G. Taino et al.: Radioprotection 2025, 60( 1), 76 – 83 81
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 / m 3 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 evidencebased 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.
References
Aberle DR, Adams AM, et al. 2011. National lung screening trial research team. reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365: 395 – 409.