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*2.1-3.6 Radiation Therapy
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A2.1-3.6 Radiation therapy
- The services included in this section are radiation treatment modalities that use high-energy, non-radioactive beams. The exception to this is brachytherapy, which is a radiation therapy that involves placement of low-dose radioactive material in the body.
- Hybrid imaging/therapy systems. Where external beam radiation therapy systems are combined with a concurrent imaging option (e.g., CT or MRI), the full design criteria for both contributing imaging/therapy devices should be applied to the hybrid service.
Space shall be provided to accommodate the equipment and staff needed for planned radiation therapy services.
*2.1-3.6.2 External Beam Radiation Therapy Suite
A2.2-3.6.2 Simulator room. Although it is not recommended, a simulator room may be omitted in small linear accelerator facilities where other positioning geometry is provided.
2.1-22.214.171.124 Examination Room
2.1-126.96.36.199 Radiation Therapy Room
*(1) Space requirements
(a) Simulator, accelerator, brachytherapy, and cobalt rooms shall be sized to accommodate the following:
(ii) Access to equipment for patient on a gurney
(iii) Medical staff access to the equipment and patient
(iv) Service access to equipment
(b) Radiation therapy rooms shall be sized in compliance with the manufacturer's technical specifications.
(i) Where a table is used, the room shall be sized to provide a minimum clearance of 4 feet (1.22 meters) on three sides of the table to facilitate bed transfer and provide access to the patient.
(ii) The door swing shall not encroach on the equipment or on patient circulation or transfer space.
A2.1-188.8.131.52 (1) Radiation therapy space requirements. The equipment manufacturer's technical specifications should be sought and followed, since space requirements may vary from one machine to another and one manufacturer to another.
2.1-184.108.40.206 Support Areas for the External Beam Radiation Therapy Suite
- Support areas for the linear accelerator. Combining the mold and block rooms shall be permitted.
- A mold room with exhaust hood and hand-washing station shall be provided.
- A block room with storage shall be provided.
- Support area for the cobalt room. A hot lab shall be provided in accordance with Section 2.1-220.127.116.11 (Hot lab for nuclear imaging services).
*2.1-3.6.3 Radiosurgery Suite
A2.1-3.6.3 The radiosurgery suite houses rotating, robotic, or gantry-based external beam therapy systems of higher power and accuracy than conventional external beam therapy systems. These are called gamma knife or cyber knife systems.
- The radiosurgery suite shall be readily accessible to the imaging services suite to facilitate image acquisition prior to radiosurgery treatment.
- Examination room
- An examination room shall be provided for each radiosurgery room except where private pre- and post-procedure patient care stations are provided in the radiosurgery suite; in that case, the examination rooms shall not be required.
- See Section 2.1-18.104.22.168 (Support Areas for Radiation Therapy-Examination room) for requirements.
2.1-22.214.171.124 Radiosurgery Rooms
- Space requirements
- Radiosurgery (i.e., gamma knife/cyber knife) rooms shall be sized to accommodate patient access on a gurney, medical staff access to the equipment and patient, and service access.
- Radiosurgery rooms shall be sized and configured to accommodate the manufacturer's technical specifications.
- A minimum clearance of 4 feet (1.22 meters) shall be provided on all sides of the patient table for maintenance access and clearance around the table sufficient to facilitate patient transfer.
- The door swing shall not encroach on the equipment or on patient circulation or transfer space.
- Hand-washing station. A hand-washing station shall be provided in each radiosurgery room.
2.1-126.96.36.199 Pre- And Post-Procedure/Recovery Accommodations
(1) Where provided, pre- and post-procedure/recovery patient care stations shall meet the requirements in Section 2.1-3.7 (Pre- and Post-Procedure Patient Care).
*(2) A gurney holding area shall not be required if each patient care station has a gurney.
A2.1-188.8.131.52 (2) The gurney hold area is not required in this case because the gurney moves with the patient.
2.1-184.108.40.206 Support Areas for Radiosurgery Rooms
The following support spaces and/or areas shall be provided:
- Space for sterilization of head-frames
- Target planning
- Medication safety zone. See Section 2.1-3.8.8 (Medication Safety Zones) for requirements.
- Storage for head-frames. Location of this at each pre- and post-procedure patient care station shall be permitted.
- Separate toilet room(s) for patients and staff
- Area for sedation of pediatric patients
2.1-220.127.116.11 Additional Support Areas for the Radiosurgery Device
- Frame pin sterilization. A work counter to accommodate a small autoclave shall be provided.
- Source delivery route. Where a radiosurgery device that uses a radioactive source is installed, a delivery route that meets the manufacturer's requirements shall be provided.
2.1-18.104.22.168 Support Areas for Patients in the Radiosurgery Suite
- Where individual pre-procedure/recovery positions in cubicles or rooms are provided, separate patient changing areas shall not be required.
- Storage for patient belongings shall be provided.
2.1-3.6.4 Proton Therapy Suite
- Application. Rooms and spaces shall be provided to accommodate the equipment manufacturer's technical specifications.
- Location. Location of proton therapy facilities in a radiation therapy suite shall be permitted.
- Examination room. Two examination rooms shall be provided for each proton therapy room. See Section 2.1-22.214.171.124 (Support Areas for Radiation Therapy-Examination room) for requirements.
A2.1-126.96.36.199 The proton therapy suite will contain neutron beam therapy and possibly diagnostic x-ray radiation. Proton therapy technology is provided under a wide range of beam dose preparation technologies and dose applications.
*2.1-188.8.131.52 Proton Therapy Room(s)
*(1) Space requirements. Proton therapy rooms shall be sized to:
(a) Accommodate the following:
(i) Proton therapy equipment
(ii) Patient access on a gurney
(iii) Medical staff access to the equipment
(iv) Patient in-room storage of equipment devices
(v) Service access
(b) Accommodate a balance between clinical support requirements and the needs of the specific equipment.
(i) The room shall be sized to provide a minimum clearance of 4 feet (1.22 meters) on three sides of the patient table to facilitate bed transfer and provide access to the patient.
(ii) The door swing shall not encroach on the equipment or on patient circulation or transfer space.
(2) Cyclotron vault. Cyclotron facility program requirements depend on specific proton therapy equipment and facility equipment type.
(3) A hand sanitation dispenser shall be located immediately inside or outside the entrance to the proton therapy room.
A2.1-184.108.40.206 Proton therapy equipment requirements. The space, clearance, access, building system support, and shielding requirements for proton therapy equipment vary greatly from vendor to vendor. Therefore, before undertaking planning and design, the type of proton therapy device to be used should be determined.
A2.1-220.127.116.11 (1) Minimum room size volume and configuration can vary significantly depending on the equipment used.
2.1-18.104.22.168 Gurney Bays
Two gurney hold bays shall be provided for each proton therapy room.
- These shall be located adjacent to the proton therapy rooms and screened for privacy.
- A separate waiting area shall be provided for queued patients.
2.1-22.214.171.124 — 2.1-126.96.36.199 Reserved
2.1-188.8.131.52 Support Areas for Proton Accelerators
The following shall be provided:
(1) General supply storage in proton therapy room for patient care supplies
(2) Storage for patient positioning devices. Location of this storage shall be permitted in or next to the proton therapy room.
*(3) Storage for patient-specific therapy devices (e.g., apertures and compensators)
*(4) Post-treatment storage for patient-specific therapy devices (e.g., apertures and range compensators)
(a) This shall be a separate shielded room. Requirements for radioactive shielding shall be verified by a certified radiophysicist.
(b) This storage room does not need to be in the immediate vicinity of the proton therapy suite.
(c) Sharing of this room with other services shall be permitted.
A2.1-184.108.40.206 (3) These devices are normally stored in the proton therapy room. They can be heavy and sometimes require a cart or wheeled trolley to move and position.
A2.1-220.127.116.11 (4) The need for this storage should be anticipated to allow for the radioactivity level to fall below NRC regulatory limits.
2.1-3.6.5 — 2.1-3.6.6 Reserved
2.1-3.6.7 Special Design Elements for the Radiation Therapy Suite
2.1-18.104.22.168 Architectural Details
(1) The floor structure shall meet the minimum load requirements for equipment, patients, and personnel.
(2) Ceiling-mounted equipment shall have properly designed rigid support structures located above the finished ceiling.
*(3) Where entry into the radiation vault is via direct-shielded door, both a motor-driven automatic opening system and a manual emergency opening system shall be provided.
(4) The height and width of doorways, elevators, and mazes shall allow delivery of equipment and replacement sources into radiation therapy rooms.
*(5) Radiation protection requirements
(a) Radiation protection shall be provided in cobalt, linear accelerator, and simulation rooms; radiosurgery rooms; and proton therapy rooms.
(b) Both photons and neutrons shall be taken into account in the shielding for electron accelerators of higher energy.
(c) Layouts shall be designed to prevent the escape of radioactive particles.
*(d) Openings into the room, including doors, ductwork, vents, and electrical raceways and conduits, shall be baffled to prevent direct exposure to other areas of the facility.
(e) Physicist and vendor input shall be obtained in the design process.
(i) A certified physicist representing the owner or appropriate state agency shall specify the type, location, and amount of protection to be installed in accordance with final approved department layout and equipment selection.
(ii) The architect shall incorporate these specifications into the building plans.
A2.1-22.214.171.124 (3) Use of a maze can greatly decrease the shielding requirement for the shielded door. For higher energy rooms, an extra door constructed of thermal neutron absorbing material at the inside of the maze may reduce the required length for the maze or the shielding requirement for the outside door.
A2.1-126.96.36.199 (5) Detailed discussion and design criteria can be obtained through the documents listed. Also see Section 2.1-188.8.131.52 (Radiation protection).
- National Council on Radiation Protection and Measurements (NCRP) Report 116: Limitation of Exposure to Ionizing Radiation
- NCRP Report 144: Radiation Protection for Particle Accelerator Facilities
- NCRP Report 151: Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities
- Nuclear Regulatory Commission Title 10 CFR Part 20: Standards for Protection Against Radiation
- Sullivan, A. H. A Guide to Radiation and Radioactivity Levels Near High Energy Particle Accelerators (Nuclear Technology Publishing, 1992).
- Tesch, K. "A Simple Estimation of the Lateral Shielding for Proton Accelerators in the Energy Range of 50 to 1000 MeV," Radiation Protection Dosimetry 11:165-72 (1985).
- Tesch, K. "The Attenuation of the Neutron Dose Equivalent in a Labyrinth Through an Accelerator Shield," Particle Accelerators 12:169-75 (1982).
A2.1-184.108.40.206 (5)(d) Ducts should be oriented to minimize direct radiation passing through the aperture and to allow the least possible amount of concrete displacement in the direction of the radiation beam. For rooms that have mazes, the ideal location for duct penetrations is directly through the shielding above the door since that location has the lowest neutron and photon flux. For rooms without mazes, the walls parallel to the gantry (which have lower shielding requirements than those in the gantry rotation plane) should be used for duct penetrations. Detailed discussion of this topic can be found in NCRP Report 151: Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities.
2.1-3.6.8 Support Areas for Radiation Therapy
The support areas in this section shall be provided. Sharing of these areas between different services in the radiation therapy suite or other areas shall be permitted.
2.1-220.127.116.11 — 2.1-18.104.22.168 Reserved
2.1-22.214.171.124 Business Office and/or Reception/Control Area
2.1-126.96.36.199 — 2.1-188.8.131.52 Reserved
2.1-184.108.40.206 Equipment and Supply Storage
- A gurney storage area shall be immediately accessible to the radiation therapy rooms.
- The gurney storage area shall be permitted to be combined with a waiting area.
2.1-220.127.116.11 Environmental Services Room
2.1-18.104.22.168 Examination Room
- Each examination room shall have a minimum clear floor area of 100 square feet (9.29 square meters).
- Each examination room shall be equipped with a hand-washing station.
Optional support areas for radiation therapy. Where the support areas listed are provided, they shall meet the requirements in this section.
- Oncologist's office. Combination of this office with a consultation room shall be permitted.
- Physicist's office. Combination of this office with the treatment planning and record room shall be permitted.
- Consultation room. Private prep/holding rooms shall be permitted to be used in lieu of a dedicated consultation room.
- Quality control area. This area shall have an image viewing station.
A2.1-22.214.171.124 Other support areas for radiation therapy. In addition to the optional support areas in the main text, the following support areas may be needed to support radiation therapy services:
- Treatment planning and record room
- Computer control area. This is usually located just outside the entry to the radiation therapy room(s).
- Dosimetry equipment area or storage for calibration phantoms
- Workstation/nutrition station
2.1-3.6.10 Support Areas for Patients
2.1-126.96.36.199 Patient Toilet Rooms
Toilet rooms reserved for radiation therapy patients shall be directly accessible to waiting areas and procedure rooms.
2.1-188.8.131.52 Patient Changing Area
Two gowning cubicles shall be provided for each proton therapy room.
- Secure storage for valuables and clothing shall be provided.
- At least one space shall be large enough for staff-assisted dressing.
2.1-184.108.40.206 Patient Waiting Areas
- A waiting area for gowned patients shall be provided adjacent to the changing area.
- Provisions shall be made for patient privacy in the waiting area.
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