errors, reveals persistent organisational weaknesses and the need to assess practices regularly. The lessons learned from these events also illustrate the fact that calibration of medical devices is a critical step in health care safety. In brachytherapy, the radiation protection of professionals and the management of high-level sealed sources are considered on the whole satisfactory. The training effort for professionals in possession of a high-level source must be maintained and reinforced for certain centres. ASN finds that new requirements concerning secure access to high-level sources are being deployed gradually, in particular measures preventing unauthorised access to these sources. The events reported underline the importance of event registration systems in order to identify malfunctions early on, as well as the need to evaluate the risks in a degraded situation (insufficient staffing levels) and to formalise and record equipment quality controls. In nuclear medicine, the inspections reveal that radiation protection is correctly taken into account in the vast majority of departments. However, improvements are needed in effluent management, in order to control discharges into the sewage networks, in formalising the coordination of prevention measures with outside contractors (for maintenance, upkeep of premises, intervention by private practitioners, etc.) and in training of professionals. ASN observes a significant commitment on the part of the nuclear medicine departments to deploy high-quality management systems and underlines the good culture of undesirable events reporting in most of the departments inspected in 2021. The events reported however underline the fact that the drugs administration process needs to be regularly evaluated, in particular for therapeutic procedures, owing to the potentially serious consequences of any administration error. In the field of fluoroscopy-guided interventional practices, ASN is still observing delays in premises being brought into conformity in order to comply with the technical design rules, more particularly in operating theatres, and recalls that these modifications are fundamental to preventing occupational hazards. Breaches of the regulations are still frequently observed, with unsatisfactory situations involving the radiation protection training of workers and patients, and preventive measures during concomitant activities, in particular with private practitioners. Non-conformities were found in 2021 in relation to non-compliance with radiation protection technical verification frequencies, as the departments had been unable to perform them in 2020 owing to the Covid-19 pandemic. Even if the deployment of medical physicists and the formalisation of the medical physics organisation plan would appear to be under way, progress is needed in the implementation of the optimisation approach, in particular in the operating theatres, where there is still insufficient analysis of the doses received by the patients. However, a reporting culture is spreading, with the adoption of event registration systems. The reporting of signif icant radiation protection events underlines the fact that maintenance operations, which can have repercussions on the doses delivered, must be correctly managed and that practitioner training in the use of medical devices is essential to dose control. Extensive work to raise the awareness of all the medical and paramedical professionals in the centres is still necessary to give them a clearer perception of the issues, especially for operating theatre staff. This is why recommendations to improve radiation protection in the operating theatres, issued in 2020, are still valid. In computed tomography, during its 2021 inspections, ASN still observes a lack of traceability of justif ication for the examinations and of the difficulties medical professionals encounter in implementing it. The lack of training of the referring practitioners, and of the use of the guide to good medical imaging practices, and the lack of justification protocols for the most common procedures partly explains the fact that the justification principle is not always applied. Furthermore, the lack of availability of other diagnostic methods (Magnetic Resonance Imaging –MRI, ultrasonography) and of health professionals limit the replacement of irradiating procedures by non-irradiating procedures. Elsewhere, ASN finds that examination protocols are optimised, quality controls of medical devices are performed at the required regulation frequency and the medical physics resources are appropriate to the tasks to be performed. ASN Report on the state of nuclear safety and radiation protection in France in 2021 19 ASN ASSESSMENTS PER LICENSEE AND BY ACTIVITY SECTOR
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