Basis of Design 75 DD BOD UD Tomotherapy.pdf

Pittsburgh VA Medical Center UD Radiation Therapy Tomotherapy Upgrade | December 12th, 2019

VA Project No: 646CSI112

VA Contract No: 36C24419N0862

Bancroft-AE Project No: 16-128

UD Radiation Therapy Tomotherapy Upgrade

Pittsburgh VA Medical Center

(UD) University Drive Division — Pittsburgh, PA 15240

January 14th, 2020

75% Design Development

BASIS OF DESIGN

Pittsburgh VA Medical Center

UD Radiation Therapy Tomotherapy Upgrade

VA Contract Number: 36C24419N0862

VA Station Number: 646-CSI-112

Bancroft Project Number: 16-128

Issued For: User and VA approval

By:

Bancroft Architects + Engineers

187 North Main Street, Wilkes-Barres, Pennsylvania 18702

610.4222.3019 | www.bancroft-ae.com

Basis of Design Table of Contents

1. Executive Summary

2. Tomotherapy Design Strategies

3. Tomotherapy Design Trends

4. Project Kick-Off

5. Architectural Basis of Design

Executive Summary

INTRODUCTION

This document is a Conceptual Design Summary that forms the current Basis of Design (BOD), a living document that will evolve through the duration of the project. This document to date has evolved through the following key elements of developmental discovery:

• Building Walk Through and Meetings with Users to Validate Scope on August 01.

• Project Kickoff Meeting on October 16.

• Architecture and Engineering Field Investigation November 07.

It is not the BOD’s function or intent to document every element of this entire process as it developed; rather it is to perform as an organized summary of the key developments of the project process. In addition to the BOD, total documentation of the design process consists of project minutes of meetings, numerous design studies and options presented for consideration.

In Autumn of 2019 Bancroft-AE was contracted to provide Architectural and Engineering design services at the

VA Medical Center in Pittsburgh, PA for the Conceptual Design, Schematic Design, Design Development, through 75% of the construction/bid documentation. Through a Design/Build contract the remaining portion of the documents will be completed.

• The main project goal is replace the existing lineal accelerator equipment with a new Accuray

Tomotherapy machine. To accommodate a pathway for the Tomotherapy Machine as well as future equipment we are to design an opening in the exterior parking deck with a removable hatch. With previous access blocked the hatch became an integral part of the design project.

It was understood by all parties early in the project that the effectiveness of the planning solution in would be limited by the requirements of the equipment manufacturer and specifications. At the project kickoff, Bancroft met with user teams to review early ideas and concepts, and to identify the clinical model aspects that are most desired. Bancroft identified site logistical concerns for removing the existing equipment and bringing in the new. From this meeting, Bancroft developed (1) room design and associated floor plans/views to accommodate key user goals as well providing an environment that promotes patient comfort in the new

Tomotherapy space. The following report outlines these initial meetings and the resulting process leading to the proposed concept designs.

PROJECT SCOPE

BUDGET

This project has been allocated a $1,100,000 construction budget. As part of this report, Bancroft will be preparing a preliminary Opinion of Probable Construction Cost (OPCC) for accomplishing the scope of work described above, and itemized areas of possible scope reduction to align the project with the budgetary limits.

Name Company Role

Mike Dwyer Pittsburgh VAMC Project COR

Earl Jursich Bancroft Architects + Engineers Senior Project Manager

Peter Moser Bancroft Architects + Engineers Project Manager

Matthew Bastin Bancroft Architects + Engineers Project Architect

Mike Wilbur Johnson Wilbur Adams Structural Engineer

Dale Bacik MES Group Mechanical/Plumbing Engineer

Dale Bacik MES Group Electrical Engineer

Earl Jursich Bancroft Architects + Engineers Cost Estimator

DESIGN TEAM

Pittsburgh VA Medical Center UD Radiation Therapy Tomotherapy Upgrade | January 14th, 2020

1 Executive Summary

APPLICABLE CODES

As of November 2019, the following Codes and Standards have been adopted by the VA:

• VA Directives, Design Manuals, Master Specifications, VA National CAD Standard Application Guide, and other Guidance on the Technical Information Library (TIL) (http://www.cfm.va.gov/til/).

• International Building Code (IBC), 2018 (Only when specifically referenced in VA Design Documents)

• NFPA 101 Life Safety Code, 2018

• NFPA National Fire Codes, with the exception of NFPA 5000 and NFPA 900

• Occupational, Safety and Health Administration (OSHA) Standards.

• National Electrical Code (NEC)

• International Plumbing Code (IPC)

• ASME Boiler and Pressure Vessel Code

• ASME Code for Pressure Piping

• Architectural Barriers Act Accessibility Standards (ABAAS) including VA supplement, Barrier Free Design

Guide (PG-18-13)

• Building Code Requirements for Reinforced Concrete, American Concrete Institute and Commentary

(ACI 318)

• Manual of Steel Construction, Load and Resistance Factor Design Specifications for Structural Steel

Buildings, American Institute of Steel Construction (AISC)

• Energy Policy Act of 2005 (EPAct)

• DOE Interim Final Rule: Energy Conservation Standards for New Federal, Commercial and Multi-Family

High-Rise Residential Buildings and New Low-Rise Residential Buildings, 10 CFR Parts 433, 434 and

435.

• Federal Leadership in High Performance and Sustainable Buildings: Memorandum of Understanding

(MOU)

• Executive Order 13423: Strengthening Federal Environmental, Energy, and Transportation Management.

• The Provisions for Construction and Safety Signs. Stated in the General Requirements Section 01010 of the VA Master Construction Specification.

• Ventilation for Acceptable Indoor Air Quality – ASHRAE Standard 62.1, 2007.

• Safety Standard for Refrigeration Systems – ASHRAE Standard 15, 2007.

http://www.cfm.va.gov/til/

Tomotherapy Goals and

Strategies

When design and preparing a site for new Radiation Therapy Equipment Patient / Staff Safety, Patient

Comfort and Efficient Layout make for a successful implementation for a facilities utilizing Radiation

Oncology . These major factors can be broken down further.

1. Provide and design Specific Shielding

2. Security of Spaces

3. Patient Privacy

4. Streamline Processes

5. Patient Distractions / Comfort

These 5 goals provide an effective and comprehensive means of evaluating design solutions for their effectiveness. From these Functional Goals, resources can be utilized from agencies and institutions to further enhance the space being developed.

Proper shielding for each space is designed to accommodate each piece of equipment and provide a level of care that minimizes any over exposure to patients as well as staff and occupants to the adjacent spaces.

Having the knowledge and familiarity with the scientific principles including references from NCRP ensure proper shielding design and installation. Nelco Worldwide will be contracted to evaluate the existing shielding and determine a path forward. We will be conducting a review of the new equipment and its placement in the room to the existing concrete, lead and steel shielding locations. The new configuration of the equipment is rotated 90° compared to the existing so its possible the existing shielding needs to be reconfigured to suit.

Additional strategies for this project also include designing and planning the safety and logistics of the entry point of the new equipment. We will be cutting approximately 77sf (7’x11’) opening in the existing concrete roof deck over the current linear accelerator control room. The finished opening is scheduled to be 6’x10’. We will design the structural reinforcing system that supports the large opening with inverted beams that will be built on top of the concrete deck. This minimizes the impact within the control room and adjacent Linear

Accelerator Room #1 during this phase of construction.

FUNCTIONAL GOALS DESIGN STRATEGIES

Tomotherapy Design Strategies 2

It is required that Linear Accelerator Room #1 be operational though out most construction activities. We will need to develop a platform style temporary partition to accommodate this requirement thru the duration of the project. Detailed coordination, timing and phasing will be documented to accommodate a safe effective environment for the patients and staff.

An Accuray Radixact Tomotherapy Machine was purchased for the Radiation Oncology Program. We will be working in tandem with their equipment planners to ensure the machine is in it’s ideal location within the existing vault. We are updating the space to reflect all of the requirements needed for site prep. We will be including equipment in the adjacent mechanical room as well as a new air compressor and electrical conditioner. There will also be an information data center installed in a communication closet near the space.

The existing Linear Accelerator (Varian) and it related components will be decommissioned and removed by Accuray.

Disciplined coordination for the laser positioning system and prep for these items will be critical for a successful installation of the machine.

Tomotherapy Design Trends

When design and preparing a site for new Radiation Therapy Equipment Patient / Staff Safety, Patient

Comfort and Efficient Layout make for a successful implementation for a facilities utilizing Radiation

Oncology . These major factors can be broken down further.

1. Provide and design Specific Shielding

2. Security of Spaces

3. Patient Privacy

4. Streamline Processes

5. Patient Distractions / Comfort

PATIENT COMFORT AND DISTRACTIONS

An important aspect of Tomotherapy procedures is patient comfort. Procedures can be make patients can become anxious or nervous as well as claustrophobic. Evidence based design and case studies elements are incorporated to distract the patient during the procedure. We will be looking at different systems to include in the space. There is limited above ceiling space in the suite which will dictate some features that will be availa-ble

Typical features that we will be investigating:

1. Imagery

2. Lighting

3. Sound / Music

Tomotherapy Design Trends 3

Architectural Basis of Design

The project commenced with a project kickoff meeting on October 16, 2019 at the Pittsburgh UD VAMC

Facility. The goal of this meetings was to establish a common understanding of project goals and evaluate some over arching concerns with the new equipment requirements and ingress and egress of equipment.

Discussions touched around access and use of Linear Accelerator #1 while the Tomotherapy vault is being remodeled, understanding the access area for the equipment and existing conditions/services that will need to be relocated as a result of the new access hatch.

PROJECT KICKOFF AND DESIGN GOALS

Project Kick-Off 4

The design of the Electrical distribution systems shall be in accordance with the following codes and standards:

A) VA Master Construction Specifications (PG-18-1)

B) VA Design and Construction Procedures (PG-18-3)

C) VA National CAD Standards Details (PG-18-4)

D) VA Equipment Guide List (PG-18-5)

G) VA Design Manuals (pg-18-10)

H) VA Design Guides (PG-18-12)

I) VA Barrier Free Design Guide (PG-18-13)

J) VA Room Finishes, Door, and Hardware Schedule (PG-18-14)

K) VA Minimum Requirements for A/E Submissions (PG-18-15)

L) VA Environmental Planning Guidance (PG-18-17)

M) VHA National CAD Standard Application Guide

N) NFPA Life Safety Code 2018

O) NCRP 151

DESIGN CRITERIA

The scope of this project is to remove the existing VARIAN Linear Accelerator and its associated support equipment and replace it with a new Accuray Tomotherapy machine and its new support equipment. The

Architectural scope include refinishing the Tomotherapy room, design ingress/egress routes for old and new equipment, upgrade spaces to maximize staff efficiency and create atmosphere to achieve patient satisfaction and comfort. As part of this project, portion of the parking deck above will be removed to accommodate ingress of new equipment, as well as ingress/egress of equipment in the future.

GENERAL

Accuray Purchasing broker will be responsible for the removal of the existing VARIAN Linear Accelerator and its supporting equipment. The contractor will remove and discard the sub-surface (under concrete slab) framing system for the table and equipment.

Equipment Logistics / Concrete Parking Deck:

The new Tomotherapy machine size makes it necessary to demolish portion of the concrete parking deck above to accommodate ingress of the new equipment. This will ensure access for future equipment changes throughout the department. A new structural framing system will be designed to carry the loads for the new opening.

Control Work room:

All MEP FP services for Linear Accelerator Room #1 and the proposed Tomotherapy Room will need to be re-routed to accommodate the new hatch opening. They will be demolished back to the work room, then re-routed around the sides of the opening.

The existing countertop that contains the computer systems and consoles is in disrepair and will be replaced.

There is an existing millwork chase that will remain in place.

Tomotherapy Room:

The existing furring partitions will be completely removed to accommodate new wall mounted supporting equipment for the Accuray Tomotherapy System. Lasers and Posisitioning systems.

All of the existing ceiling system and components will be removed. We will be salvaging the existing Light Box for the facilities re-use in a different location.

Existing floor finishes and integrated and/or wall base will be removed in their entirety.

EXISTING CONDITIONS / DEMOLITION

Portion of the existing slab on grade will be removed to accommodate new foundations and electrical and piping trenches for the new Tomotherapy equipment.

Mechanical Room:

Existing power conditioner will be removed and replaced with the Accuray System component.

A new exterior condenser for the cooling unit in the Tomotherapy room will be replaced.

Architectural Basis of Design Demolition 4

A task per the scope of work is to add a roof opening in the existing parking deck to create access for the new Tomotherapy equipment as well as other future equipment removal and additions. The hatch covering for the opening needs to be removable (non-permanent) component. It will be A pre-manufactured skylight will be an ideal design consideration. These systems have predetermined structural loads as well as lifting points built in which creates an all-in-one solution. They also double as skylight allowing natural light to stream into the basement giving the space much needed ambient light.

The basis of our design and detailing will utilize ‘KalWall’ removable self supporting Ridge Skyroof with gabled ends.

The clear opening size for equipment transport will be 10’x6’. This will accommodate the new Tomotherapy equipment as well as all future equipment installation and removal. When needed the self-supporting roof can be unbolted and craned off, new equipment lowered in and the roof can be installed back on the opening with-in hours.

No rework, disassembly, or component replacement necessary.

The structure to reinforce the opening will be installed and connected to the top of the existing concrete deck (inverted beams). This will enable all the deck reinforcing to be completed with minimal work in the control room. Once the reinforcing beams are completed the adjacent roofing, flashing and prep for the skylight can be completed prior to cutting the large opening in the concrete deck. This will enable the skylight to be installed directly after the opening being created minimizing the possiblilty of weather infiltrating the space below.

NEW EQUIPMENT ACCESS

New 6’x10’ Opening

Architectural Basis of Design New Work 4

The Bancroft-AE design team developed conceptual diagrams of major elements within MRI room, adjacent toilet/changing room and control room.

A conceptual understanding of space requirements for the design of the rooms mentioned above were discussed in the kick-off meeting and further analyzed with our technical experts, equipment requirements and staff procedural input.

Concept #3 includes a 3D gypsum panel with special accent lighting with light motion and color changing to mimic the natural phenomenon of the

Aurora Borealis. This feature was also included on the ‘foot wall’ around the control room window. The movement of the lighting distracts the patients even when the are in the bore of the MRI and may not be able to see the wall or ceiling.

Due to the contrast IV being inserted inside the exam room a sink was added to provide proper handwashing and infection prevention which reduces risk and adds patient comfort. In this scheme the sink and counter are on the left side of the machine.

The Mobile IV Supply Cart floats in the space and can be parked near the

MRI Machine.

The Siemens Coil Cart as well as additional storage cabinet for coils is provided on the left side on the MRI Machine.

NEW EQUIPMENT ACCESS

Architectural Basis of Design New Work 4

The Bancroft-AE design team developed conceptual diagrams of major elements within MRI room, adjacent toilet/changing room and control room.

A conceptual understanding of space requirements for the design of the rooms mentioned above were discussed in the kick-off meeting and further analyzed with our technical experts, equipment requirements and staff procedural input.

Concept #3 includes a 3D gypsum panel with special accent lighting with light motion and color changing to mimic the natural phenomenon of the

Aurora Borealis. This feature was also included on the ‘foot wall’ around the control room window. The movement of the lighting distracts the patients even when the are in the bore of the MRI and may not be able to see the wall or ceiling.

Due to the contrast IV being inserted inside the exam room a sink was added to provide proper handwashing and infection prevention which reduces risk and adds patient comfort. In this scheme the sink and counter are on the left side of the machine.

The Mobile IV Supply Cart floats in the space and can be parked near the

MRI Machine.

The Siemens Coil Cart as well as additional storage cabinet for coils is provided on the left side on the MRI Machine.

MEP Basis of Design

Perform all work in compliance with all applicable federal, state, and local codes, regulations, and standards adopted by the authority having jurisdiction. All work must adhere to the latest VA Design Guides and VA Design Manuals.

International Building Code (2018)

International Energy Conservation Code (2018)

International Mechanical Code (2018)

NFPA 101-2018, The Life Safety Code

NFPA 70-2017, National Electrical Code

NFPA 72-2019, National Fire Alarm Code

DESIGN CRITERIA

Demolition – Existing Power

Demolish existing devices not needed to support new Tomotherapy equipment back to source panel. Retain existing circuits for reuse. Demolish existing devices serving existing control equipment for Accelerator 1 in Work Area BW254A. Intercept existing underfloor feeders in room BW254 and reroute to new base from pullbox below the new Radixact Treatment Delivery System. Demolish existing 150 Amp Main Circuit Breaker Panel and 60 Amp OBI Circuit Breaker Panel.

General purpose receptacles on normal and emergency power will be provided as required. All receptacles will be duplex NEMA 5-20R, hospital grade, unless otherwise noted. Ground Fault Circuit Interrupter (GFCI) receptacles will be provided at all locations required by NEC and will not serve other receptacles from their load-side terminals. GFCI receptacles will have a self-test feature.

Building wiring will be high conductivity copper, 600 volts, insulated. Feeders and branch circuit ampacity shall be adequate to supply the load served in accordance with NEC requirements. Wire sizes may be increased for voltage drop, ambient temperature, number of conductors in a raceway, etc. Wire size for voltage drop shall be designed to comply with NEC recommendations.

Conductors will be copper unless noted otherwise. Conductor size less than or equal to 350 kcmil shall have THHN/THWN insulation. Conductor size greater than 350 kcmil shall have XHHW insulation.

Electric Metallic Tubing (EMT) shall generally be used for interior installation throughout the facility.

Schedule 40 PVC raceways are allowed only on circuit runs outside of the building.

Safety disconnect switches shall be heavy duty, 600V rated, non-fused, NEMA 1 (general purpose) or NEMA 3R (weatherproof) enclosure as required.

Power Requirements – General

Demolition – Existing Lighting

Demolish existing lighting and controls for lighting in Room BW 254 to accommodate lighting requirements of new Radixact Treatment Delivery System. Also demolish lighting and controls in room BW254A to accommodate new skylight. Continuity of existing circuits feeding light fixtures outside of the area of work to be maintained during and after construction. Temporary lighting to be provided during construction where necessary.

Power Requirements – Radixact Treatment Delivery System

A new Radixact Treatment Delivery System will be provided in Tomotherapy Room BW254 to replace the existing Accelerator. The new Tomotherapy Equipment will have a 480V/3Ø connection for the PDU and the Frequency Converter Unit. An enclosed circuit breaker with shunt trip mechanism shall be located just outside the Tomotherapy Room. Local emergency power off (EPO) switch(es) shall be located in the room to shunt trip the main power feed to the Accelerator. Power for supporting equipment will trace back to panel WBG, located in room 224, unless noted otherwise.

All conduits, wiring, raceways and appurtenances indicated on the Tomotherapy equipment manufacturer drawings shall be coordinated with the Tomotherapy equipment vendor and contractor prior to installation.

New 2x2 dimmable fluorescent lighting fixtures meeting the VA design standards will be provided within room BW254. The existing lighting circuits retained from demolition will be reused for this area.

New CFL dimmable downlights and fluorescent dimmable 2x2 light fixtures will be provided in the BW254A.

The existing lighting circuits retained from demolition will be reused in this area.

Lighting controls shall be provided in each room to achieve the requirements of the VA Design Manuals and Design Guides. In Use lighting will be provided at the entrance doors to the suite and will be connected to their associated equipment and shall turn on when the equipment is in use.

Lighting Requirements

MEP Basis of Design Demolition 5

Low voltage communication wiring will be required for the new Tomotherapy control area. New communication wiring will be pulled to room BW254A from the existing data closet. Conduit and wiring will be routed through the VA ceiling space to the new control area communication outlets in room BW254A.

Communication Requirements

The existing linear accelerator in room BW254 is being removed and replaced with Tomotherapy equipment. Heat output from the new equipment is greater than that of equipment being removed and therefore requires a larger volume of cooling airflow to satisfy design conditions. Room BW254 is currently conditioned by a variable air volume terminal unit with hot water reheat. The air terminal unit is served by a central station air handler and receives hot water from the facilities heating hot water plant. The existing VAV box and associated supply/return ductwork will be upsized to account for additional cooling air required. Per manufacturer requirement, a supplemental 12”x10” supply duct will be routed down below the treatment room slab to beneath the Tomotherapy machine where it cools the equipment directly.

Tomotherapy treatment room design conditions are as follows: 68-75 degrees Fahrenheit, 30-60% relative humidity and 55-degree Fahrenheit maximum supply air temperature.

All new and existing ductwork and piping above Work Area BW254A must be routed (or rerouted) to accommodate installation of the new skylight. The location of supply diffusers and return grilles in the Work Area will be adjusted as well.

The new Tomotherapy equipment includes an iDMS System Server as one of its components. This system server will be located in a room with dedicated HVAC on 24-hour operation and emergency power backup.

The room will be maintained at or below 68 degrees Fahrenheit. The system will include remote temperature -monitoring or a temperature activated alarm. Location of this equipment has not been finalized at this point in the design process.

HVAC Requirements

Room BW254 is furnished with a counter mounted lavatory located in the northwest corner. This sink is to be removed. A new lavatory will be installed on the south wall. Cold/hot domestic water pipes, sanitary pipe and vent pipe connected to the existing lavatory are to be demolished back to above the ceiling and below the floor and then extended as required to connect new fixture. Existing medical gas piping in room BW254 is to be rerouted as required to facilitate new equipment.

Compressed air for room BW254 comes from an existing air compressor located in Mech. Elec. Room 224.

This service is shared by multiple rooms. A new air compressor will be installed in Mech. Elec. R224 to serve the new tomotherapy equipment exclusively. The new compressor air flow rate and quality will meet the following manufacturer requirements:

• 30 SCFM @ 90 PSIG

• -40 Degree F Dewpoint (or lower) @ 90 PSIG

• Completely Oil Free Compressor

0.5 Micron Filter

All new and existing plumbing above Work Area BW254A must be routed (or rerouted) to accommodate installation of the new skylight.

Plumbing Requirements

The existing fire sprinkler system is a dry pipe system. Modifications to this system include the relocation of sprinklers as required to maintain adequate coverage in accordance with the hazard classification of the room being renovated. All new and existing fire sprinkler pipe above Work Area BW254A must be routed (or rerouted) to accommodate installation of the new skylight.

Fire Protection