abroad, need to be better taken into account. ASN considers this situation to be unacceptable. At a time of an unprecedented increase in workload, the sector must meet a major challenge in the fight against falsification and counterfeiting, at all levels along the subcontracting chain, involving prevention, detection and dealing with the cases identified. RADIATION PROTECTION CULTURE MUST BE MAINTAINED IN THE MEDICAL SECTOR In 2023, the level of radiation protection in this sector is satisfactory, but prior weaknesses still persist with no notable improvement. For a number of years now, ASN has observed that the radiation protection culture for fluoroscopy-guided interventional practices in the operating theatre has been improving too slowly. In 2023, this led ASN to enforce measures to ensure the compliance of premises and the radiation protection training of personnel. ASN notes the efforts made by the professionals to provide training appropriate to the specific issues of each discipline, which must continue to guarantee that skills further improve and that these issues are correctly understood. In addition, and even if the radiation protection culture appears to be mature, implementation of the quality assurance approach needs to be re-examined and fully taken on board. This is the case in radiotherapy, where an unprecedented number of undesirable target error events occurred in 2023 (wrong-side or positioning errors). ASN recalls the importance of an advance risk assessment, evaluation of the effectiveness of the barriers put in place and consideration of both local and national OEF. In this respect, the principles of a risk assessment methodology were presented in the “Patient safety” bulletin in October 2023. ASN also observes weak signals which, although not directly linked to significant or serious undesirable events, indicate conditions that are prejudicial to radiation protection. By means of inspections and the whistle-blower system, ASN thus notes an increase in reports of internal conflict situations. The “radiation safety culture trait talk” in medicine proposed by the International Atomic Energy Agency (IAEA) include a respectful work environment, that is necessary for effective communication and guaranteeing that all personnel are able to report their concerns, question a decision or organisation and thus exercise their individual responsibility. Furthermore, the lack of resources, shortness of staff and resorting to temporary workers or outside contractors, the rising use of teleradiology, or the sharing of resources, against a backdrop of healthcare authorisation reforms, are leading to new and often complex organisations, which can result in a certain dilution of responsibilities. In the face of these organisational changes, ASN is remaining attentive – whether during oversight activity, inspections or the issue of licenses and authorisations – to compliance with the regulatory obligations. It draws the attention of the decision-makers to the need to evaluate the impact of these changes on the organisation and on the work of individuals and the need for a precise definition of the roles and responsibilities of all players in order to guarantee that the radiation protection culture is maintained and indeed developed. THE PROTECTION OF RADIOACTIVE SOURCES AGAINST MALICIOUS ACTS NEEDS TO BE IMPROVED The protection of radioactive sources against malicious acts was an unregulated subject in France just a few years ago. Increased awareness of this aspect is required on the part of all those concerned. It also requires the adoption of technical, organisational and human measures designed to protect sources of ionising radiation, but also the “sensitive information” concerning them. In addition to these specific means, this above all implies that their potentially malicious use must be considered, which is sometimes hard to reconcile with the culture of establishments that are public access and/or devoted to health care. ASN has been monitoring source security since 2019, and in 2023 it reviewed the results achieved. These results show that the level of competence of the players and implementation of the measures have progressed but remain insufficient. Many challenges are still to be met in order to guarantee the security of sources, in particular when they are being moved, which can then create points of vulnerability at the interfaces. ASN recalls the importance of progress in the security culture, which implies better information, especially in distributing OEF to the users (increased threat awareness, dissemination of event reports, participation in anti-malicious acts networks, etc.). 6 ASN Report on the state of nuclear safety and radiation protection in France in 2023 Editorial by the Commission
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