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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
The approach of the Italian Na1onal Radon Ac1on Plan
for preven1on in new buildings
and mi1ga1on in exis1ng buildings
and considera1on on the forthcoming
new European Direc1ve on Basic Safety Standards
Francesco Bochicchio
(Italian Na*onal Ins*tute of Health)
on behalf of the Working Group of
the Italian Na9onal Radon Ac9on Plan
on Preven9ve Measures and Remedial Ac9ons against Indoor Radon
Radon protec8on conference
New challenges for the European construc8on
and ven8la8on branches of Europe
Dresden (Sachsen, Germany)
December 2
nd
–3
rd
2013

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Introduc1on
The
Italian Na*onal Radon Ac*on Plan (INRAP)
was prepared in
2002 by an working group of several experts (physicists, medical
doctors, architects) and approved by the Ministry of Health.
Its implementa*on started on 2005 and later on it evolved taking
into account results of
epidemiological studies
and recent
interna*onal recommenda*ons and regula*ons

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Cases Controls RR (95% CI) 100 Bq/m
3
2 Chinese studies (2004)
1028
1974
1.13 (
1.01
–1.36)
only complete (25y) Rn meas.
464
1.32 (
1.09
–1.88)
13 European studies (2004-5)
7148 14208
1.08 (
1.03
–1.16)
corrected for Rn exp. uncertainty 7148
14208
1.16
(
1.05
–1.31)
7 North-American studies (2005) 4081
5281
1.11 (1.00–1.28)
only complete (25y) Rn meas.
1621
2323
1.21 (
1.03
–1.50)
Important results from epidemiological studies
Pooled analysis of residen1al epi studies

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Important results from epidemiological studies
Pooled analysis of European epi studies
!

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
• Results are
homogenous
across studies
• Strong synergism
between
radon
and
cigarePe smoking
=> smokers have similar
rela8ve
risk
but much greater
absolute
risk
The increase of the lung cancer risk is
sta*s*cally significant
also selec*ng subjects exposed
up to 200 Bq/m
3
RR 100–200 Bq/m
3
vs <100 Bq/m
3
= 1.2 (1.03–1.30)
• Non linear models and models with
threshold do not improve
the fit goodness
, compared with linear model with no
threshold
150 Bq/m
3
upper bound
(95% CL) for a threshold
Important results from epidemiological studies
Results of European pooled analysis

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Important results from epidemiological studies
Interac1on of Rn and cigareCe smoking
• Most residen*al case ­controls studies show very similar
rela*ve
risk for current smokers, ex ­smokers and never ­smokers
(i.e. ~mul*plica*ve interac*on between radon and smoking)
(from Darby et
al, 2006)

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Recent epidemiological studies on miners are
characterized by
low radon exposures and concentra*ons
Important results from epidemiological studies
Recent epi studies on miners

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Methods
Cohort studies, ~ 10,000 miners, 574 lung cancers (87% excess)
Low exposures and low exposure rates
(i.e. low concentra*ons)
Good evalua*on of the exposure
Results
Life1me risk ~ 2 1mes higher
than ICRP ­65 (1993)
Risk decreases with *me since exposure and age
No inverse dose rate effect for concentra*ons < 4 WL
Important results from epidemiological studies
Recent results of miner epi studies

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
New risk/dose evalua1on from ICRP
ICRP ­115 (2010):
30 Bq/m
3
=> 1 mSv/y
ICRP ­65 (1993):
60 Bq/m
3
=> 1 mSv/y

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
• Due to the log ­normal shape of radon distribu*on,
most of lung
cancers aPributed to radon are related to exposure levels
up to
~200 Bq/m
3
, i.e. below most Ac*on/Reference Levels (ALs/RLs),
but
where the increase of the risk is s*ll sta*s*cally significant
ac1on/reference levels should be reduced in order
to significantly reduce the number of lung cancers
NRPs (Na1onal Radon Plans) should include plan
for some
ac1ons in a much higher number of
dwellings
than with present ALs/RLs
Important results from epidemiological studies
Implica1ons on regula1ons and NRP

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
• For the same radon exposure level, individual
excess absolute risk
(EAR) for smokers is ~25 *mes
the individual excess absolute risk
for
never smokers
e.g. age 75 y, 200 Bq/m
3
: EAR = 1.3 x 10
­3
(NS)
EAR =32 x 10
­3
(S)
– Although most of the popula*on is non ­smoker,
most of lung
cancers aPributed to radon
are
actually due to the
synergism
between
radon and cigarePe smoking
– Therefore,
NRPs should be connected with programs on cigarePe
smoking reduc*on
– Moreover,
specific ac*ons addressed to smokers would be very
effec*ve
to reduce lung cancer risk from radon
Important results from epidemiological studies
Implica1ons on regula1ons and NRP (2)

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Recent and forthcoming recommenda1ons and regula1ons
WHO Handbook on Indoor Radon (2009)
A Public Health Perspec1ve
Structure
Introduc1on
1.
Health Effects of Radon
2.
Radon Measurements
3.
Preven1on and Mi1ga1on
4.
Cost ­Effec1veness
5.
Radon Risk Communica1on
6.
Na1onal Radon Programmes
5 key messages for each chapter

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
European project “RADPAR”
The
RADPAR (Radon Preven*on and Remedia*on)
was an
European project funded by the Execu*ve Agency for Health and
Consumers (EAHC) of the EU Directorate General SANCO, and
carried out in 2009–2012, in the framework of the Health
Programme 2008–2013.
11 associated
partner ins*tu*ons from
10
European countries
(Greece, Germany, UK,
France, Italy, Austria, Norway, Finland,
Belgium, Czech Rep.)
7 collabora*ng
partners from
6 countries
(Switzerland, UK, Finland, Spain, Portugal
Ireland) and
1 Int. Organiza*on
(WHO)
RADPAR logo

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
RADPAR Recommenda1ons
A number of documents were produced within RADPAR, some of
which can be downloaded from
hCp://web.jrc.ec.europa.eu/radpar/documents.cfm
A major document is a booklet of
detailed (and quite comprehensive)
recommenda*ons:
The RADPAR Recommenda1ons

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
The RADPAR recommenda1ons: seven sec1ons
1. Recommenda1ons on
radon policy and strategy
2. Recommenda*ons on
protocols
for indoor radon concentra*on
measurements
3. Recommenda*ons to improve radon
risk communica*on
4. Assessment of poten*al
conflicts
between
energy conserva*on
in buildings and radon exposure reduc*on
5. Establishment of measurement
protocols for radon control
technologies
6. Design of
training courses
for radon measurement, preven*on,
remedia*on
7. Recommenda*ons on analysis of
cost effec*veness
and health
benefits of radon control strategies

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
The INRAP approach for preven1ve
measures in new buildings (1)
Preven*ve measures
are recommended in
ALL the new
buildings
(and for
renova*ons
involving the lowest floor)
standard (=> less expensive) methods
problems of area or site classifica*on are avoided
Scope: reduce the ingress of radon
from soil
and
provision for post ­construc*on systems
to facilitate a
further reduc*on of radon concentra*on, if necessary
The final goal is to
reduce both the global burden
and individual (high) risks

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
The INRAP approach for preven1ve
measures in new buildings (2)
Main components of preven1ve measures
1. a membrane to
reduce passively
radon ingress
2. a
passive ven*la*on system
installed in the crawl
space (if it is present) or in the sub ­soil
a
fan can be applied
, if necessary,
amer construc*on
In any case,
simple modifica*ons of usual construc*on
methods
are recommended
to avoid the need of significant specific training on radon
to be
applicable to a high number of buildings

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
The INRAP approach for mi1ga1on
in exis1ng buildings (1)
Present regula*on in Italy deal with
workplaces only
,
with ac*on level =
500
Bq/m
3
=> a rela*vely
low number of buildings
is expected to
require mi*ga*on/remedia*on
Transposi*on of the forthcoming EU direc*ve, with
reference level ≤
300
Bq/m
3
in both
workplaces and
dwellings
=>
a much higher number of buildings
is expected to
require mi*ga*on

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
The INRAP approach for mi1ga1on
in exis1ng buildings (2)
=> a
network of local building professionals trained and
qualified in radon mi*ga*on
is needed
However, this could be difficult
=> “
normal” building professionals
(i.e. with no specific
training or qualifica*on in radon mi*ga*on)
could also be
involved for radon remedial ac*ons
, provided that they
receive clear and opera*ve instruc*ons from professionals
qualified in radon mi*ga*on or can find such instruc*ons
in technical guides.

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Some considera1ons regarding the
forthcoming European Direc1ve (1)
Direc*ve sets the
minimum protec*on level
and it is flexible.
More protec*ve levels/tools are permiPed.
In transposing EU direc*ve and serng up Na*onal Ac*on Plans
we should try to learn from (and adapt) the previous experience
of other countries
We need to
develop (and use) guidelines
(e.g. WHO, IAEA,
RADPAR, ecc.)
In many EU Countries a recommendatory approach appears not
to be very effec*ve: a
compulsory approach
could be more
effec*ve and could be easily applied in several situa*ons (e.g.
building codes, public buildings, rent houses)

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Some considera1ons regarding the
forthcoming European Direc1ve (2)
European radon regula*ons are set ­up in the Euratom
framework, however:
we should
link
radon programs and regula*ons
with
other
programs/regula*ons
related with radon exposure and
radon health effects (
cigarePe
smoking
,
energy saving
,
building construc*ons/maintainance, indoor air
)
Links and coordina*on are
recommended by WHO, IAEA,
EC
, but they need large efforts due to administra*ve
separa*on of related agencies/department

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Some considera1ons regarding the
forthcoming European Direc1ve (3)
Lower reference levels required by the EU Direc*ve
=> we need
research for mi*ga*on systems
capable
to reduce
“intermediate” radon concentra*ons
(i.e.
100–400 Bq/m
3
)
in such cases we do not need high reduc*on
efficiency

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F. Bochicchio – The approach of the INRAP for preven8on and mi8ga8on and the new Direc8ve on BSS
Radon Protec8on Conf.
Dresden, 2–3 Dec. 2013
Italian Na8onal
Ins8tute of Health
Danke Ihnen für Ihre Aufmerksamkeit
Thank you for your kind attention