ASN Report 2022

ASN Assessments – BY ACTIVITY SECTOR – THE MEDICAL SECTOR On the basis of the inspections carried out in 2022 and an analysis of the period 2018-2022 enabling the entire fleet 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 Fluoroscopy-guided Interventional Practices (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 Operating Experience Feedback (OEF) approaches and the preliminary risk assessments remain insufficiently updated ahead of an organisational or technical change, or following OEF from events that have occurred in the profession. In the field 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 both by the workers and the patients are progressing too slowly and the awareness of non-specialists in ionising radiation, such as surgeons, needs to be increased to ensure a clearer perception of the issues and enhance the assimilation of radiation protection measures. Although the fundamentals of quality assurance are today well-established in the radiotherapy departments, they are still being gradually deployed 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 the fact that the training of professionals, management of maintenance work and the implementation of technical barriers controlling the use of medical devices, which constitute the fundamental basis of safety, are areas for improvement 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, FGIPs and computer tomography sectors, following on from the checks carried out in 2022, with particular attention being paid to the weak points identified in 2022, as well as to 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 Committee for the analysis of new techniques and practices using ionising radiation (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 purposes of optimisation and monitoring of exposure from medical imaging among the French population. In radiotherapy, the inspections carried out by ASN in nearly one quarter of the radiotherapy units in 2022, in conjunction with those carried out over the period 2018-2021, enabling the entire fleet to be covered, confirm that the safety fundamentals are in place: organisation of medical physics, equipment verifications, training in the radiation protection of patients, deployment of quality assurance procedures, recording and analysis of events. However, the analysis of the period 2018-2022 confirms that evaluation of the effectiveness of the corrective actions is still the weak point of the OEF approaches and is struggling to become more widely adopted. Although the preliminary risk assessments are inadequately updated ahead of an organisational or technical change or following OEF from events, ASN sees as positive the voluntary development of peer review practices in medical physics, when new equipment is installed. ASN underlines that the buy-outs of centres are situations entailing considerable disruptions that lead to risks if the impact on the working activity of the professionals is not analysed and if these changes are not prepared for with all the teams. ASN also observes that the formalisation of the position qualification procedures, which have been mandatory since August 2021, is being deployed although with differences between the professional categories. Finally, the occurrence of events such as patient identification errors, delineation of organs at risk and/or target organs, and once again calibration, still reveals organisational weaknesses and the need to regularly assess practices. ASN also observes that the lessons learned from past Significant Radiation protection Events (ESR) are forgotten, along with a regular fall in the number of ESR reported to ASN since 2015. Although this can be partly ascribed to safer treatments, a drop in the internal events reporting culture is perceptible with less numerous significant event reports and less detailed analyses. The occurrence of cyberattacks also underlines the new changes faced by radiotherapy professionals at a time of increasing digitisation of data. Finally, the new techniques and practices, which are constantly evolving, are not always sufficiently evaluated to allow an assessment of the long-term radiation induced effects (adaptive radiotherapy, hypofractionation, flash-radiotherapy, etc.). 26 ABSTRACTS – ASN Report on the state of nuclear safety and radiation protection in France in 2022 ASN Assessments