3. Synthesis and prospects On the basis of the inspections carried out in 2022 and an analysis of the period 2018-2022 enabling the entire base of facilities to be covered, ASN considers that the state of radiation protection in the medical sector is being maintained at a good level, relatively comparable from one year to the next, although with a number of persistent shortcomings. In nuclear medicine and for FGIPs, deviations persist as the years go by in terms of radiation protection training of the professionals and the coordination of prevention measures during concomitant activities, notably during interventions by private practitioners. In radiotherapy, the evaluation of the effectiveness of the corrective measures taken is still the weak point of the ILS approaches and the preliminary risk assessments are still insufficiently updated prior to an organisational or technical change, or after the analysis of events that have occurred in the profession. In the area of FGIPs, and more particularly in the operating theatre, work to bring the premises into conformity with the technical design rules and steps to optimise the doses received by workers and patients alike are progressing too slowly, and raising the awareness of non-specialists in ionising radiation, such as surgeons, remains necessary to ensure a clearer perception of the risks and enhance the assimilation of radiation protection measures. Although the quality assurance fundamentals are today well-established in the radiotherapy departments, they are still being deployed too slowly in the other sectors, in particular concerning the requirements for internal reporting of events and formalisation of the procedures for qualifying professionals for the particular positions. The events reported to ASN underline that the training of professionals, the management of maintenance work and the implementation of technical barriers controlling the use of medical devices, which constitute the fundamental basis of safety, need to be improved in order to make practices safer. ASN also observes that the lessons learned from past event reports are forgotten. In 2023, ASN will continue its inspections in the radiotherapy, nuclear medicine, FGIP and computer tomography sectors, following on from the checks carried out in 2022, paying particular attention to the weak points identified in 2022, as well as to the implementation of the quality assurance obligations. From the regulatory viewpoint, ASN will in 2023 continue revising resolution 2008-DC-0095 of 29 January 2008 setting out the technical rules for the elimination of effluents and waste contaminated by radionuclides. ASN will also continue to contribute to the regulatory work conducted by the Ministry responsible for health concerning the organisation of medical physics and the deployment of clinical audits, which could be a pertinent means of ensuring progress with regard to the justification of procedures. Finally, ASN will maintain its commitment to subjects linked to the spread of new techniques and practices, jointly with the various institutional players in the health sector and the learned societies, while calling on its expert groups, in particular the Canpri, in order to promote and facilitate safe working frameworks and improve the evaluation of long-term radiation induced effects for therapeutic procedures. As part of the 2nd National imaging dose management plan (2018-2022), ASN will aim to encourage all actions to promote implementation of the justification principle, access to the least irradiating imaging techniques and the automated collection and analysis of doses for the purpose of optimising and monitoring exposure from medical imaging in the French population. ASN Report on the state of nuclear safety and radiation protection in France in 2022 235 • 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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