2.1.3 Radiation protection situation in external-beam radiotherapy The installed base of external-beam radiotherapy facilities in 2021 comprises 543 particle accelerators installed in 171 radiotherapy centres subject to ASN licensing (see Graph 1). More than 200,000 patients(3) are treated each year, which represents nearly 4.2 million radiation sessions. The French radiotherapy observatory (French National Cancer Institute –INCa), lists 891 radiation oncologists in 2020. ASN issued 84 licenses in 2021. The majority of cases concerned the updating of an existing license. The safety of radiotherapy treatments has been a priority area of ASN oversight since 2007 on account of the high doses delivered to the patient. The inspection programme for the 2020‑2023 period places the emphasis on the ability of the centres to deploy a risk management approach. Skills management, the implementation of new techniques or practices and the mastery of the equipment are also examined in depth, depending on the centres. ASN has continued its graded approach to inspection: ∙ by reducing, in the light of the progress made in the control of treatment safety, the average frequency of inspection, which since 2016 has been reduced to once every four years (instead of the previous three-yearly frequency), enabling all the centres to be inspected every four years; ∙ by maintaining a higher frequency for the centres presenting vulnerabilities or risks, particularly for some centres having necessitated tightened inspections. As in 2020, ASN adapted its oversight actions on account of the Covid-19 pandemic. It continued to give priority to the more critical inspections, but some were carried out remotely or postponed, while taking care to observe the four-yearly frequency. ASN thus carried out 43 inspections in 2021, covering 25% of the national total. Of the 43 inspections performed, 7 were conducted entirely remotely. 3. In 2019, 205,585 people with cancer were treated by radiotherapy in 4,284,242 sessions (source: INCa Observatory). 2.1.3.1 Radiation protection of external-beam radiotherapy professionals When the radiotherapy facilities are designed in accordance with the rules in force, the radiation risks for the medical staff are limited due to the protection provided by the facility. The results of the inspections carried out in 2021 reveal no major problems in this sector: ∙ the effective designation of Radiation Protection Advisors (RPA) was confirmed in the majority of the centres inspected; ∙ the radiation protection technical controls were carried out in about 90% of the centres inspected and were satisfactory. 2.1.3.2 Radiation protection of radiotherapy patients The assessment of the radiation protection of radiotherapy patients is based on the inspections focusing on implementation of the treatment quality and safety management system, made compulsory by ASN resolution 2008-DC-0103 of 1 July 2008. This resolution has been repealed and replaced by ASN resolution 2021-DC-0708 of 6 April 2021, applicable since 17 August 2021. Since 2016, in the course of its inspections ASN verifies the adequacy of the human resources, and in particular the presence of the medical physicist and the internal organisation procedures for tracking and analysing adverse events –or malfunctions– recorded by the radiotherapy centres. A medical physicist is effectively present during the treatments in 100% of the inspected centres. All the centres have a medical physics organisation plan, but the quality of the plans varies from one centre to another. The detection of adverse events, their reporting (internally or to ASN) and their recording are deemed satisfactory on the whole. Furthermore, distinct progress is seen in the analysis of these adverse events, the defining of corrective actions and capitalising on them: they are satisfactory in 74% of the inspections, compared with 66% in 2020 (see Graph 2). This confirms a trend towards improvement. The improvement in practices through experience feedback and assessment of the effectiveness of the corrective actions were deemed satisfactory in only 30% of the centres inspected GRAPH Breakdown, by ASN regional division, of the number of centres and external-beam radiotherapy accelerators inspected and the number of new licenses or license renewals issued by ASN in 2021 1 0 10 20 30 40 50 60 70 80 90 100 Strasbourg Division Paris Division Orléans Division Nantes Division Marseille Division Lyon Division Lille Division Dijon Division Châlons-enChampagne Division Caen Division Bordeaux Division Licensed centres Accelerators Authorisations issued ASN Report on the state of nuclear safety and radiation protection in France in 2021 211 07 – MEDICAL USES OF IONISING RADIATIONS 08 07 13 04 10 06 12 14 03 09 05 11 02 AP 01
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