In brachytherapy, the inspections confirm that the radiation protection rules are duly taken into account. The challenges associated with maintaining the resources and skills necessary for this activity in the years to come subsist. The gradual deployment of the new requirements relative to the protection of high-activity sources against malicious acts is continuing, particularly as regards putting in place a protection policy, measures for preventing unauthorised access to these sources and the identification and control of sensitive information. This situation is gradually improving but cannot yet be considered compliant. In nuclear medicine, the inspections find that patient radiation protection is duly taken into account as concerns application of the principle of optimisation with recording and analysis of the DRLs, while underlining that further progress is required in QMS deployment. The ESRs reveal that the administration processes must be regularly assessed to ensure control of the medication circuit, particularly the processes that can lead to errors affecting several patients (use of the dose calibrator). ASN alerts the RNAs to the risk of extravasation with lutetium-177, which can lead to significant exposures at the injection site, and is currently working in collaboration with the professionals to establish the lessons learned from the notified ESRs. It has moreover published an “Experience feedback” sheet on the complications that occurred during the treatment of a hepatic cancer by radioembolisation using yttrium-90. Furthermore, particular attention must be paid to management of the effluents (functioning of decay tank alarms) and the waste generated by the patients, linked to the introduction of new radiopharmaceuticals. Lastly, despite some progress in the training of professionals, the situation observed in 2024 concerning occupational radiation protection and monitoring of equipment and sources (dosimetry analysis, verifications, coordination of prevention measures during concomitant activities) is less satisfactory. In the area of FGIPs and more particularly in the operating theatre, regulatory nonconformities persist over the years, concerning the technical rules for fitting out facilities, radiation protection training requirements (occupational and patient radiation protection training courses) and the coordination of prevention measures during concomitant activities. ASN observes that the centres are turning increasingly to RPOs and that this outsourcing, if it is not adequately managed, leads to a dilution of the responsibilities of the RNAs and poorer assimilation of, or even a deterioration in, radiation protection. Furthermore, the inspections of employer private practitioners reveal poor knowledge of the statutory radiation protection obligations of the Labour Code with respect to themselves and their employees. Lastly, ASN observed that several medical centres had not registered their radiation generating equipment and decided to take enforcement action against one hospital. In 2025, ASNR will continue its inspections in the priority sectors, namely radio- therapy, radiosurgery, nuclear medicine, FGIPs and CT. In radiotherapy, after having led a reflection involving all the stakeholders, ASNR will update its inspection guidelines and launch its new four-yearly inspection programme in 2025. In nuclear medicine, it will adjust the inspection frequency to better integrate the radiation protection risks, particularly for the departments conducting clinical trials. In radiotherapy and nuclear medicine respectively it will continue its specific inspections on the command of the accelerator calibration process and the verification of non-contamination on the basis of the lessons learned from the ESRs notified in the last few years. Concerning the FGIPs, ASNR will continue to conduct targeted inspections of private practitioners with employer status. Lastly, having observed deficiencies in dental surgeons’ command of the utilisation of CBCT and the deployment of the optimisation approach during the work to update ASN resolution 2019-DC-0667 on the diagnostic reference levels, ASNR will initiate an inspection campaign in this area. As part of this campaign it will provide the RNAs with a self-assessment matrix for the dental surgeons. On the regulatory front, in 2025 ASNR will revise ASN resolution 2019-DC-0667 of 18 April 2019 setting DRL values, to update the values for mammography and CBCT procedures. It will continue the preparatory work for the revision of ASN resolution 2008-DC-0095 of 29 January 2008 laying down the technical rules applicable to the disposal of effluents and waste contaminated by radionuclides. ASNR will also publish in 2025 the lessons learned from its teleradiology study. Lastly, particular attention is still focused on the deployment of new therapy techniques and practices (radiotherapy, ITR). ASNR will continue its work in cooperation with the various institutional actors in the health sector, the professional organisations and assisted by its groups of experts, particularly the Canpri, particularly with regard to flash radiotherapy and the project group set up to define the adaptive radiotherapy evaluation methods which will be deployed as of 2025. In therapeutic nuclear medicine, the radiation protection risks for patients and their family circle, workers, and the management of effluents and waste are a priority in a context of introduction of new radiopharmaceuticals, projected increase in the number of patients eligible for these new treatments with limited infrastructure and the conditions of treatment on an out-patient basis. ASNR will give an opinion in early 2025 based on the work of IRSN and GPRP and the lessons learned from the European Commission’s SimpleRad project. 244 ASN Report on the state of nuclear safety and radiation protection in France in 2024 Medical uses of ionising radiation
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