title: Chest X-ray screening examinations among French uranium miners: exposure estimation and impact on radon-associated lung cancer risk.
abstract: BACKGROUND
  Medical surveillance of uranium miners can include periodic chest X-ray examinations. This study aimed to assess the X-ray exposure due to occupational health monitoring in the French cohort of uranium miners, and to test whether consideration of this additional radiation exposure impacts the excess risk of lung cancer death associated with radon exposure.
  
  
  METHODS
  X-ray exposure due to occupational health monitoring was estimated retrospectively based on review of a sample of miners' medical records and bibliographic data. Four exposure scenarios were designed, differing in their assumptions about the type of procedures performed, their frequency, and the lung dose delivered. Radon exposure and lung doses from exposure to α-particle emitters and external γ rays have previously been individually assessed. Exposure-risk and dose-risk relations were estimated by Poisson regression with a linear excess relative risk (ERR) model.
  
  
  RESULTS
  The cohort included 5086 miners with a mean follow-up duration of 30.1 years. The mean number of chest X-ray examinations ranged from 15.1 in the lowest to 34 in the highest-exposure scenario, and produced a mean cumulative lung dose ranging from 4.6 to 34.2 mGy. The role of occupation-related imaging screening X-ray procedures in total equivalent lung dose appeared insignificant compared to α-emitter exposure. X-ray exposure was not associated with lung cancer mortality risk. The ERR associated with radon remained significantly positive when X-ray exposure was included in the multivariate analysis.
  
  
  CONCLUSIONS
  X-ray exposure did not confound the exposure-risk relation between radon and lung cancer.
authors.affiliation: Institute for Radiological Protection and Nuclear Safety (IRSN), PRP-HOM, SRBE, LEPID, Fontenay-aux-Roses, France Sorbonne Paris Cité, Université Paris Descartes, Paris, France AP-HP, Hôpitaux Universitaires Paris Centre, Occupational Health Unit, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Laborde-Castérot
authors.affiliation: Institute for Radiological Protection and Nuclear Safety (IRSN), PRP-HOM, SRBE, LEPID, Fontenay-aux-Roses, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Laurier
authors.affiliation: Institute for Radiological Protection and Nuclear Safety (IRSN), PRP-HOM, SRBE, LEPID, Fontenay-aux-Roses, France.
authors.forename: Sylvaine
authors.initials: S
authors.lastname: Caër-Lorho
authors.affiliation: Institute for Radiological Protection and Nuclear Safety (IRSN), PRP-HOM, SER, UEM, Fontenay-aux-Roses, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Etard
authors.affiliation: AREVA NC, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Acker
authors.affiliation: Institute for Radiological Protection and Nuclear Safety (IRSN), PRP-HOM, SRBE, LEPID, Fontenay-aux-Roses, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Rage
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000396:Air Pollutants, Radioactive / Q000633:toxicity*; D015331:Cohort Studies; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000528:radiation effects; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D008906:Mining; D015999:Multivariate Analysis; D009381:Neoplasms, Radiation-Induced / Q000000981:diagnostic imaging* / Q000401:mortality; D016273:Occupational Exposure / Q000032:analysis; D011829:Radiation Dosage; D013902:Radiography, Thoracic / Q000009:adverse effects*; D011886:Radon / Q000633:toxicity*; D017974:Uranium Compounds; D014965:X-Rays / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000396:Air Pollutants, Radioactive; D017974:Uranium Compounds; D011886:Radon
keywords: Lung Cancer; Mass Chest X Ray; Occupational Medicine