ASN Report 2022

In brachytherapy, the inspections carried out in 2022 in nearly one quarter of the brachytherapy units, in conjunction with those carried out over the period 2018-2021, enabling the entire fleet to be covered, reveals no breach of the radiation protection rules. The radiation protection of the professionals and the management of high-level sealed sources are thus considered to be satisfactory. The training effort for professionals in possession of a high-level source must be maintained and reinforced for certain centres. ASN notes that the new requirements relative to safeguarding access to high-level sources, which fully came into force in 2022, are continuing to be gradually deployed, in particular regarding measures to prevent unauthorised access to these sources. However, some centres are faced with conformity difficulties when this demands significant work. 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. In nuclear medicine, the inspections in 2022, in conjunction with those performed over the period 2018-2021, enabling the entire fleet to be covered, reveal that radiation protection is correctly taken into account in the vast majority of the departments, with improvements observed for those departments inspected in the past two years, in particular for radiation protection of patients. Nonetheless, improvements are required in three fields: effluent management, in order to control discharges into the sewage networks, formalising the coordination of prevention measures with outside contractors (for maintenance, cleaning of premises, intervention by private practitioners, etc.) and radiation protection training of professionals. Similarly, the organisation of medical physics was felt to be inadequate in 20% of the units inspected in 2022, notably with respect to the radiation protection issues associated with the therapeutic treatments; its improvement is an area for progress at a time new therapies based on innovative radiopharmaceuticals are being deployed. The engagement by the nuclear medicine units in the deployment of quality management systems is continuing and ASN notes progress in the formalisation of the procedures for qualifying professionals for the positions. Even if the undesirable events reporting culture is indeed present in most of the units inspected in 2022, it must continue to be developed further. The reported events again reveal that the drug administration process must be regularly evaluated in order to control it, particularly for therapeutic procedures, due to the potentially serious consequences of a drug administration error. In the FGIPs field, the 2022 inspections, in conjunction with those performed over the period 2018-2021, allowing coverage of all the facilities considered to have radiation protection risk implications, reveal the fact that radiation protection makes very little progress from one year to the next, with a situation that is still better in the intervention rooms than in the operating theatres, along with persistent shortcomings. Thus, in most facilities, the premises are slowly being brought into conformity to comply with the technical design rules, even though these modifications are essential in order to prevent the occupational risks. Even if the appointment of radiation protection expertofficers, the marking out of regulated areas, the performance of technical checks and quality controls of medical devices are considered to be satisfactory, deviations from the regulations are still frequently observed, both for radiation protection of the professionals and for that of the patients, with unsatisfactory situations concerning the radiation protection training of workers and patients and the coordination of prevention measures during concomitant activities, in particular with private practitioners. Although the use of medical physicists and formalisation of the medical physics organisation plans appear to be gaining ground, progress must be made in the implementation of the optimisation procedure, particularly in the operating theatres where doses are still insufficiently analysed and inappropriate or non-existent protocols can still be observed. The reporting culture, however, has been spreading in the past four years, with the deployment of events recording systems. The reporting of ESRs underlines that maintenance operations, which can have consequences on the delivered doses, must be correctly supervised and that the training of practitioners in the use of medical devices is crucial for control of the doses. Extensive work to raise the awareness of all the medical, paramedical and administrative professionals in the centres is still necessary to give them a clearer perception of the risks, especially for operating theatre staff. In computed tomography, ASN’s oversight mainly concerns actual implementation of the requirements of its resolution 2019‑DC-660 of 15 January 2019 notably concerning the formalisation of the justification principle, in order to avoid unnecessary doses for the patients, along with qualification of the professionals for the position. During its inspections in 2022, ASN again observed differing deployments of the quality assurance system concerning the traceability of examinations justification in the centres, with practices that are satisfactory in some units and far less so in others. Progress is also required in the formalisation of qualification of the professionals for the position. ABSTRACTS – ASN Report on the state of nuclear safety and radiation protection in France in 2022 27 ASN Assessments