of 2020 and will also lead to an update of ASN Technical Guide No. 18 of 26 January 2012. One of the 15 recommendations of the Working Group report “Discharging of effluents containing radionuclides from nuclear medicine units and research laboratories into the sewage network” published in June 2019 on asn.fr introduces the notion of setting “contractual” or “management” guidance levels, if applicable, in the discharge license mentioned in Article L. 1331-10 of the Public Health Code. These guidance levels, whose value would be specific to each centre, are management levels which, in the event of a drift in the measurement results, must trigger an investigation and, if necessary, corrections in the centre’s effluents collection and disposal system. ASN has asked IRSN to propose a measurement protocol and provide the centres with a method to use the results to define their own “local” guidance levels, which could figure in the discharge licenses between the centre producing these discharges and the sewage managers. IRSN’s recommendations are expected in 2023. 2.3.3 The radiation protection situation in nuclear medicine The nuclear medicine facilities base in 2022 comprises 244 licensed nuclear medicine departments, of which 45 practice high-activity ITR requiring hospitalisation in an ITR room, 140 practice moderate-activity ITR on an out-patient basis, and 59 only carry out diagnostic examinations. 119 nuclear medicine licenses were delivered during 2022, most of which concerned changes of cameras or license extensions to allow the use of new radionuclides, increases in the activity of radioisotopes already used and licences for performing clinical studies with new RPD (such as actinium-225). ASN inspections in nuclear medicine are scheduled applying a graded approach that takes into account the breakdown of the types of procedures performed in the departments, with risks that differ depending on whether they concern diagnostic or therapeutic procedures. In this context, the inspection frequency is five-yearly for departments that only perform diagnostic examinations, four-yearly for departments performing diagnostic examinations and out-patient therapeutic procedures (delivery of iodine with activities below 800 MBq, synoviortheses, etc.) and three-yearly for the departments performing complex therapies using iodine with delivered activities exceeding 800 MBq, lutetium-177, yttrium-90 (with hospitalisation in a room that may or may not be radiation-proof). Consequently, about a quarter of the French nuclear medicine base is inspected each year, that is to say about 15 of the 45 departments performing complex therapies, 34 of the 140 departments performing diagnostic examinations and out-patient therapies, and 11 of the 59 departments only performing examinations for diagnostic purposes. With regard to the radiation protection risks, the ASN inspections focus on radiation protection of workers (organisation of radiation protection, delimiting restricted areas, ambient dosimetry, staff dosimetry) and patients (analysis of DRL, quality control of medical devices, control of dispensing of RPD) and source management (circuit followed by unsealed sources, from delivery to disposal, such as the delivery reception premises, storage tanks and effluent discharges). In 2022, 79 nuclear medicine departments were inspected, representing 32% of the facilities. 2.3.3.1 Radiation protection of nuclear medicine professionals From the radiological viewpoint, the personnel are subjected to a risk of external exposure – in particular on the fingers – due to the handling of certain radionuclides (case with fluorine-18, iodine-131, gallium-68 or yttrium-90) when preparing and injecting RPD, and a risk of internal exposure through accidental intake of radioactive substances. The results concerning radiation protection of professionals (see Graph 5) show that the radiation protection measures implemented by nuclear medicine departments are generally satisfactory with regard to the appointing of a Radiation Protection Expert-Officer (RPE-O) dedicated to this activity (valid certificate issued by the employer in all the inspected departments), the analysis of the dosimetric results of the medical staff, and the consistency between the delimiting of restricted areas and the results of the working environment verifications. These results remain relatively stable over an observation period allowing the entire nuclear medicine base to be covered (2019‑2022), even if the inspected centres differ from one year to the next. GRAPH Breakdown by ASN regional division of the nuclear medicine facilities, the number of departments with out‑patient therapies and departments with hospitalisation rooms dedicated to internal targeted radiotherapy in 2022 4 0 10 20 30 40 50 Strasbourg Division Paris Division Orléans Division Nantes Division Marseille Division Lyon Division Lille Division Division Dijon Châlons-enChampagne Division Caen Division Bordeaux Division Licensed centres Departments with out-patient therapies Departments with therapies with hospitalisation and ITR rooms ITR rooms ASN Report on the state of nuclear safety and radiation protection in France in 2022 223 • 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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