and organisational changes. ASN Report on the state of nuclear safety and radiation protection in France in 2024 243 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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