The analysis of these events underlines that the control of risks in brachytherapy must be based on appropriate quality controls and the implementation of organisational measures to better manage informing of the patient, the sources and emergency situations. SUMMARY In brachytherapy, the inspections carried out in 2022 in nearly one quarter of the brachytherapy units, considered alongside those carried out over the period 2018-2021, enabling all the departments to be covered, reveal no breach of the radiation protection rules. The radiation protection of medical staff and the management of high-activity sealed sources are thus considered satisfactory. The training effort for professionals in possession of a high-level source must be maintained and reinforced for certain centres. ASN observes that deployment of the new requirements concerning safeguarding access to high-activity sources, which came fully into force in 2022, continues to progress, in particular regarding measures to prevent unauthorised access to these sources. However, some centres are faced with difficulties when bringing into compliance necessitates major works. The events reported in 2022 underline the importance of having an active events recording system so that malfunctions can be identified as rapidly as possible, equipment quality controls can be formalised, performed and recorded, while ensuring that these latter comply with professional standards and the manufacturer’s recommendations. 2.3 Nuclear medicine Nuclear medicine is a medical discipline that uses radionuclides in unsealed sources for diagnostic purposes (functional imaging in vivo or medical biology in vitro) or therapeutic purposes (ITR). Thanks to the increase in new radionuclides and vectors, nuclear medicine has developed strongly over the last few years, for diagnostic and therapeutic purposes alike. Nuclear medicine forms part of ASN’s inspection priorities. The main radiation protection risks are linked in particular to the use of unsealed sources, which generate radioactive waste and effluents, and can lead to contaminations. Nuclear medicine is moreover the main contributor to doses at the extremities of professionals in the nuclear sector (see point 1.2.1). During inspections, particular attention is focused on management of the sources, waste and effluents, occupational radiation protection, control of drug dispensing, through quality assurance obligations and the experience feedback process. 2.3.1 Description of the techniques In vivo diagnostic nuclear medicine allows the production of functional imaging which is complementary to the purely morphological imaging obtained by the other imaging techniques. This technique consists in examining a function of the organism by administering a specific radioactive substance called a RPD to the patient. The choice of RPD depends on the studied organ or function. The RPD conventionally consists of a radionuclide which can be used alone (in this case the radionuclide constitutes the RPD) or be attached to a vector (molecule, hormone, antibody, etc.). In the latter case, it is the specific attachment of the vector that determines the studied function. Table 3 presents some of the principal radionuclides used in various explorations. It is by detecting the ionising radiation emitted from the radionuclide by using a specific detector that the RPD can be located in the organism and images of the functioning of the explored tissues or organs can be obtained. The majority of detection devices allow tomographic acquisitions and crosssectional imaging and a three-dimensional reconstruction of the organs. The imaging techniques depend on the type of radionuclide used: Single Photon Emission Computed Tomography (SPECT), sometimes called “gamma-camera”, uses radionuclides emitting gamma radiation, while Positron Emission Tomography (PET) uses radionuclides emitting positrons. In order to make it easier to merge functional and morphological images, hybrid appliances have been developed. They combine PET cameras or gamma cameras with a computed tomography scanner (PET-CT or SPECT-CT). A PET camera can also be coupled with an MRI scanner, but this is rarer. GRAPH Breakdown of the number of brachytherapy centres, high dose-rate brachytherapy centres and new licenses or license renewals in 2022, by ASN regional division 3 0 2 4 6 8 10 12 14 16 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 Including high dose-rate centres New licences or licence renewals ASN Report on the state of nuclear safety and radiation protection in France in 2022 221 • 07 • Medical uses of ionising radiation 07 01 08 13 AP 04 10 06 12 14 03 09 05 11 02
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