RFP Attachment 1 - Radiation Therapy Design Guide.pdf

Radiation Therapy Service Design Guide April 2008

Table of Contents

Section 1 Foreword & Acknowledgements Foreword Acknowledgements Introduction Definitions Abbreviations Legends and Symbols

Section 2 Narrative General Considerations Functional Considerations Technical Considerations

Section 3 Functional Diagrams

Section 4 Guide Plates (typical order) Floor Plan Reflected Ceiling Plan Design Standards Equipment Guide List

Section 1: Foreword and

Page

Foreword ............................................ 1-2

Acknowledgements ............................ 1-3

Introduction ........................................ 1-4

Definitions .......................................... 1-5

Abbreviations ..................................... 1-6

Logistical Categories .......................... 1-7

Legends and Symbols ........................ 1-8

Forward and 1-1

Foreword

The material contained in the Radiation Therapy Design Guide is the culmination of a part nering effort by the Department of Veterans Affairs Veterans Health Administration and the Facilities Quality Office. The goal of the Design Guide is to ensure the quality of VA facilities while controlling construction and operating costs.

This document is intended to be used as a guide and as a supplement to current technical manuals and other VA criteria in the planning of Radiation Therapy Service. Radiation Ther apy Service is referred to as Radiation Therapy throughout this document. The Design Guide is not to be used as a standard design, and the use of this Design Guide does not limit the project Architect’s and Engineer’s responsibilities to develop a complete and accurate project design that best meets the user’s needs and the applicable code requirements.

Lloyd H. Siegel, FAIA Director, Strategic Management Office Office of Construction & Facilities Management Washington, DC

Forward and 1-2

The following individuals are those whose guidance, insight, advice and expertise made the update and revision of the Radiation Therapy Design Guide possible:

Facilities Management Office

Lloyd H. Siegel, FAIA ACFMO for Strategic Management Washington, DC

Kurt Knight Director Facilities Quality Service

VHACO (181A)

Washington, DC

Donald L. Myers, AIA, NCARB Senior Architect Facilities Quality Service

VHACO (181A)

Washington, DC

Radiation Therapy Advisory Group

Betty M Hall BS (R) (T) GV (Sonny) Montgomery Medical Center 1500 East Woodrow Wilson Blvd.

Jackson, MS 39216

Prime Consultant

Cannon Design

Jose M. Silva, AIA, Project Principal

Ronald Villasante, Assoc. AIA, CAP

Scott Speser, NCARB, LEED

Millard Berry III, PE, LEED

Ronald Curtis, PE

Michael Dlugosz, PE

Ryszard K. Druzcz, PE

J. Joe Scott, CPD

Elizabeth Randolph

Blake Bowen

Radiology / Imaging Specialty Sub-consultants

Junk Architects / MRI-Planning

Tobias Gilk, M Arch

Robert Junk, AIA, AHRA

Forward and 1-3

Introduction

The Radiation Therapy Design Guide was developed as a tool to assist Contracting Officers, Medical Center Staff, and Architects and Planners with the design and construction of Radia tion Therapy Medicine facilities. It is not intended to be project specific; but rather provide an overview with respect to the design and construction of Radiation Therapy facilities.

Guide plates for various rooms within Radiation Therapy are included in this chapter to illus trate typical VA furniture, equipment, and personnel space needs. They are not project spe cific as it is not possible to foresee future requirements. The project specific space program is the basis of design for an individual project. It is important to note that the guide plates are intended as a generic graphic representation only.

Equipment manufacturers should be consulted for actual dimensions, utilities, shielding, and other requirements as they relate to specified equipment. Use of this design guide does not supersede the project architects’ and engineers’ responsibilities to develop a complete and accurate design that meets the user’s needs and complies with appropriate code require ments.

Forward and 1-4

Definitions

CT Simulation: A CT procedure in which the specific pathology is localized within the patient, who is placed in a precise and reproducible position, for use in treatment planning for radia tion therapies. CT Simulation utilizes conventional a CT Scanner outfitted with specific simu lation hardware and software.

External Radiation Therapy: The use of high-energy penetrating wave or particle beams used to damage or destroy cancerous cells. External Radiation Therapy may also be used as a form of treatment for some non-cancerous diseases, and is frequently delivered on a recur ring outpatient basis. High-energy beams do not leave the patient ‘radioactive’ and there are no concerns about exposure of the patient to other persons post-treatment. See Linear Ac celerator.

Intensity Modulated Radiation Therapy (IMRT): IMRT is an advanced external beam radia tion therapy which utilizes computer images to match radiation to the size and shape of a tumor. Through the use of multiple smaller beams from different angles and of varying inten sities, IMRT varies the shape of the radiation delivered to the treatment area, minimizing damage to surrounding healthy tissue. See Stereotactic Radiosurgery.

Internal Radiation Therapy: The use of low-level radioactive implants or ‘seeds’ to deliver radiation to local tissue structures. Frequently implanted in tumors, the radioactive decay damages or destroys the immediately surrounding tissue. Implants are specifically chosen to match the prescribed radiation dose necessary to damage the tumor while protecting the sur rounding healthy tissues. Radioactive implants are placed surgically. Depending upon the implant’s intensity, patients may be ‘radioactive’ for a period of time post-implantation and may need to remain in hospital, segregated from others until the radioactive decay reduces the strength of the implant.

Linear Accelerator (Linac): Device which produces and delivers high-energy beams which, in the hospital setting, is used to damage or destroy targeted tissues or structures, frequently cancerous tumors, within the patient’s body. See Stereotactic Radiosurgery.

Picture Archiving and Communication System (PACS): The digital capture, transfer and storage of diagnostic images. A PACS system consists of workstations for interpretation, image/data producing modalities, a web server for distribution, printers for file records, image servers for information transfer and holding, and an archive of off-line information. A com puter network is needed to support each of these devices.

Stereotactic Radiosurgery: The process by which lower-intensity radiation beams are pro jected to the tumor or target area from multiple points of origin. This allows relatively high ra diation doses to the target area while exposing the surrounding tissues to significantly lower levels of radiation energy. Stereotactic Radiosurgery equipment is available in both frame-based systems for treatment of head and neck, and frameless systems which can treat any anatomic area.

Treatment Planning: Following precise identification of the position, size and shape of a tu mor or target area, typically through MR or CT based simulation, the optimal means of radia tion therapy is planned in which the precise radiation doses are delivered to target areas while minimizing the radiation exposure to adjacent and surrounding tissues. This plan is typically mapped out three dimensionally and computer plotted to guide radiation therapy / radiosurgery.

Forward and 1-5

Abbreviations

A Amps

AC Air Conditioning

ABA Architectural Barriers Act

AC/HR Air Changes per Hour

ADA Americans with Disability Act

ADAAG ADA Accessibility Guidelines

A/E Architectural / Engineering Firm

AHJ Authority Having Jurisdiction

AIA American Institute of Architects

ANSI American National Standards Institute

AR As Required

ASRAE American Society of Heating Refrigerating & Air-Conditioning Engineers

BGSF Building Gross Square Feet

BTU British Thermal Unit

CARES Capital Asset Realignment for Enhanced Services

CFM Cubic Feet per Minute

DOE Department of Energy

DGSF Departmental Gross Square Feet

DVA Department of Veterans Affairs

FAR Floor Area Ratio

FC Foot Candle

OCFM Office of Construction & Facilities Management

GSF Gross Square Feet

GSM Gross Square Meters

HIPAA Healthcare Insurance Portability and Accountability Act

HP Horsepower

HVAC Heating, Ventilating and Air Conditioning

IAQ Indoor Air Quality

IBC International Building Code

JCAHO Joint Commission (on Accreditation of Healthcare Organizations)

LB Pound, Pounds

LUX Lumen Per Square Meter

NEC National Electrical Code

NFPA National Fire Protection Association

NHCU Nursing Home Care Unit

NSF Net Square Feet

NSM Net Square Meters

NTS Not to Scale

NUSIG National Uniform Seismic Installation Guidelines

Forward and 1-6

OSHA Occupational Safety and Health Administration

RCP Reflected Ceiling Plan

RH Relative Humidity

SF Square Feet, Square Foot

SMACNA Sheet Metal and Air Conditioning Contractor’s National Association

SqM Square Meters

TIL Technical Information Library

TV Television

UBC Uniform Building Code

UFAS Uniform Federal Accessibility Standards

V Volts

VA Department of Veterans Affairs

VACO Veterans Affairs Central Office

VAFM Veterans Affairs Facilities Management

VAMC Veterans Affairs Medical Center

VHA Veterans Health Administration

VISN Veterans Integrated Service Network

LOGISTICAL CATEGORIES (LOG CATS)

VV: Department of Veterans Affairs furnished and installed - Medical Care Appropriations

VC: Department of Veterans Affairs furnished and Contractor installed - Medical Care Appro priations for Equipment and Construction Appropriations for Installation

CC: Contractor Furnished and Installed - Construction Appropriations

CF: Construction Appropriations - Department of Veterans Affairs furnished - Installed by the Department of Veterans Affairs or Contractor

Forward and 1-7

Section 2: Narrative

Page

General Considerations

Overview ..................................... 2-2

Functional Considerations

Operations .................................. 2-3

Space Planning Issues................ 2-4

Technical Considerations

General ....................................... 2-6

Architectural ................................ 2-7

Structural .................................... 2-9

Equipment................................... 2-9

HVAC.......................................... 2-9

Plumbing ................................... 2-10

Electrical ................................... 2-11

Life Safety ................................. 2-12

Energy Conservation................. 2-13

Communications ....................... 2-13

Waste Management .................. 2-14

Transportation........................... 2-15

Narrative 2-1

General Considerations

Overview

What is Radiation Therapy?

Radiation Therapy is a clinical specialty that employs radiation to treat cancer and other medical conditions. Two types of Radiation Therapy are available; External Radiation Ther apy and Internal Radiation Therapy. External Radiation Therapy utilizes high-energy pene trating wave or particle beams that are used to damage or destroy cancerous cells. External Radiation Therapy may also be used as a form of treatment for some non-cancerous dis eases, and is frequently delivered on a recurring outpatient basis. High-energy beams do not leave the patient ‘radioactive’ and there are no concerns about exposure of the patient to other persons post-treatment.

Internal Radiation Therapy employs the use of low-level radioactive implants or ‘seeds’ to de liver radiation to local tissue structures. Frequently implanted in tumors, the radioactive de cay damages or destroys the immediately surrounding tissue. Implants are specifically cho sen to match the proscribed radiation dose necessary to damage the tumor while protecting the surrounding healthy tissues. Radioactive implants are placed surgically. Depending upon the implant’s intensity, patients may be ‘radioactive’ for a period of time post-implantation and may need to remain in hospital, segregated from others until the radioactive decay reduces the strength of the implant.

Current Trends

Radiation Therapy has been used as a cancer treatment for more than 100 years. Advances in technology during the 1970’s have set the stage for today’s treatment methods and equipment. Current methods of Radiation Therapy include the use of 3 dimensional data col lection, the use of computer aided treatment planning, and the use of highly accurate radia tion delivery equipment. This methodology attempts to identify where cancer is located, de termine the best method of treatment, and deliver controlled radiation that targets the cancer while maintaining healthy surrounding body tissue.

Stereotactic Radiosurgery is currently being performed to treat tumors with a precise delivery of a single, high dose of radiation. This one-session treatment has such a dramatic effect in the target areas that the resulting changes are considered "surgical." This may be performed using a specially configured Linear Accelerator or a Gamma Knife. Radiosurgery performed with a Gamma Knife is limited to treating disorders of the head and neck while treatments us ing a Linear Accelerator may address the whole body. Cyber Knives have been developed as another method of treating disorders located in areas other than the head and neck. Currently this technology is limited to a few centers of excellence, but it is anticipated that more facilities will provide this treatment as the cost of the equipment is reduced.

Picture Archiving and Communications Systems (PACS) has become the VA standard for the capture, transfer, storage, and manipulation of diagnostic images. These systems con sist of workstations for image interpretation, a web server for distribution, printers for file re cords, image servers for information transfer and handling, and archive systems for off-line information storage.

Narrative 2-2

Future Trends

Advances in technology will continue to improve methods of Radiation Therapy. It is antici pated that imaging modalities, such as CT, PET, and MR, will merge to provide more precise delineation of tumors and improve treatment planning. This will allow for more intense and focused treatment of tumors without affecting surrounding tissue; a major goal in Radiation Therapy. Technology advances in precision and resolution of images will continue with the PACS systems deployment at Radiation Therapy areas. Improvements in equipment posi tioning systems accuracy and automation will provide greater targeting performance. In the future, Radiation therapists will be able to more accurately target, deliver, and verify treat ment.

Functional Considerations

Operations

Radiation Therapy is a referral-based treatment service. Treatments include external beam therapies and internal implant therapies. These may be in conjunction with other treatments such as chemotherapy, surgery, and hormone therapy that are not performed in the Radia tion Therapy service areas. Support functions for may be shared between Radiation Ther apy Services and Nuclear Medicine Services.

Treatment Process

The patient is referred for Radiation Therapy.

Upon arrival, the patient is received, their records are verified, and the patient is directed to either outpatient or inpatient waiting.

Prior to treatment, patients may gown and be taken for simulation imaging in anticipation of treatment planning. Following simulation, a treatment plan is devised.

Once a treatment plan is developed, a schedule of therapy is outlined.

For external radiation therapy, a series of treatments are scheduled; typically on an outpa tient basis. The patient arrives for their treatment, may be gowned, receive the treatment, and leave.

Periodically, new scans may be performed to determine the effectiveness of the current treatment. Based on the results of these scans, the treatment plan may be revised to ac commodate changing conditions.

Patient Care Concept

Effective diagnosis and care of cancer patients require an interdisciplinary approach to clini cal programs and involves multiple screening, diagnostic, and treatment modalities. Family participation is common during the treatment planning process and should also be accom modated in the treatment process itself. This includes assistance in driving, parking, and help with dressing and mobility.

Providing convenient access to treatment in a non-institutional, non-threatening environment is an objective of the Radiation Therapy Service. Ease of access is particularly important due to the frequency of treatment commonly prescribed by the treatment plan. The provision

Narrative 2-3 of a healing environment is critical to cancer patients who are dealing with the stress of a po tentially life-threatening condition. Patient education and family consultation may be used to further aid in a positive patient outcome.

Patient Base

VA Radiation Therapy facilities are focused upon serving the Veteran and may include shar ing agreements, joint ventures, and referrals. The aging veteran patient population with co morbidities and increased severity of illness necessitate design features that emphasize safety and prevention of risks.

Medical Records

Diagnostic evaluations and treatment records generated within the department become part of the Veteran’s Consolidated Health Record. Evaluations are communicated to the ordering physician in electronic form. Image manipulation, interpretation, archiving, retrieval, and dis tribution procedures may occur within Radiation Therapy or remotely.

Patient Protocol

Initial patient appointments are established through a referral network. Multiple scheduled visits are planned over the therapy period. Scheduled visits are included for assessment, counseling, treatment planning, therapy sessions, examination, and follow-up.

Special Requirements

Teaching facilities may require more technical support space including space to accommo date small groups in control rooms, treatment planning, and consultation areas. PACS view ing spaces and remote viewing screens need to be factored into these spaces.

Space Planning Issues

Radiation Therapy is typically a stand-alone unit to maximize privacy for patients and fami lies. However, in new facilities, options should be explored to share space and staff with other diagnostic imaging modalities.

Appropriate staff and support spaces and their proper functional adjacencies must be clearly defined and understood early in the planning and design process in order to achieve opera tional efficiency. Flexibility and adaptability should be anticipated within the design of the fa cility to accommodate evolutions in technology. Way-finding should be clear, and easy ac cess provided to outpatients who are stressed and often weakened due to their illness. Pa tient privacy and dignity is a prime consideration in the design of Radiation Therapy.

Shared staff support facilities including staff lockers, lounges, inpatient holding, and registra tion should be considered. Shared patient support facilities are not recommended due to the nature of the patient’s illness.

Flexibility

The physical mass requirements to accommodate the radiation shielding often restrict the lo cation of Radiation Therapy Facilities to lower floor locations. Shielding requirements also

Narrative 2-4 place demands on space. If an entrance maze is required it should be designed to minimize shielding while providing convenient access of a stretcher and equipment to the treatment room. Radiation Therapy Facilities need to be placed where they will not impede expansion of the surrounding services. Due to the permanent nature of these facilities, flexibility in de sign is important to provide for advances in technology. Increased space allocation and shielding in excess of vendor minimums outlined at the initial design will help to provide this flexibility for the future. Close coordination between the equipment vendor, the designers, and the Radiation Therapy Physicists is critical during the design process.

Human Factors

The VA is committed to providing a healthcare facility that includes components that create a healing environment. It is important that the design of Radiation Therapy reinforces this con cept. Patient’s vulnerability to stress from noise, lack of privacy, poor lighting, and other causes, and the harmful effects it can have on the healing process is well known and docu mented. Patient dignity and self-determination should be accommodated while considering operational efficiencies. Security is addressed by planning, design, and detail considera tions. Handicap accessibility is accommodated by the application of ABA and ADA design guidelines to space and fixed equipment layouts.

De-emphasizing the institutional image of traditional health care facilities and surrounding the patient and family members with architectural finishes and furnishings that are familiar and non-threatening should be a prime objective. It is important to remember, however, that this is a healthcare environment and ease of maintenance, durability, and sanitation should be primary considerations when selecting materials and finishes. An inherent opportunity exists in the design of Radiation Therapy to address these issues and put forth creative solutions that enhance patient comfort and contribute to positive outcomes.

Treatment

Radiation Therapy commonly maintains two patient care areas; treatment planning and ra diation treatment. Treatment planning with assessment and evaluation generally occurs dur ing the patient’s initial visit. After a treatment approach is determined, the patient generally accesses the treatment area repeatedly during the course of treatment.

Patient Access / Way-finding

Travel distance from parking and main patient entrance to Radiation Therapy Service waiting should be minimized due to the frequency of patient access. Consideration should be given to co-location of Radiation Therapy with other diagnostic facilities which may assist in way-finding and coordination of patient service.

Organizational Concepts

The spatial organization of Radiation Therapy is predicated on four functional areas. These areas are Reception, Patient Care / Treatment Planning, Support, and Staff and Administra tion.

The reception area controls access to the patient areas and prevents unauthorized access to the department.

Narrative 2-5

Outpatient waiting areas should be separate from inpatient waiting areas. Outpatients are typically accompanied by at least one family member or visitor who will also require waiting space.

High volume services within the patient service areas should be located near the Waiting Areas to facilitate ease of patient access.

Patient areas should be consolidated to control patient access and to maintain patient pri vacy, security, and dignity.

Referral, treatment planning, consultation and interpretation areas should not accessible to patients and should be private staff work areas to maintain patient confidentiality.

Patient and Staff circulation should be separated. Staff functions may be located within the service or in a convenient location that is shared with another service.

Locate clean and soiled utility functions close to the patient areas they support.

Infrastructure Support areas (e.g., electrical and telecommunications rooms) should be lo cated in proximity to the Radiation Therapy Suite.

Functional Adjacencies

Radiation Therapy should be located close and on the same floor as the Radiology Service.

Close but a different floor location is acceptable for the following services:

Ambulatory Care

Audiology and Speech Pathology

Intensive Care Nursing Units

Medical Research and Development Service

Surgical Service

Technical Considerations

General

Seismic

Where required, install all components and equipment with seismic provisions as outlined in the various discipline specific VA Design manuals for healthcare projects. Refer to VA Con struction Standard Handbook PG-18-03 (CD-54), “Natural Disaster Resistive Design Non-structural” for additional information.

Mycobacterium Tuberculosis

Current Center for Disease Control (CDC) requirements for design of public areas within the building to accommodate Mycobacterium Tuberculosis patients must be addressed by archi tectural and mechanical disciplines. Check current requirements with the VA task force on transmission of Mycobacterium Tuberculosis, TB criteria in HVAC Design Manual for Hospi-

Narrative 2-6 tal Projects, and the CDC Guidelines for Preventing the Transmission of Mycobacterium tu berculosis in Healthcare Settings, 2005.

Sustainability

In 2006, the Department of Veterans Affairs joined other Federal agencies who are partici pating in principles outlined in the Memorandum of Understanding for the Federal Leadership in High Performance and Sustainable Buildings. The purpose of these guidelines is to en courage the use of life cycle concepts, consensus-based standards, and performance meas urement and verification methods that utilize good science and lead to sustainable buildings.

The goals of the members of this initiative are to establish and follow a common set of sus tainable Guiding Principles for integrated design, energy performance, water conservation, indoor environmental quality, and materials aimed at helping Federal agencies and organiza tions:

Reduce the total ownership cost of facilities.

Improve energy efficiency and water conservation

Provide safe, healthy, and productive built environments

Promote sustainable environmental stewardship

These principles should be addressed in the design of all VA facilities.

Architectural

Interior Materials and Finishes

Partitions

Interior partitions should be primarily painted gypsum wallboard on metal studs. Partitions enclosing physician offices, and exam rooms should be provided with sound attenuation batts between the studs in accordance with H-18-03, VA construction standard CD 34-1, Noise Transmission Control.

Partitions for CT Simulator areas will likely require shielding. Partitions around Linear Accel erator equipment will require significant quantities of shielding. Partitions may be constructed of high-density concrete (or other materials) and finished with furred gypsum wallboard.

Floors

Floors in offices, conference rooms and waiting areas should be carpet with a 4 inch high re silient base. Floors in toilet rooms should be ceramic tile with a ceramic tile base. Floors in exam rooms, treatment rooms, and most other spaces should be vinyl composition tile with a 4-inch high resilient base. Floor trenching and special floor boxes may be required for Ra diation Therapy equipment. Identify area where floor trenching is required to receive equip ment infrastructure.

Narrative 2-7

Ceilings

Ceilings should be primarily lay-in acoustic ceiling tile. Certain areas, such as procedure rooms and treatment rooms, should have lay-in acoustic ceiling tile with a washable sprayed plastic finish. Coordinate the ceiling height requirements with the equipment manufacturer.

Wall Protection

Wall and corner guards should be used in corridors and all other areas where damage from cart and stretcher traffic is anticipated.

Interior Doors and Hardware

Interior doors should be 1 ¾ inch thick solid core flush panel wood doors or hollow metal doors in hollow metal frames.

Doorjambs, except in rooms with radiation shielding, should have hospital type sanitary stops that stop 8 inches from the floor to facilitate mopping. Hollow metal doors should be used where high impact is a concern and where fire rated doors are required. Kick / mop plates should generally be applied to both sides of the doors. Handicapped accessible hardware should be used throughout. Door interlocks are provided and coordinated with the hardware.

Refer to VA Handbook PG-18-14, Room Finishes, Door and Hardware Schedule, for addi tional information.

Radiation Therapy Treatment

The treatment unit is commonly housed in a reinforced concrete, radiation shielded vault with an entry maze. Direct entry is also an option. The vault is entered through a special electro pneumatic operated neutron shielded door. The configuration of the maze and vault, and the types and thicknesses of shielding materials shall be as prescribed by a registered radiologi cal physicist approved by the American Board of Radiology in accordance with the National Council of Radiation Protection standards and regulations.

Floor materials should be a seamless sheet product with an integral cove base. Wall and ceiling finish materials should be selected for durability and ease of maintenance.

Due to the nature of treatment in this area with the potential for increased patient anxiety, ef fort should be made to provide a calming environment. This may be achieved through the use of innovative design features. One example is the inclusion of a backlit photo mural as part of the ceiling assembly to create a diversion during treatment. Another is the use of color to provide a calming and non-institutional environment.

Radiation Therapy Space Allocation

Radiation Therapy space requirements are outlined in the VA Handbook 7610 Chapter 277 – Radiation Therapy Service.

Film Processing

It is the goal of the VA to implement Picture Archiving and Communications Systems (PACS) in all VA healthcare facilities. As this conversion to PACS is implemented, some existing fa-

Narrative 2-8 cilities are currently utilizing conventional film processing. It is anticipated that any significant renovation will include conversion to PACS as a basis for design.

Structural

General

Obtain equipment data sheets for each type of equipment under consideration. Proportion structural elements to meet strength and serviceability requirements established by equip ment manufacturers.

Shielding

Shielding associated with this equipment is very massive. Protecting adjacent occupancies typically requires several feet of reinforced concrete. Placing this occupancy on grade and isolating its mass and stiffness from the overall building lateral system is recommended.

Proportion structural elements to meet shielding requirements prescribed by the radiological physicist.

Equipment

Casework

Casework may be millwork or modular. Casework systems should be chosen that provide flexibility for planning and utilization purposes. Casework systems should incorporate com ponents dimensioned for ease of multiple re-use installation applications. Casework used for the storage of molds and immobilizers should be designed to accommodate the wide variety of shapes and sizes and their unique storage needs. Casework systems should provide for cable management and ergonomic placement of workstations and flat screen monitors.

Information Management Systems

Information Management Systems shall include elements of image retrieval, processing, storage, treatment planning, electronic patient records including patient registration, patient charges, physician order entry, and patient / staff movement. Additional shielding may be required to prevent interference with the electronic signals. These systems elements will re quire access to the main facility information system as well as the departmental local area network. A standardized structured cable system and pathway system are provided to facili tate current and future network access. All components should be planned for compatibility.

HVAC

When HVAC services must penetrate a shielded enclosure, coordination is required between HVAC design and the health physicist certifying the construction documents.

Narrative 2-9

Operation

Air conditioning systems should be provided to heat, cool and ventilate the individual spaces, as required to satisfy the VA design criteria.

Capacities

The number of people and the air conditioning load noted on the room design standard sheet is for the purpose of establishing the basis of design guide and its use in planning. Verify the actual number of people and the air conditioning load to agree with the project requirements.

Verify equipment AC loads based on the actual equipment furnished on the project.

Air Quality and Distribution

All simulation, treatment and equipment rooms not required to be under negative pressure shall have positive air pressure with respect to the adjoining areas. This is to help maintain a reduced dust environment with respect to the electronic equipment.

The transferred air should be no more than 150 cfm (71.0 Liters/second) per undercut door.

Design of air distribution system shall be in accordance with criteria given in the HVAC Deign Manual. Provide linear diffusers for the spaces qualified to receive linear diffusers.

Mycobacterium Tuberculosis – Refer to General Comments

Seismic – Refer to General Comments

Noise Level

Select HVAC equipment, ductwork and air distribution devices to achieve noise levels listed in the VA HVAC Design Manual.

Plumbing

Water and Waste Systems

The plumbing systems should be provided to satisfy the departmental plumbing needs. The department domestic cold water should be piped to all plumbing fixtures and equipment re quiring this utility.

The department domestic hot water should be piped to all plumbing fixtures and equipment requiring this utility. A hot water return system should be provided to ensure the design tem perature at the farthest outlet. The department plumbing fixtures and drains should be drained by gravity through soil, waste and vent stacks. In addition, the department special waste should be drained through corrosion resistance flame retardant piping into either a lo cal or centralized acid dilution tank.

Narrative 2-10

Medical Gas Systems

The department medical gases outlets are shown to establish the basis of design guide and its use in planning. The engineers/designers shall verify the medical gases location and quantities for individual projects.

Electrical

Illumination

Illumination is typically provided utilizing recessed fluorescent luminaries with acrylic pris matic lenses. The fixtures typically use F32T8 lamps in compliance with the National Energy Policy Act of 1992, with subsequent revisions in 1998 and 2005. Lamps have a minimum color rendering index (CRI) of 85 and a color temperature of 4100 degrees Kelvin (K), which is close to the “cool white” color temperature of 4150 degrees K. Dimmable fixtures are nor mally used for setup lighting, allowing adjustment of the illumination intensity by the therapist while alignment of the patient to the laser positioning location is facilitated. Lighting intensi ties conform to the VA design criteria, the IES Lighting Handbook, and ANSI/IESNA RP-29 06, the Recommended Practice: Lighting for Hospitals and Healthcare Facilities.

Lighting is typically controlled by wall mounted switches located at the entrance to the room.

Dimmer switches are utilized for variable lighting levels in control and treatment areas. Lar ger spaces may utilize multiple switching by separate switches for lighting of individual zones or areas. Rooms utilized for viewing will typically have direct / indirect lighting systems for visual comfort, reduced glare, reading accuracy, and critical determinations. Dimmer switches are utilized for the variable illumination level.

For Radiation Therapy rooms, fixed or mobile procedure lighting may also be required.

Lighting fixtures utilized in rooms which require special shielding should have proper shield ing provisions per the specific radiation shielding requirements.

Power load densities for lighting are listed by use for the mechanical HVAC load calculation purposes. Load densities should be verified for the actual design, as they may vary depend ing on the room configuration, fixture types, lamps and ballasts used.

Power

Each Hospital determines which specific equipment needs to function during a power outage and be connected to emergency power. Radiation Therapy power requirements have to be specifically coordinated with the equipment manufacturer. Separate power feeds may be re quired for Radiation Therapy computer equipment, power conditioners, and air conditioning systems. General purpose duplex receptacles are typically provided on each wall of a room or space. Workstations with personal computers (PC’s) are typically provided with quadra plex receptacles for the PC, monitor, printer, or PACS workstations.

Duplex receptacles on the critical branch of the emergency power system are provided for selected pieces of equipment (such as refrigerators and PCs) to allow for limited operation during a power outage. All receptacles essential to the specific procedure should be on the critical branch, while the selected Radiation Therapy equipment is on the equipment branch.

If the modality is used for interventional or emergent imaging, provide emergency power re ceptacles as required to support critical equipment and patient care.

Narrative 2-11

Junction boxes are provided for equipment requiring a hardwire connection. Provide shield ing behind all boxes and other penetrations in shielded scanning room surfaces. Certain modular casework units are provided with a utility access module with surface mounted elec trical pre-manufactured raceways, which provides a chase for wiring. Conduits and junctions boxes are provided to connect to the utility access module for power wiring.

Power conditioning and uninterruptible power supplies equipment may be required for Radia tion Therapy equipment, computers, or PACS workstations, where an interruption of power would not be acceptable during a specific procedure. Power conditioning and UPS equip ment require physical space, working clearances, maintenance access, cooling / ventilation access, and coordination with casework.

Power and grounding of modern medical electronic equipment, computers, and displays re quires careful consideration of power quality principles. The basic need for proper voltage and frequency is supplemented by other power quality concerns including:

• Source and load compatibility.

• Distortion of voltage and current wave forms by harmonics present in the power systems.

• Sensitivity and susceptibility of electronic equipment loads to interruptions, surges, har monic wave form distortions, and noise (RF, EMI, etc.).

Power systems and equipment characteristics need to be evaluated to determine effective solutions to reduce the potential sources of interference, reduce the susceptibility of the load equipment, or to apply power conditioning equipment (IEEE Std. 1100-1999, the IEEE Rec ommended Practice for Powering and Grounding Electronic Equipment).

Security and Access Control

Security and access control requirements may apply to selected areas of the Radiation Therapy Suite. Specific Patient Privacy and HIPPA requirements may affect IT system com ponents location, separation from non-secure components, and local staff screen or display orientation. Radiation Materials storage rooms and cabinets, and PACS server rooms and other critical IT infrastructure areas may require access control systems. Radiation detectors and alarms may be required at selected areas of Radiation Therapy.

Life Safety

Purpose

The life safety program should be developed to provide a reliable system to protect the build ing occupants, firefighting personnel, building contents, building structure, and building func tion. This can be accomplished by limiting the development and spread of a fire emergency to the area of origin and thereby reduce the need for total occupant evacuation.

The design aspects of the facility which relate to the fire and life safety include:

Structural Fire Resistance

Building Compartmentalization

Fire Detection, Alarm and Suppression

Smoke Control and Exhaust

Narrative 2-12

Firefighter Access and Facilities

Emergency Power;

Emergency Egress Lighting

Exit Lighting

New hospital construction and renovated areas of existing facilities are required to be fully protected by an automatic fire suppression system.

The minimum width of corridors and passageways in Radiation Therapy areas is 5’-0” in ar eas used by staff. The minimum width of corridors in areas used by inpatients is 8’-0”

Provide handrails on both sides of the corridors in patient areas.

Nurse control areas are permitted to be open to the corridors.

Waiting areas are also permitted to be open to the corridors.

Refer to the latest editions of NFPA 101 “Life Safety Code”, International Building Code and additional standards published by the National Fire Protection Association (NFPA).

Energy Conservation

The HVAC, Plumbing, Power and Lighting Systems should be designed for overall energy ef ficiency and lowest life-cycle cost. This should include the use of high efficiency equipment and fixtures and a programmable control system. The minimum energy standard shall be the latest edition of ASHRAE/IESNA Standard 90.1.

Communications

Telephone

Telephone outlets are typically provided at each workstation or in each room. Desk outlets are 18” AFF and wall phone outlets are 48” AFF. Desk outlets may be combined with modu lar data ports into a single-gang outlet. Certain modular casework units are provided with a utility access module that houses communication outlets and provides a chase for cabling.

Infrastructure will be extended to local telecommunications room via available pathways util izing cable tray, sleeves through fire / smoke partitions, and conduit stubs / backboxes to work area. Conduits and junction boxes are provided to connect to the utility access module for telephone service. Current technologies such as “voice over internet protocol”, or VoIP, and IP wireless systems require coordination with the ADP/LAN telecommunications infra structure.

Automatic Data Processing (ADP)

ADP, or computer outlets, are typically provided at each workstation with a personal com puter (PC) and/or printer. ADP includes local area networks (LAN’s), PACS applications, and wireless LAN’s (WLAN). Desk outlets are 18” AFF. Multi-port telecommunications out lets are provided in accordance with BICSI and ANSI-EIA/TIA standards for telecommunica tions. Infrastructure will be extended to local telecommunications room via available path ways utilizing cable tray, sleeves through fire / smoke partitions, and conduit stubs / back-

Narrative 2-13 boxes to work area. Certain modular casework units are provided with a utility access mod ule that houses communication outlets and provides a chase for cabling. Conduits and junc tion boxes are provided to connect the utility access module for ADP service. Cable and jack identification and color coding are essential to proper administration of the ADP systems.

Public Address

The Radiation Therapy department will not have an independent public address (PA) system.

The department will be included as part of the hospital-wife PA system. Speakers are typi cally located in corridors and public spaces. The actual system configuration will depend on the overall design layout and the functional requirements.

Miscellaneous Systems

A local sound system may be provided for selected Radiation Therapy rooms to provide background music during the procedure. Nurse call and/or intercom systems may be pro vided for communications between the control room and the Radiation Therapy room. A closed circuit TV system may be provided for direct observation of the patient during the pro cedure. Other systems, such as MATV, CATV, or local digital video monitoring may be pro vided.

Waste Management

Medical Waste

Medical waste is generated in exam and treatment spaces where it is bagged, collected and transported to the soiled utility rooms. Then it is held in separate containers pending trans port to the medical waste handling facility.

General Waste

General waste is generated in all spaces and is held in containers for collection and sorting into carts or bagged and placed in a waste chute and transported to the waste handling facil ity.

Recycling

Methods for sorting, collecting, transporting and disposing of recyclable products must be specifically analyzed for each facility and location.

The optional use of disposable and reusable products should be considered.

Soiled Linen

Soiled reusable linens are generated in exam rooms, treatment spaces, and patient and staff gowning areas. They are collected in carts or hampers in the soiled utility room; or bagged and transported to (a) central collection area(s) via soiled linen chutes or carts.

Disposable linens are included with either general recyclable waste or medical waste as ap propriate.

Narrative 2-14

Utensils

Reusable utensils include bedpans, urinals, emesis basins and other stainless steel items, which are used in exam and treatment areas. They are transported to the soiled utility room where they are processed (if steam washers are available) or collected for reprocessing and transported to the Sterile Processing Department.

Space Requirements

Space requirements will vary with the selection of waste collection and recycling methods / systems. Space requirements need to be analyzed for each optional method or system con sidered for new and existing facilities.

Transportation

Records

Radiation Therapy utilizes digital imaging and retrieval techniques. Viewing, interpretation and video image manipulation areas should have data communication access.

Specimens

Specimens may be collected locally in procedure rooms and transported to the pathology lab as required.

Pharmaceuticals

Pharmaceuticals, including narcotics, are transported by pharmacy personnel in locked carts or by a robotic system to the department. Narcotics are delivered to a narcotics locker which is located in a clean supply or patient prep area and is remotely alarmed to the nearest nurs ing control station.

Materials

Clean supplies are transported by exchange carts which are stored in the Clean Supply Room. Supplies are transported by Service Elevator and through hospital corridors sepa rated from patient traffic where possible. Deliveries are scheduled during hours when patient visits are not schedules

Linen

Disposable linens are delivered as part of clean supplies.

Sterile Supplies

The use of sterile supplies is minimal as is accommodated by prepackaged or disposable items delivered with clean supplies.

Narrative 2-15

Food

Meal and nourishment deliveries to Radiation Therapy are not required.

Waste

Waste is collected by housekeeping staff and transported to the Soiled Utility Room, from where it is disposed.

Narrative 2-16

Section 3: Functional Diagrams

Page

Functional Diagram ..................... 3-2

Functional Diagrams 3-1

RADIATION THERAPY: Functional Diagram

Functional Diagrams 3-2

Section 4: Guide Plates Page

Patient Areas

Linear Accelerator

(IMRT) Room & Control Area ...... 4-2

CT Suite Key Plan..................... 4-10

CT Simulator Unit Room ........... 4-11

CT Simulator Control Area ........ 4-13

Ultrasound Planning

Unit Room ................................. 4-22

Treatment Planning

Computer Room-

Dosimetry Room ....................... 4-31

Guide Plates 4-1

LINEAR ACCELERATOR (IMRT) ROOM (XTLA1):

Design Standards

ARCHITECTURAL

Ceiling: Acoustical Tile Ceiling Ceiling Height: Coordinate with

Equip. Manufacturer Wall Finish: Paint Wainscot: - Base: Integral Cove Base Floor Finish: Seamless Sheet Sound Protection: -

Notes:

1. Provide a 4’-0” electro-pneumatic operated neutron shielded door into the Linear Accelerator Room.

2. Consider use of a special design feature to reduce the patient stress level associated with this procedure

LIGHTING

Treatment Room

General: Fluorescent lights will provide higher illumination level up to 75 FC during patient transfer on and from the table, equipment setting, room cleaning, and equipment maintenance.

Special: Incandescent dimmable ‘setup lighting” luminaires controlled by dimmer will provide lower illumination levels down to 10 FC during the laser positioning and treatment. Luminaires shall be located to avoid direct glare for patient comfort.

Decorative ceiling illumination is provided for patient comfort during treatment.

Control Room

General: Fluorescent lights will provide higher illumination level up to 30 FC.

Special: Incandescent luminaires controlled by dimmer will provide lower illumination levels down to 5 FC during treatment procedure scanning for monitor viewing.

Notes:

1. 2’x2’ fluorescent recessed luminaire, acrylic prismatic lens, with (3) FB031T8-U lamps, 4100 K, CRI=85 (minimum).

2. 8-inch dia., recessed incandescent downlight, with recessed Fresnel lens, and 150W/A21 inc. horizontally mounted lamp.

3. Decorative ceiling illumination and features to be determined.

4. Dual head emergency battery pack

5. Master switch with pilot light for control of treatment room lights, set-up lights, laser positioning lights, and CCTV system via Relay box.

POWER

General: The electrical power as shown is to be used as a guide only. Equipment locations, dimensions and wiring requirements should be per the Linear Accelerator system suppliers’ equipment drawings. Step down transformer, power conditioner, UPS unit may be required.

Electrical trades should provide all necessary conduits, openings, bushings, nipples, flexible conduits, surface, recessed, wall mounted and floor raceways, etc., as required at the various junction boxes, duct and conduit terminations to allow proper connections of the treatment equipment and related accessories

Emergency: Emergency power for linear accelerator equipment, controls, and selected receptacles as determined by the Hospital

Notes:

1. 250V, 3P-150A main circuit breaker, with adjustable trip, shunt trip and under-voltage relay, flush mounted for linear accelerator.

2. Emergency Power Off pushbutton station; connect to shunt trip at main breaker. Do not locate in the primary beam area.

3. Door switch with NO/NC contacts.

Connect to the system control circuit.

4. “BEAM ON” and ‘BEAM READY” warning lights. Provide interface with controller via interface relay to match Linear Accelerator equipment requirements. Locate BEAM-ON light next to EPO.

Guide Plates 4-4

5. Laser positioning light interlocked with room lighting and set-up lights;

provide adjacent receptacle.

6. 480V, 3P-60A circuit breaker, with adjustable trip, shunt trip, flush mounted for On-Board Imager (optional).

7. 120V, 1P-30A circuit breaker…