ASN Report 2020

8. Synthesis and prospects The year 2020 was marked by the Covid‑19 pandemic which considerably disrupted the health care system. Consequently, ASN reduced the number of inspections in the medical sector and adapted its oversight methods, in particular by deploying remote inspections. Remote inspections account for 26% of the inspections performed, with the highest proportion in nuclear medicine (35%) and the lowest in computed tomography (5%). Consequently, the state of radiation protection in 2020 is based on a significantly smaller number of inspections than in the preceding years (28% fewer). On the basis of the inspections conducted in 2020, ASN considers that the state of radiation protection in the medical sector is comparable with that of 2019. No major deficiency was detected in the areas of radiation protection of medical professionals, patients, the public or the environment. Nevertheless, it is still necessary to better anticipate the arrival of new machines, new practices and new radiopharmaceuticals and to improve the level of radiation protection culture in non- specialist users of ionising radiation. Such is the case with surgeons who are increasingly required to perform fluoroscopy- guided procedures in the operating theatres. Furthermore, laterality and fractionation errors in radiotherapy, errors in the administration of radiopharmaceutical drugs in nuclear medicine, exceeding of extremity or whole body dose limits in practitioners during interventional procedures, and contaminations or exposures in nuclear medicine are still reported, reminding us of the need to regularly assess practices. Updating of the regulatory framework continued in 2020 and early 2021 with the adoption of two ASN resolutions concerning putting in place the new registration administrative system applicable to risk-prone FGI practices and to CT scanners, and the qualification of physicians and dental surgeons who use ionising radiation and the coordinating physician when a legal person is licensed or registered. In addition, two circular letters were issued for the professionals, one concerning radiation protection in the operating theatre and the management of patients, the other concerning waste and effluent management when using lutetium-177 and updating the licensing requirements for nuclear medicine departments. ASN will continue its inspections in 2021, addressing the radiotherapy, therapeutic nuclear medicine and Fluoroscopy- Guided Interventional practices in priority, drawing on the lessons learned from the new inspection methods used due to the health crisis. It will also continue to contribute to the regulatory work conducted by the Minister responsible for health concerning the duties of medical physicists, the organisation of medical physics, the reform of the health care activity authorisations and the deployment of clinical audits. Lastly, putting in place new equipment, new practices and new radiopharmaceuticals remains a priority for ASN. The work to better anticipate and manage the organisational and technical changes in radiotherapy, conducted with the IRSN in collaboration with volunteer radiotherapy centres, hospital federations and health care institutions shall be continued. ASN will also examine the follow-ups to the initial work of the Committee for the Analysis of New Techniques and Practices using Ionising Radiation (Canpri), set up in 2019, concerning a device combining a self-shielding technology with a linear accelerator. 236 ASN Report on the state of nuclear safety and radiation protection in France in 2020 07 – MEDICAL USES OF IONISING RADIATION