The report gives results of follow-up tests in 38 difficult-to-mitigate Pennsylvania houses where indoor radon reduction systems had been installed 2 to 4 years earlier. Objectives were to assess system durability, methods for improving performance, and methods for reducing installation and operating costs. The durability tests indicated that the 38 systems have not experienced any significant degradation in indoor radon levels or in system flows/suctions, except in 6 houses where system fans failed, and in houses where homeowners turned off the systems. Tests to improve performance indicated that nearly all of the elevated residual radon levels are due to re-entrainment back into the house of very-high-radon exhaust gas from the soil depressurization systems, and to radon release from well water. Tests to reduce system costs showed that premitigation sub-slab suction field measurements can help prevent installation of too many suction pipes when communication is good, but suggest a need for too many pipes when communication is poor. Soil depressurization fans could not be turned down to the extent expected in some systems that were over-designed. Between 6 and 42% of the exhausted air was withdrawn from the house.