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Home All issues Volume 60 / No 1 (January-March 2025) Radioprotection, 60 1 (2025) 76-83 Full HTML
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Radioprotection
Volume 60, Number 1, January-March 2025
Page(s) 76 - 83
DOI https://doi.org/10.1051/radiopro/2024041
Published online 14 March 2025

© G. Taino et al., Published by EDP Sciences, 2025

Licence Creative CommonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1 Introduction

Radon (Rn) is a noble gas, inert, odorless, tasteless and colorless at standard temperature and pressure. Radon is produced by the radioactive decay of Radium 226 (226Ra), in turn produced by radioactive decay of Uranium 238 (238U), found in ores such as lave, tables, granites and pozzolane. 222Rn’s half-life is 3.8 days, decaying into radioactive daughters. Especially worth of note are two unstable isotopes of Polonium (218Po and 214Po) which, being electrically charged may react with particulate pollution and, once inhaled, reach the lower respiratory tract. Polonium isotopes alpha decay and are the culprit of cellular damage. Other daughters are unstable, beta-decaying, isotopes of lead and bismuth and are less harmful. Alpha particles are Helium nuclei and being both highly charged and heavy have a very short mean free path. Because of this they can reach only the most superficial layer of the skin and therefore are of lesser concern in case of external exposure, but become a major hazard in case of internal contamination (such as from skin injuries, ingestion or inhalation) (Bochicchio et al., 2005; Darby et al., 2005; Krewski et al., 2005; UNSCEAR, 2006).

Epidemiological surveys showed a strong link to lung cancer and on the basis of these results Radon was acknowledged as carcinogen in Group I (sufficient evidence of carcinogenicity in humans) according to International Agency for the Research on Cancer (IARC) (IARC 1988); therefore, further epidemiological studies were designed to investigate home exposure.

The main results are the following:

  • incidence of lung cancer is directly related to Radon concentration;

  • risk of lung cancer increases proportionally to the length of exposure;

  • the risk increase mirrors the “usual” epidemiology for lung cancer, with lower incidence up the age of 45 years, and increasing incidence up the 65;

  • being equal Radon concentration and exposure length, the risk for lung cancer is much higher among smokers (approximately 25 times related risk among those smoking 1pack/day vs. not smokers) (Darby et al., 2005); this demonstrates that Radon is especially dangerous for smokers.

Epidemiological studies performed in 11 European Countries including Italy showed how, with 30-years long exposure, the risk for lung cancer is increased by 16% every 100 Bq/m3 and doubles at 600 Bq/m3. The overwhelming majority of Italian population is exposed to average mean Radon concentration below 100 Bq/m3, 4% is exposed to an average mean concentration higher than 200 Bq/m3 and 1% to concentration above 400 Bq/m3 (Darby S et al., 2005).

According to the Italian Higher Institute of Health (Istituto Superiore di Sanità, ISS), among the 31000 yearly cases of lung cancer, between 1000 and 5500 may be attributed to exposure to Radon, especially among smokers (Epicentro, ISS).

Requirements for exposure to Radon in the workplace are governed by Italian Legislative Decree 101/2020, transposition of Directive 59/2013/ Euratom in accordance with the recommendations of The International commission on radiological protection (ICRP) 103 (ICRP, 2007) This legal framework identifies the “reference level” as an operational tool for radiation protection. This, for the Radon, is defined as the concentration of activity in the air, to be considered as a value above which it is not appropriate for exposure to occur. However, it is not an “hard limit” and protective interventions must also be adopted below this level; therefore, it is no longer to be understood as a “threshold”. This reference level understood as the average annual concentration of Radon is set at 300 Bq/m3 (EU Directive 59/2013/ Euratom and Legislative Decree 101/2020) in the living and working places. For houses built after 31/12/2024 a lower limit will be applied, equal to 200 Bq/m3.

The first assessment of the average annual concentration of Radon activity at the workplace must be carried out within 24 months from the start of the activity or from the definition of the areas at risk or from the identification of specific types in the National Plan. The employer must also assess the risk of exposure to Radon in cases where there are workers who remain in underground or semi-underground environments (at least three walls bordering the ground) for at least 10 hours a month. The rules relating to protection from Radon in the workplace apply to work activities carried out in underground environments, in spas, in basement workplaces and on the ground floor if located in priority areas (Italian Law, D. L. 101/2020). The document that is drawn up following the assessment is an integral part of the Risk Assessment Document (Italian Law, D. L. 81/2008). The timing of the measures is defined in advance: every time structural interventions are made at the level of ground connection, or thermal insulation; every 8 years, if the concentration value is less than 300 Bq/m3.

If the reference level of 300 Bq/m3 is exceeded, corrective measures must be taken within two years to lower the level below the reference value. The effectiveness of the measures is evaluated through a new assessment of the concentration. In particular: following a positive result (less than 300 Bq/m3, which means a good result as the Radon levels found are sufficiently low) the measurements are repeated every 4 years; if the concentration is still higher, it is necessary to evaluate the annual effective doses through a radiation protection expert who issues a specific report. The "reference level" in this case is 6 mSv per year, according to the conversion factor for Radon updated according to the ICRP137 recommendation (ICRP, 2017).

If the result of the assessments is lower than the maximum reference levels, the employer must keep the effective doses or exposures of workers under control; furthermore, they are required to keep the results of the evaluations for at least 10 years.

If the results of the assessments are instead higher than the maximum reference limits, the employer must adopt the measures provided for by title XI of Legislative Decree 101/20, in particular appointing the “Medico Autorizzato” (according to Italian law, a physician especially trained in the matter of radioprotection and registered to the Ministry of Labour after passing the required examination; such figure is the only allowed to carry out medical surveillance of the exposed to ionizing radiation) for health surveillance (as indicated by the Directorate-General Environment, Nuclear Safety and Civil Protection of the European Commission, Radiation Protection 112, 1999).

2 Overview of risks factors and health surveillance

The health surveillance of workers exposed to Radon is aimed at the prevention and early diagnosis of lung cancer.

In fact, the 5-year survival of lung cancer patients in Italy is 16%, while the 10-year survival is 12%, negatively affected by the large proportion of patients diagnosed at an advanced stage. Diagnosis of lung cancer at an early stage offers the real possibility of reducing mortality through new treatments.

3 Identification of factors associated with the development of lung cancer

The main risk factor for lung cancer is cigarette smoking, which accounts for 85–90% of all cases. The relative risk increases about 14 times in smokers and up to 20 times in heavy smokers (Crispo et al., 2004; Alberg et al., 2005).

Several studies show that passive smokers have an increased risk of developing lung cancer between 20 and 50% compared to non-smokers (Zhong et al., 2000; Taylor et al., 2007).

Environmental factors, such as exposure to atmospheric particulate matter and pollution, has been classified by the IARC as a human carcinogen. An increased risk of lung cancer in association with increased concentrations of fine particles was identified in the AHSMOG-2 study (Gharibvand et al., 2017).

In the ESCAPE study a 55% increase in the risk of developing lung adenocarcinoma by fine particles (Particulate matter air pollution) was found (Raaschou-Nielsen et al., 2013).

Among lung cancer’s risk factors there is occupational exposure to toxic substances, such as Radon and asbestos, and heavy metals (chromium, cadmium, arsenic, etc.).

The marginal role of genetic predisposition has been highlighted in recent years, especially as regards genetic polymorphisms (Yokota et al., 2010).

Among lung cancer’s risk factors: chronic inflammatory processes, such as tuberculosis.

While tobacco smoke is the main risk factor for lung cancer, exposure to Radon is the first cause in non-smokers, and retains the second place in smokers where it is shown to have synergistic behavior (Lorenzo-González et al., 2019). Despite this, residential Radon exposure is very often underestimated and usually no risk score for lung cancer includes Radon among the variables under study (Lorenzo-González et al., 2019).

4 Effectiveness of low-dose spiral chest CT in the diagnosis of lung cancer

The results of the American National Lung Screening Trial (NLST) highlighted the favorable prospects for the identification of lung cancer through the use of low-dose chest CT (LDCT) in screening; despite so, the cost-benefit profile of lung cancer screening to date is still a subject of debate in the scientific community (Aberle et al., 2011). The LDCT allows to obtain highly detailed 3D images to identify small tumors a few millimeters wide, with a low exposure to radiation. However, this also highlighted a large amount of indeterminate pulmonary nodules (IPN), 96% of these being benign in nature and the study failed to show a significant decrease in lung cancer mortality.

The most important studies relating to the use of spiral chest CT in the early diagnosis of lung cancer are collected below (see Table 1).

In all of these studies a significant increase in lung tumors diagnosed at an early stage, therefore surgically treatable, was shown, both compared to studies with chest X-ray and compared to clinical experience. Although CT revealed preclinical tumors, no reduction in lung cancer-specific mortality was observed. On the contrary, the number of false positives was high, with the percentage of surgically treated non-malignant nodules reaching almost 50%. For these reasons, aspects related to the morbidity and cost-benefit ratio of LDCT screening have been considered more in subsequent studies.

In a major randomized controlled trial published by Bach et al. on JAMA, 2007, over 3,000 smokers were recruited and followed up at the National Cancer Institute in Milan and two other US research centers (Bach et al., 2007). After 5 years, 144 tumors were diagnosed with low-dose computed tomography (LDCT) scan (annual screening) (Bach et al., 2007), instead of the 44 expected with the mathematical model, and 109 lung resections were performed instead of the 11 expected. Early diagnosis therefore appears to work and has increased operable tumors by 90%. As regards advanced-stage cancers, however, screening did not significantly increase the number of diagnoses: from the 33 expected cases, 42 were diagnosed. Furthermore, the mortality data failed to confirm the preventive efficacy of lung screening with LDCT: the deaths expected after 5 years were 38.8, against the 38 actually found.

The same study showed however that the survival of patients undergoing resection for stage I lung cancer diagnosed with spiral CT was high. At 5 years, the mortality observed in the subjects of the study mirrored that expected for non-screened smokers. It can therefore be deduced that radiological screening ensures earlier diagnosis, but fails to change the natural history of the disease, as it seems that at only less aggressive, slow-growing tumors can be diagnosed, and not the more aggressive histotypes, more prone to metastases.

The National Lung Screening Trial (NLST) was the largest study designed to verify whether, in a randomized clinical trial, LCDT screening compared with chest X-ray screening can reduce specific mortality from lung cancer. Conducted between 2002 and 2010, it enrolled 53,454 high-risk individuals, divided into 2 groups, patients undergoing annual control through chest x-ray and Patients undergoing spiral CT annually. With the use of LDCT, a reduction in mortality of 20% was observed compared to screening conducted with chest X-ray but, at the same time, a rate of false positives of 96.4% was described, with an overdiagnosis of 78.9% for bronchoalveolar lung tumors.

In general, in most of the studies that have been conducted, regardless of the increase in the diagnosis and treatment rate of lung cancer during screening, no significant reduction in lung cancer-specific mortality was observed. Furthermore, although the excellent survival of patients with early-stage lung cancer in some studies (particularly in the NLST study) is a strong argument for the LDCT screening, it should be able to intercept the most aggressive forms of cancer, those with the greatest impact on mortality and limiting false positive cases, to be considered useful and effective.

The researchers showed also that 18% of patients with lung cancer detected through LDCT, 22% of patients with non-small cell lung cancer (non-small cell lung cancer, NSCLC) and up to 78.9% of patients initially diagnosed with bronchioalveolar carcinoma were overdiagnosed, leading to further examinations with a significant percentage of comorbidities (1.4% in the LDCT group and 1.6% in the chest x-ray group), such as hemothorax, lung collapse, and psychosocial consequences, therefore casting shadows on the cost-effectiveness of LDCT screening (Patz et al., 2014).

Table 1

Low-dose spiral chest CT scan (LDCT) studies

5 Biomarkers in the diagnosis of lung cancer

In view of the high sensitivity of LDCT, capable of identifying a non-calcific pulmonary nodule in one out of two tested subjects, the need to identify suspicious nodules more accurately has arisen. Many studies have considered blood biomarkers for early diagnosis: such markers should be able to distinguish aggressive from indolent disease to have a significant impact on mortality and lead to a change in treatments.

Research has focused on organ and tissue specific markers, such as microRNAs (miRNAs). MiRNAs are short sequences of non-coding RNA that regulate gene expression by linking to specific sequences of messenger RNA (mRNA), degrading it and inhibiting its translation. They could be ideal candidates in early-stage cancer screening, because by acting as extracellular messengers of biological signals deriving from the communication between the tumor and its surrounding microenvironment, they allow the identification of early changes relating to the biological reactivity of the host (Uso et al., 2014).

The use of these non-invasive tests, such as those based on miRNA, could help reduce the number of false positives of LDCT. The results of the bioMILD study showed that the combination of miRNA signature classifer (MSC) and LDCT reduced the false positive rate identified by the LDCT from 19.4% to 3.7% and that the risk groups identified by the MSC were found to be significantly associated with shorter survival. Furthermore, the MSC showed a high sensitivity (87%) and specificity (81%) and a negative predictive value of 99% (Sozzi et al., 2014).

A systematic review was published in 2018 on the studies carried out between 2000 and 2015 about biomarkers in the diagnosis of lung cancer. (Chu et al., 2018):

Out of a total of 99 studies examined, only 3 were included, all phase 3 studies. The other studies did not meet the inclusion criteria.

The first study (Jett et al., 2014) evaluated the use and diagnostic performance of the Early CDT Lung ELISA test in 1613 patients in 48 different states. The positivity of the test included any antigen titration that had a dose response and one or more of these 7 autoantibodies: P53, NY-ESO-1, CAGE, GBU4-5, SOX2, HuD, MAGE A4. The patients were then followed up for a period of 6 months and then the clinician decided whether to make the diagnosis of neoplasm. Limitations of this study include unclear eligibility criteria, unclear diagnosis and cancer staging criteria.

The second study (Sozzi et al., 2014) evaluated the diagnostic performance of the MSC test in 1000 plasma samples from 4099 patients enrolled in the Multicenter Italian Lung Detection (MILD) Trial. These were smokers or former smokers ≥ 50 years of age with no history of cancer. Patients were followed up for 5 years. The limitations of this study are the lack of criteria in determining the size of the sample and the lack of identification of other pathologies and of alternative diagnoses to lung cancer.

The third study (Montani et al., 2015) evaluated the diagnostic relevance of the miR-test in a group of 1008 patients enrolled in the COSMOS study (Continuous Observation of Smoking Subjects) and in patients with diagnostic lung cancer outside the study (subjects >50 years, smoking history >20 pack years). The limitations of this study lie in the lack of available clinical information, the lack of sample determination criteria and the lack of other diagnoses of lung diseases.

All three groups of biomarkers studied showed a good diagnostic performance in the early diagnosis of lung cancer. The MSC test (24 mRNA Classifier) is currently the best tool in terms of specificity, sensitivity and likelihood ratio. Its effectiveness is greater when combined with LDCT.

This leads to the concrete hypothesis that these biomarkers can be used complementarily to imaging in the cancer screening process. The limitations of these methods lie in the lack of data and scientific evidence, which are being sought through prospective phase 4 studies, which are still in progress.

Another review conducted by Gasparri et al. (2018), looking at articles from 1976 to date regarding biomarkers in the diagnosis of lung cancer, have been examined with the aim of identifying a substance produced specifically by the tumor and easily found in the urine or blood. The following biomakers emerged from the analysis of the review.

  • miRNA: fluctuations in circulating miRNA levels are associated with various malignant and non-malignant diseases including lung neoplasms. In 2015 Wang et al. (2015) identified a set of 5 miRNAs associated with the presence of cancer in a cohort of affected patients and healthy controls. Bianchi et al. (2011) analyzed 174 serum samples from patients in the COSMOS study where they identified 34 miRNAs, then reduced to 13, which can be used in early diagnosis in asymptomatic individuals, with a specificity of 80%. The advantages of using miRNAs are in the ease of sample collection and in its high stability. It is also possible to classify patients in different histological subtypes and in different disease stages. Studies are currently moving towards the development of a standardization of sample collection, identification and analysis procedures.

  • VOLATILE ORGANIC COMPOUND (VOC). They are easily found by analyzing the exhaled air. They can be divided into different classes: saturated (ethane, pentane, aldehydes) and unsaturated (isoprene) hydrocarbons, compounds containing oxygen (acetone), sulfur (ethyl-mercaptan, dimethyl-sulfur) and nitrogen (dimethylamine, ammonium). The most commonly used are isoprene, acetone, ethanol, methanol and other alcohols and alkanes. These may be related to oxidative stress, the Warng effect and genetic mutations associated with the development and progression of neoplastic pathology.

Phillips et al., about 20 years ago (Phillips et al., 1999), identified a possible correlation between exhaled compounds and the presence of neoplasia, analyzing 108 subjects. In a subsequent study in 2008 (Phillips et al., 2008) they collected samples of exhaled air from 193 subjects with neoplasia and 211 healthy controls, highlighting the presence of neoplasia with a specificity of 81% and a sensitivity of 84.5%, with a model of 30 VOCs. The limitation of this method is the need of a mass spectrometer capable of gas chromatography, a complex, time consuming, and expensive assessment. For this reason, the researchers focused on new, more sensitive and economical methods, such as the use of electronic sensors similar to those used in the food industry, called “artificial noses”. Gasparri et al. (2016) conducted a study, with an electronic nose with a quartz microbalance, on 146 patients (70 with neoplasia and 76 healthy controls). The pattern of patients with cancer was differentiated from that of healthy controls, with a specificity of 91% and a sensitivity of 81%. Peled et al. (2012) instead evaluated the combination of spectrography and electronic nose in 53 patients with neoplasia and 12 with benign pulmonary nodules. The spectrography showed higher concentrations of 1-octene in patients with cancer and the electronic nose could distinguish benign from malignant nodules with a specificity of 96% and a sensitivity of 86%.

AUTOANTIBODIES. Seven autoantibodies were identified from Chapman’s group (Chapman et al., 2012) that were 90% specific for lung cancer, but with a sensitivity of 40%. Bigbee and colleagues instead identified a pattern of 10 serum biomarkers (Bigbee et al., 2012), used to identify subjects with neoplasia, with a specificity of 76.2% and a sensitivity of 77.1%.

URINE ANALYSIS. In 2010 Carrola et al. (2011) examined urinary metabolites (hippuric acid, trigonellin and hydroxyisovalerate, hydroxy-isobutyrate, aceyl-glutamine and creatinine), to identify individuals affected by neoplasia. Haznadar et al. (2016) analyzed, by mass spectrometry, 178 urine samples from affected individuals and 351 from healthy controls, identifying an association between the development of the disease and the elevated levels of creatine-riboside. More recently, Park et al. (2017) evaluated the association with urinary nicotinic equivalents and CYP2A6 activity (ratio between 3’ hydroxycotinine and urinary cotinine).

6 Discussion

Lung cancer is still a disease with a high mortality rate responsible, worldwide, for about one in five deaths due to cancer. Among the main causes of lung cancer have been identified air pollution and smog, exposure to toxic agents of industrial origin and, above all, smoking. Many substances of occupational origin are recognized as pulmonary carginogens. An important role is played by Radon, present in homes and workplaces. This noble gas is the second leading cause of lung cancer after cigarette smoking, accounting for 10-20% of lung cancer cases in Western countries and causing about 3,000 deaths per year in Italy. The carcinogenic potential of Radon increases about 25 times in smokers (WHO Handbook on Indoor Radon, 2009).

Since the therapeutic failure of lung cancer is mostly caused by the presence of metastatic disease at the time of diagnosis, it is therefore of fundamental importance to identify the disease at the early stages.

At present, however, screening strategies are proposed only in populations at high risk of developing the disease, as it is difficult to find a single very sensitive and highly specific biomarker. This situation implies that healthy subjects are subjected to CT only after the onset of symptoms, leading to often late diagnosis, without a survival benefit.

Currently, the use of biomarkers (miRNA, MSC) associated with CT and LDCT for early diagnosis and even more so for primary prevention seems promising.

An optimization in the future of these tools and the cost-benefit ratio will open their use in early diagnosis, as well as also in the health surveillance of those exposed to Radon. The challenge for the future will be to use biomarkers in clinical practice in an efficient and practical way, as well as to develop markers capable of detecting tumors at a preclinical stage of the disease, regardless of their aggressiveness. Anticipating the clinical diagnosis by one or two years could in fact significantly change the tumor burden and improve the effectiveness of systemic therapies and the chances of recovery.

The objective in the future will then be to replace the use of imaging (CT, HRCT) with these biomarkers (also in the context of health surveillance), according to the screening concept which involves: safety of the method; acceptability by the population (compliance); possibility of modifying the course of the pathology; sustainable costs for the community; high reliability (sensitivity and specificity) also minimizing the effects of ionizing radiation administered with HRCT (even more with CT) (Bertho and Habib, 2023) according to the principles of justification and optimization which establish, respectively, that “the exposure of the individual and the population to additional doses of radiation is justifiable only if the benefits deriving from the practices that generate the additional doses are greater than the set of statistically foreseeable negative effects” and “that, if justified, the exposure of the population must be kept at the lowest level reasonably achievable (ALARA principle = As Low As Reasonably Achievable) also taking into account economic and social factors”(ICRP, 2007).

An important theme to consider is whether it is always justified, in terms of radiation protection, to expose “healthy” people to radiations, even if for primary prevention and health surveillance in a population at risk of cancer. It is therefore necessary to carry out a risk-benefit assessment to protect the worker as much as possible. If we consider a population of selected workers at risk of developing a neoplasm (for example in this case lung cancer), it may be justified to subject them to radiological examinations to monitor their conditions. Even more so, it would be optimal to use biomarkers for monitoring that potentially have the same degree of sensitivity and specificity as CT and HRCT without the use of ionizing radiation.

Taking into account the analysis of the Literature and the options currently available regarding the prevention/early diagnosis of lung cancer, in the context of the health surveillance of occupationally exposed workers provided for by Legislative Decree 81/08 and by the recent Legislative Decree 101/20, the Medico Autorizzato has to pay special attention to the risk assessment phase and has to identify adequate and effective preventive measures for exposure to risk (which are often also of an organizational nature) before selecting and adopting health protocols that consequently provide specific clinical indications, instrumental assessments and tests on the worker, in particular if linked to new methods such as biomarkers, tests that are difficult to manage and justify due to the results still uncertain about their preventive effectiveness.

The Medico Autorizzato must also contribute in a comprehensive and technical way, together with the Employer, the Expert in Radon remediation interventions and other technical prevention figures, in the correct management of the risk with the aim of protecting the workers’ health.

7 Conclusions

According to the recent Legislative Decree 101/20 when the exposure levels are stably above the 300 Bq/m3 threshold and the appointment of the Radiation Protection Expert and the Authorized Doctor becomes mandatory, some consequential evaluative interventions are necessary.

The first preventive phase (but with important health implications regarding the criteria for clinical or instrumental protocols) is to propose and set up, resorting to Bodies and experts in the sector, a careful and accurate measurement of the effective dose for workers exposed in the specific workplace, according to the procedures established by the legislation and the current technical standards.

The second preventive step requires evaluating the real exposure of workers with respect to the reference level of 6 mSv/year of effective dose which represents the threshold above which it is necessary to carry out technical interventions to reduce the level of exposure. However, the technical possibilities of risk containment are often not possible or applicable (e.g. Tourist guides or security personnel who work in natural caves or speleological museums for most of the shift). In many cases preventive intervention, which often requires the important contribution of the Medico Autorizzato as a global health counselor, can be exclusively or mainly organizational, for example through a reduction in working time in environments with significant exposure risk, which often allows a significant reduction of the risk down to acceptable levels (as an effective dose below 6 mSv/year). This second preventive/sanitary step is the most important one and has to be studied and optimized using every available and possible technical and organizational strategy, often beyond what may emerge after the first approach to the expositional context.

The principle of optimization is also based on this and, more generally, the application of the fundamental principles of radiation protection (i.e. justification and optimization) which must be assessed by the Competent Doctor in the context of health surveillance.

In the regulatory context this falls under the art. 156, Scope The title on medical exposures, which concerns: patients in the context of their respective medical diagnosis or treatment; people in the context of health surveillance; people involved in health screening programs; asymptomatic subjects and patients who voluntarily participate in medical or biomedical research programs in the diagnostic or therapeutic field; people in the context of procedures for non-medical purposes conducted with medical-radiological equipment.

Only in the (few) cases in which each technical and organizational measures are not able to guarantee adequate protection of worker, the intervention of the Medico Autorizzato will be necessary to assess the surveillance and screening criteria of the working population’s susceptibility to Radon risk. Smokers and/or workers with higher seniority could be subjected, for example, to targeted and evidence-based screening programs for lung.

These assessments, in relation to the clinical and instrumental strategies proposed and agreed on the basis of literature data, may be included in the Health Protocol drawn up by Medico Autorizzato or introduced and justified as health promotion interventions.

The medical (and medico-legal) issue remains to this day very complex and constantly evolving. Only when some of the oncological screening tools for lung cancer will demonstrate sufficient predictivity it will be possible to have available clinical and instrumental protocols applicable also in the health surveillance of subjects occupationally exposed to Radon.

Funding

This research did not receive any specific funding.

Conflicts of interest

The authors declare that they have no conflict of interest.

Data availability statement

The research data associated with this article are included within the article.

Author contribution statement

G. Taino: Conceptualization and Methodology; G. Taino, F. Solazzo: Writing original draft; A. Delogu, R. Pintucci, L. Semborowski, A. Osuchowski: Visualization, Investigation. G. Taino, A. Delogu, E. Oddone: Supervision; G. Taino, A. Delogu, E. Oddone, F. Solazzo: Writing-Reviewing and Editing.

Ethics approval

Ethical approval was not required.

Informed consent

This article does not contain any studies involving human subjects.

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Cite this article as: Taino G, Delogu A, Pintucci R, Semborowski L, Oddone E, Osuchowski A, Solazzo F. 2025. Medical surveillance of workers exposed to radon: new perspectives in lung cancer prevention. Radioprotection 60(1): 76–83. https://doi.org/10.1051/radiopro/2024041

All Tables

Table 1

Low-dose spiral chest CT scan (LDCT) studies

In the text

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