The number of healthcare workers occupationally exposed to ionizing radiation (IR) is increasing every year. As health effects from exposure to low doses IR have been reported, radiation protection (RP) in the context of occupational activities is a major concern. This study aims to assess the compliance of healthcare workers with RP policies, according to their registered cumulative dose, profession, and perception of radiation self-exposure and associated risk. Every healthcare worker from one of the participating hospitals in France with at least one dosimetric record for each year 2009, 2014, and 2019 in the SISERI registry was included and invited to complete an online questionnaire including information on the worker's occupational exposure, perception of IR-exposure risk and RP general knowledge. Hp(10) doses were provided by the SISERI system. Multivariate logistic regressions were used. Dosimeter wearing and RP practices compliance were strongly associated with 'feeling of being IR-exposed' (OR = 3.69, CI95% 2.04-6.66; OR = 4.60, CI95% 2.28-9.30, respectively). However, none of these factors was associated with RP training courses attendance. The main reason given for non-compliance is unsuitability or insufficient numbers of RP devices. This study provided useful information for RP policies. Making exposed workers aware of their own IR-exposure seems to be a key element to address in RP training courses. This type of questionnaire should be introduced into larger epidemiological studies. Dosimeter wearing and RP practices compliance are associated to feeling being IR-exposed. RP training courses should reinforce workers' awareness of their exposure to IR.

Health workers exposed to ionizing radiation account for + 50 • Radiation exposure of healthcare workers in most medical departments has steadily decreased between 2009 and 2019 in several French hospitals. • The number of zero doses consistently increased during the study period. • Workers in nuclear medicine departments are the most exposed, especially radiologic technologists and physicians.

Il est aujourd'hui établi que les pesticides épandus se propagent bien au-delà de la zone sur laquelle ils sont appliqués, du fait de phénomène de dérive de pulvérisation et de volatilisation. Les populations riveraines des zones agricoles sont donc potentiellement exposées et lien entre exposition environnementale résidentielle aux pesticides d'origine agricole et le risque d'HM dans la population générale est accréditée par des études. Nous proposons un indicateur indirect de proximité et d'intensité aux terres agricoles permettant d'évaluer le plus précisément possible l'exposition de la population Française aux pesticides. Nous présentons les résultats du pilote réalisé sur 8 départements tests (44, 85, 79, 17, 16, 86, 87 et 33). Cet indicateur est construit en partenariat avec l'Institut national de l'information géographique et forestière (IGN). En utilisant leurs données des couches d'occupation du sol grande échelle (OCS GE), nous sommes capables d'identifier finement et de façon exhaustive les parcelles agricoles. A partir de ces informations, et en utilisant le géocodage des adresses, issu de la base adresse nationale, nous calculons pour chacune d'entre elles : la distance la plus courte vers une parcelle agricole (proximité) ; le pourcentage de surface agricole utile dans des buffers de 250, 500 et 1000m autour des points géolocalisés (intensité). L'indicateur indirect d'exposition des riverains aux pesticides est approximé par la moyenne harmonique de l'intensité et de la proximité culturale dans les buffers considérés. Cet indicateur est compris entre 0 (pas d'exposition) et 1. Il peut être utilisé dans les études cas/témoins ou dans les études écologiques en agrégeant l'information par unité spatiale considérée. Une base de données de 2 999 952 adresses sur les départements concernés comprenant les données intensité/proximité ainsi que les indicateurs pour les différents buffers et types de cultures a été constituée. La figure 1 présente la carte de chaleur pour l'indicateur d'exposition à la vigne, agrégé par commune. Les données d'expositions sont disponibles pour huit départements et pour la fenêtre temporelle 2006-2017. Les indicateurs proposés peuvent être utilisés à la fois pour des études cas/témoins mais également écologique. Dans ce dernier cas, le biais de spécification semble bien contrôler avec un indicateur très proche de la probabilité individuelle des populations de l'unité spatiale considérée d'être exposés. Exposition , Pesticide , Riverains , Intensité , Proximité Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.

Abstract Background Health workers exposed to ionizing radiation (IR) account for +50% of workers exposed to artificial IR in France. Over the last 10 years, the use of IR in medicine has developed due to the introduction of new practices. The EXPERTS study aims to evaluate and characterize the trends in IR exposure of health workers in France between 2009 and 2019. Methods The study includes all health workers with at least one dosimetric record in the System for occupational dosimetry registration (SISERI) database for each of the years 2009, 2014, and 2019, in the 6 hospitals included in the study (in Paris & Bordeaux). Individual passive external doses, professional activity, age and gender were collected via SISERI and occupational medicine units. Doses were estimated from badges worn at chest level under the lead apron. Results 1,999 workers were included. Mean Hp(10) doses significantly decreased between 2009 and 2019 (-0.004 mSv/year; p < 0.05). Workers in Bordeaux hospitals were more exposed than those in Paris in 2009 and 2014, while trend was reversed in 2019 (p > 0.05). Doses in men were significantly higher than women's doses in 2009 and 2014 (p < 0.02), but were similar in 2019 (p = 0.99). Physicians had the highest mean IR doses between 2009 and 2019 (0.14mSv ±1.09), and more specifically surgeons and cardiologists, but their exposure tended to decrease in recent years. Radiological technologists have similar mean doses (0.14mSv ±0.38), relatively stable over the study period - the most exposed in the nuclear medicine unit (0.60mSv ±0.58). Conclusions IR exposure of health workers in France decreased significantly between 2009 and 2019, despite an increase in practices using IR - this decrease was partly recorded in orthopaedic surgeons. This may be related to radiation protection rules' application. However, badges may not always be worn properly. This study could be extended to other healthcare centres to study local specificities and to adapt radiation protection policies Key messages Despite the increase in medical practices using ionising radiations (IR), the average exposure of health workers to IR has decreased over the 10 last year, mainly in Bordeaux hospitals. Differences in average IR exposure were found by occupation, gender, health care units, and hospitals. Policies should use these results to promote radiation protection rules.

Although medical ionizing radiation (IR) has clear clinical benefits, it is an established carcinogen. Our study estimates the number of new cancer cases in France in 2015 attributable to IR exposure from medical procedures. Exposures from external (X‐rays, CT scans, interventional radiology) and internal (nuclear medicine) sources were considered. We used 2007 national frequencies of diagnostic examinations by sex and age to estimate the lifetime organ dose exposure adjusted for changes in the use of such procedures over time. The Biological Effects of Ionizing Radiation VII risk models were used to estimate the corresponding excess cancer risk, assuming an average latency period of 10 years. Additionally, we used cancer incidence data from the French Cancer Registries Network. Of the 346,000 estimated new cancer cases in adults in France in 2015, 2300 cases (940 among men and 1360 among women) were attributable to diagnostic IR, representing 0.7% of all new cancer cases (0.5% for men and 0.9% for women). The leading cancers attributable to medical IR were female breast (n = 560 cases), lung (n = 500 cases) and colon (n = 290 cases) cancers. Compared to other risk factors, the contribution of medical IR to the cancer burden is small, and the benefits largely outweigh its harms. However, some of these IR‐associated cancer cases may be preventable through dose optimization of and enhanced justification for diagnostic examinations.

Radon is the second leading cause of lung cancer after smoking. Since the previous quantitative risk assessment of indoor radon conducted in France, input data have changed such as, estimates of indoor radon concentrations, lung cancer rates and the prevalence of tobacco consumption. The aim of this work was to update the risk assessment of lung cancer mortality attributable to indoor radon in France using recent risk models and data, improving the consideration of smoking, and providing results at a fine geographical scale. The data used were population data (2012), vital statistics on death from lung cancer (2008–2012), domestic radon exposure from a recent database that combines measurement results of indoor radon concentration and the geogenic radon potential map for France (2015), and smoking prevalence (2010). The risk model used was derived from a European epidemiological study, considering that lung cancer risk increased by 16% per 100 becquerels per cubic meter (Bq/m3) indoor radon concentration. The estimated number of lung cancer deaths attributable to indoor radon exposure is about 3000 (1000; 5000), which corresponds to about 10% of all lung cancer deaths each year in France. About 33% of lung cancer deaths attributable to radon are due to exposure levels above 100 Bq/m3. Considering the combined effect of tobacco and radon, the study shows that 75% of estimated radon-attributable lung cancer deaths occur among current smokers, 20% among ex-smokers and 5% among never-smokers. It is concluded that the results of this study, which are based on precise estimates of indoor radon concentrations at finest geographical scale, can serve as a basis for defining French policy against radon risk.

Nuclear power plants (NPPs) release toxic emissions into the environment that may affect neighboring populations. This ecologic study was designed to investigate the possibility of an excess incidence of cancer in the vicinity of French NPPs by examining the incidence by municipality of 12 types of cancer in the population aged 15 years and older during the 1995-2011 period. Population exposure to pollution was estimated on the basis of distance from towns of residence to the NPP. Using regression models, we assessed the risk of cancer in a 20-km zone around NPPs and observed an excess incidence of bladder cancer (Relative Risk (RR), 95% Credibility Interval (95% CI)) in men and women (RRmen = 1.08; 95% CI: 1.00, 1.17 and RRwomen = 1.19; 95% CI: 1.02, 1.39). Women living within the 20-km proximity areas had a significantly reduced risk of thyroid cancer (RRwomen = 0.86; 95% CI: 0.77, 0.96). No excess risk of hematologic malignancies in either sex was seen. The higher than expected incidence of bladder cancer may be due to an excess incidence localized around the Flamanville NPP and the nearby La Hague nuclear waste treatment center, which is a source of chemical contaminants, many (including arsenic) of them known risk factors for bladder cancer. Differences in medical practices could explain the reduced risk of thyroid cancer. In this first study of adults living near NPPs in France, cancer incidence is significantly higher than in the references populations for one of the cancer types studied: bladder cancer.

Introduction Recent results of epidemiological studies renewed the debate on health effects of environmental exposure to nuclear power plants (NPPs) emissions. Hundreds of thousands of people are living around such facilities in France. The aim of this work is to study the incidence of cancer in adults living around NPPs in France and to assess whether this approach could be extended to other French nuclear facilities. Methods We conducted an ecological study focusing on population aged 15 and over living within 20 km of 7 NPPs in France. Incidence rates were estimated for different cancers associated to chemical and radioactive releases from NPPs: liver, brain, leukaemia, female breast, ovary, bladder and thyroid cancers. Cases have been obtained from the French cancer registries at the municipality level between 1995 and 2012. This study used distance to NPPs as a proxy of exposure. A geographic correlation study, based on generalized additive models and Bayesian hierarchical models, was used to estimate the association between risk of cancer and proximity to NPPs accounting for potential confounding factors (deprivation, smoking, population density, residential mobility, roads density, presence of other industrial sites, and levels of benzene in the air). Results This study will examine cancer types by 5-years age groups, sex and calendar year. Analysis and interpretation of results are ongoing. Discussion Given the design of our study, the questions regarding cancer's incidence around NPPs will be answered. Nevertheless no causal conclusion could be drawn on this basis. This pilot study will highlight technical challenges related to health surveillance around NPPs. Data pooling with other international similar studies could enhance the efficiency of such scheme.

Background : Much concerns surround the potential health impacts associated to living near nuclear facilities in France. For the first time, a national pilot study will be performed to analyse canc...

Les impacts des installations nucléaires sur la santé des populations à leurs alentours font l’objet de préoccupations et de questionnements. Une étude multi-sites pilote sera réalisée afin d’étudier le risque de cancer de l’adulte autour de six centrales nucléaires. Elle permettra d’évaluer si une telle approche peut être généralisée à l’ensemble des installations nucléaires françaises. Cette étude de type écologique géographique multicentrique analysera l’incidence des cancers entre 1995 et 2012 dans la population âgée de 15 ans et plus résidant dans un rayon de 20 km autour de six centrales nucléaires. Les données d’incidence proviennent des registres de cancers, pour les localisations dont le lien est établi avec les rejets radioactifs ou chimiques des centrales. L’exposition sera estimée par la distance par rapport à la centrale, et à partir des données sur les rejets radioactifs dans l’air et dans l’eau. Un modèle de régression de Poisson sera réalisé, en tenant compte des facteurs de confusion potentiels. L’incidence par type de cancer sera étudiée par période de cinq ans, classe d’âge et sexe. L’association entre le risque de cancer et les indicateurs d’exposition aux rejets radioactifs des centrales sera estimée. Cette étude écologique multicentrique apportera des éléments de réponse à la préoccupation sociétale sur une éventuelle sur-incidence des cancers autour des centrales nucléaires, mais elle ne permettra pas de conclure sur un éventuel lien de causalité. Enfin, cette étude pilote permettra d’évaluer la faisabilité d’une extension à l’ensemble des installations nucléaires de France d’un tel dispositif.

Background : Knowledge on Radiofrequency (RF) and Extremely Low Frequency (ELF) electromagnetic fields (EMF) exposure of children remains scarce, despite their growing use and their potential health effects. There is a need for studies taking into account every source of children exposure, including emerging ones, with longitudinal design to capture changes while growing, from in-utero to the adolescence. Aims: to characterize and follow RF and ELF exposure in children of the French ELFE birth cohort. Methods: 18918 children born in 2011 have been included. RF and ELF exposure will be assessed by questionnaires. Jobs and company activity will be coded with international classifications, and a job-exposure matrix will be applied to assess maternal occupational exposure during pregnancy. Domestic uses (Wi-Fi, cordless phone, mobile phone, electrical appliances, transportation means…) will be collected on questionnaires. Residential exposure will be assessed by using geocoded residential addresses and mapping of EMF sources. An exposure study will be performed in a subgroup of 400 children (when 3 yrs old). Housing and household characteristics and a time-activity diary will be completed, and numerous RF bands and ELF 50Hz will be measured at different places in each room and during 24 h in the living room. Results : questionnaires at birth, 2 months and 1 year of life have been already administered, and follow-up at 2 years is scheduled in 2013. Perspectives: Interactions between EMF and other radiations or chemical exposures will be studied, in relation with health outcomes collected at each follow-up. Other factors influencing children's health and development (social, psychological, medical and familial factors), also collected will allow an accurate assessment of the etiology of health events. Future collaboration with other international birth cohorts to better understand the etiology of rare diseases such as pediatric cancers will be considered.

D'après des études récentes, il existe un lien entre le risque de cancer du poumon et l'exposition domestique au radon. Pour autant, la prise de conscience du problème en France s'est faite relativement tardivement. Nous avons choisi de mener une expérience portant sur la concentration en radon dans une maison particulière du Calvados. Il s'agit de mettre en exergue que la présence d'une cheminée dans une maison peut accélérer le transfert convectif du radon et que des aménagements intérieurs et extérieurs simples peuvent réduire de manière significative la concentration en radon à l'intérieur de cette habitation.Recent studies indicate a link between the risk of lung cancer and residential radon exposure. However, in France, awareness of this problem was made relatively late. Accordingly this study examines the radon concentration in a private home in Calvados. Findings show that the presence of a fireplace in a house can accelerate radon convective transfer, and that simple adjustments to interior and exterior accommodation can significantly reduce radon concentrations in the home.