To monitor the practical implementation of this new regulatory framework, a qualitative and quantitative assessment involving all the professions was carried out in 2022. An inventory of the training offerings has been drawn up to identify the main players (health facilities, learned societies, continuous training organisations). For the guide for radiotherapy professionals and the guide for radiographers working in imaging, a specific assessment has been conducted by the Centre of Studies on the Evaluation of Protection in the Nuclear Field (CEPN) at the request of ASN, on the number and content of these two training courses. This assessment focused on compliance with the regulations, the organisation of the training courses, their teaching methods and the level of satisfaction of the professionals who have followed the courses. The first results show that the training guides are broadly followed by the training organisations (whether public or private). This work was presented to the committee that monitors the national plan for controlling imaging doses and to the GPRP (see chapter 2) and will continue in 2024 with, in particular, a presentation of the results to the organisations providing training in patient radiation protection. 1.4 THE RISKS AND OVERSIGHT PRIORITIES In order to establish its oversight priorities, ASN has classified the nuclear-based medical activities according to the risks for the patients, the personnel, the public and the environment. This classification takes particular account of the doses delivered or administered to the patients, individually or collectively, the fitting out of the premises and the conditions of use of sources of ionising radiation by the medical professionals, the production of waste and effluents contaminated by radionuclides, the source security risks (high-activity sealed sources), lessons learned from significant events reported to ASN and the radiation protection situation in the institutions exercising these activities. On the basis of this classification (see point 1.3.3, Table 1), ASN considers that its inspection priorities must focus in priority on external-beam radiotherapy – including radiosurgery, brachytherapy, nuclear medicine and FGIPs. The inspection frequencies, based on an approach graded according to the radiation protection risks (see Table 2), enable all the safetysignificant activities to be inspected over a period of three to five years, depending on the sectors. These frequencies are increased when vulnerabilities that could have an impact on radiation protection are identified (difficulties linked to human resources, technical or organisational changes, quality management or insufficient control of risks – lateness in formalising practises, absence of risk assessments, lack of risk culture, particular risks associated with certain techniques, etc.). This can lead ASN to place certain centres under tightened surveillance, when significant persistent malfunctions have been found, and to inspect them at least annually (see chapter 3). The inspection frequency for FGIPs can be reduced by ASN depending on the knowledge of the radiation protection situation of the facilities, on the basis in particular of the inspections carried out when issuing a registration. As from 2018, ASN defined a list of systematic inspection points concerning the radiation protection of workers, patients and the public, the management of sources, waste and effluents, and the security of sources. These inspections, associated with indicators, enable regional and national assessments to be carried out and the developments to be measured over time. Some indicators are common to all the inspected activities, such as the organisation of worker radiation protection and of medical physics, and training in radiation protection of workers and patients. Others are specific to a given activity, such as the management of waste and effluents in nuclear medicine or the security of sources in brachytherapy. These indicators serve in particular as the basis for assessing the radiation protection situation in the medical sector (see point 2). These systematic checks are complemented by investigations on specific themes defined in an annual or multi-annual framework and adapted to the particular situations encountered in the inspections. The main themes chosen in 2023 were: ∙ in radiotherapy – including radiosurgery, and brachytherapy: risk management, management of skills and training, mastery of the equipment and the security of high-activity sealed sources; ∙ in nuclear medicine: the quality assurance approach, the management of adverse events and the process of specific work tasks training and authorisation; ∙ in FGIPs: implementation of the optimisation approach. Although the RNAs are given advance notice of the majority of routine inspections (see chapter 3), unannounced inspections may be carried out. Two unannounced inspections were carried out in radiotherapy in 2023 (see point 2.1.3). Furthermore, inspections may be carried out in the commissioning context when installing new MDs or for new facilities, and when investigating ESRs. 1.5 SIGNIFICANT RADIATION PROTECTION EVENTS It is mandatory for ASN to be notified of ESRs pursuant to the Public Health code (Articles L. 1333-13, R. 1333-21 and 22) and the Labour Code (Article R. 4451-74 – see chapter 3, point 3.3). In the medical field, ESRs have been reported to ASN since 2007. Reporting these events makes it possible, after analysing them, to give feedback to the medical professionals with a view to continuous improvement of radiation protection. An on-line services portal has been provided at teleservices.asn.fr to enable all the medical professionals to file their reports on line. This portal is integrated in the adverse public health events TABLE Inspection frequency by nuclear-based medical activity NUCLEAR-BASED MEDICAL ACTIVITY ROUTINE FREQUENCY External-beam radiotherapy Every 4 years Brachytherapy Every 4 years Diagnostic nuclear medicine Every 5 years Therapeutic nuclear medicine on out-patient basis (e.g. iodine < 800 megabecquerels (MBq), synoviortheses, etc.) Every 4 years Therapeutic nuclear medicine with complex therapies using iodine > 800 MBq, lutetium-177, yttrium-90 and hospitalisation Every 3 years Fluoroscopy-guided interventional practices Every 5 years Computed tomography (emergencies or paediatrics with radiation protection risks) Sampling: about twenty facilities per year 2 ASN Report on the state of nuclear safety and radiation protection in France in 2023 211 • 07 • Medical uses of ionising radiation 07 05 15 08 11 04 14 06 13 AP 03 10 02 09 12 01
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