RADIOTHERAPY ROOM LAYOUT.ppt aiims gorakhpur x

radiotherapy room layout

1. RADIOTHERAPY ROOM LAYOUT DR ANJALIKRISHNA NP PG RADIOTHERAPY AIIMS GORAKHPUR 03-05-2024 1

2. Register the institute e-Licensing of Radiation Applications It facilitates online submission for layout approval Licence Registration RSO approval of radiation facilities eLORA

3. RADIOTHERAPY FACILITY DESIGN 03-05-2024 5

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5. 03-05-2024 7 https://www.healthcareexecutive.in/blog/tdesigning-the-new-age-oncology-radiation-therapy-

6. Periphery of the hospital complex. Proximity to adjacent facilities Ready access for in-patients and out patients, Radiological services. Below ground level Reduction in shielding costs for floors & outside walls weighed against the expense of excavation, watertight sealing & of providing access. On or above ground level outside walls always require shielding;& additional structural support for heavy equipment & for the additional weight of shielding barriers. LOCATION OF RT DEPARTMANT 03-05-2024 8

7. RADIOTHERAPY FACILITY DESIGN 03-05-2024 9

8. Basic considerations The medical and physical well-being of the patient (b) Protection of the patient, staff, visitors and other members of the public from radiation hazards (c) Geographical and functional integration of the various activities related to the treatment of the patient. 03-05-2024 10

9. EXTERNAL BEAM RADIOTHERAPY BRACHYTHERAPY Examination rooms Simulator room Treatment planning room Mould room Treatment room Waiting areas Operating theatre Radiographic imaging system Treatment planning room Treatment room 03-05-2024 11

10. EXTERNAL BEAM RADIOTHERAPY 03-05-2024 12

11. Examination Room Close proximity to treatment room. Include standard and gynaecological examination table. Head and neck examination chair. Other appropriate examination instruments and medical supplies. 03-05-2024 13

12. Simulation Room Large enough to accommodate simulator with full range of motion of table. Patient positioning lasers securely mounted on wall at points appropriate for projection of lines through isocentre. Means for dimming room light. Adequate space for cabinetry to store treatment devices and daily used QA equipment. 03-05-2024 14

13. 03-05-2024 15 Simulation Room

14. Treatment Planning Room Should be located in close proximity to simulation room. Should house Treatment planning computers, printer, plotter and other required equipment. Space for viewing CT scan and plane X-ray films. 03-05-2024 16

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16. Mould Room To fabricate custom designed blocks and compensators. Space for tools, a block cutter and counter-top workspace for pouring and mounting the blocks is required. Adequate ventilation should be provided if shielding materials are melted in this area. 03-05-2024 18

17. Treatment Room Should be large enough to accommodate the treatment machine, allowing the full range of motion of the treatment table. Heavy electrically operated door with door interlock. Or an extended corridor (called a maze) leading into the room. Warning sign at the entrance. Means for dimming Room lights. Patient positioning lasers securely mounted on wall at points appropriate for projection of lines through isocentre. Space for a console immediately outside the treatment area overlooking the treatment room door. 03-05-2024 19

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19. WAITING ROOM Separate waiting areas for patients attendants Treatment waiting area should be adjacent to treatment room, with space for seating of about 12 people for each machine. Area for pts on stretchers large enough to accommodate 3 stretchers. Appropriate changing facilities close to entrance of treatment room. 03-05-2024 21

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21. EQUIPMENT IMAGING TREATMENT PLANNING TREATMENT DELIVERY QUALITY ASSURANCE RADIATION SAFETY

22. 03-05-2024 24 Photo of a technician adjusting a linear accelerator built into a gantry

23. 03-05-2024 25 Photo of a gantry turned to an angle of about 45°

24. COLLIMATOR TELE - COBALT LINAC Collimator jaw indication either mechanical /electrical Rotation At least ± 100 Secondary collimators to reduce penumbra - Transparent shadow tray

25. COUCH TELE – COBALT LINAC Table Top should have transparent window exceeding max field size Limits of angle of rotation of top +/- 180 0. +/- 90 Range of patient lateral motion +/- 20 cm Vertical movements should be motorized with min height ≤ 80 cm not < 40 cm below isocentre & At least upto 3 cm above isocentre Longitudinal range ≥ 70 cm Sag of table top should be ≤ 5 mm with patient of 80 kg weight

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27. Radiation shielding Reduce the effective equivalent dose from a linear accelerator to a point outside the room to a level that is determined by individual states. 03-05-2024 29

28. Primary Radiation Secondary barrier for Scattered Radiation Secondary barrier for leakage Radiation Door shielding Protection against neutrons. TYPES OF SHIELDING 03-05-2024 30

29. SHIELDING MATERIALS For new buildings to house radiation treatment facilities, concrete will usually be the material of choice since it is the least expensive. However, if space is at a premium it may be necessary to use a higher density building material. Shielding material Characteristics Lead High physical density - small space requirements High atomic number - good shielding for low energy X-rays Relatively expensive Not self supporting Iron/ Steel Relatively high physical density – space requirements acceptable Self supporting structure - easy to mount Relatively expensive Concrete Cheapest material, easier to bring to site and use for construction Self supporting - Easy to use Relatively thick barriers required for megavoltage radiation. Density varies according to local aggregate- Needs checking More difficult to monitor and control. Other Hematite concrete: thickness is reduced proportional to their densities Walls, bricks, wood, any structure used for building High density concrete (density up to 4g/cm 3 as compared with around 2.3 for normal concrete) Composite materials, eg , metal bits embedded in concrete ( eg . ledite

30. SOURCES OF RADIATION Primary radiation - Directly emitted from treatment machine Scatter radiation - radiation produced by scattering of primary radiation from pt , collimators, beam shaping devices, air, room wall, floor or ceiling. Leakage radiation: Escapes through shielded head of therapy unit 03-05-2024 32

31. Primary barrier - irradiated directly by photons from target or source. Secondary barrier: Scatter of primary Leakage radiation TYPES OF BARRIERS 03-05-2024 33

32. Required Information: Equipment type Workload Limit value in area to be shielded Use factor and direction of primary beam Occupancy of area to be shielded Distance to the area of interest Radiation limit Materials SHIELDING CALCULATIONS 03-05-2024 34

33. Three steps to calculate thickness of shielding material as per NCRP 151 report Establishing a dose value P in a given occupied area. Estimating dose D that would be received if no shielding were to be provided. Obtaining the attenuation factor that is necessary to reduce D to P; for example, finding ratio D/P. 03-05-2024 35

34. LIMIT VALUE(P) Usually 20 mSv per year for occupationally exposed persons, and 1 mSv for public. Occupational exposed persons i.e. only for radiographers, physicists and radiation oncologists . 03-05-2024 36

35. REQUIRED THICKNESS (T) Barrier material such as concrete has a known tenth-value-layer thickness (TVL) (in cm) Thickness required = TVL × log 10 (D/P). 03-05-2024 37 EXPOSURE LEVEL (D) D = WUT / d 2 W = Workload, U = Use factor, T = Occupancy factor, d = Distance

36. WORKLOAD The machine output in Gy per week at a well defined point (usually machine isocentre at 100 cm from the source) in the treatment room. Two components: The clinical workload : workload produced at the point of interest in the treatment room during the treatment of patients. The physics workload : Use of the machine for calibration, quality assurance, phantom measurements, servicing and maintenance. The total workload is the sum of the clinical and physics workload W Total = W Clinical + W Physic

37. Use factor U (for primary barriers ) Fraction of the operating time during which the beam is directed towards a particular barrier. Use factor U for all secondary barriers = 1 USE FACTOR Primary Barrier Use factor Floor 1 Walls 0.25 Ceiling 0.25 Each rotational direction 1 Gantry pointing down 1

38. OCCUPANCY FACTOR Fraction of operating time during which area of interest adjacent to the treatment room is occupied by the individual. Occupancy factor T Offices, full occupancy areas:1 Adjacent treatment room: 0.5 Corridors, employee lounges: 0.2 Waiting rooms:0.125

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40. DISTANCE Distance (d) : Distance in meters from the source to the area to be protected In linacs and isocentrically mounted Cobalt units measured from the isocentre . Very important for shielding as dose falls off with distance squared…...Inverse Square Law

41. BEAM STOPPERS Beam stoppers minimize required thickness of primary barriers . used in installations in which space constraints prevent the use of adequate primary barrier thickness. Treatment machines equipped with beam stoppers are cumbersome with regard to patient setup on machine. With the use of beam stoppers, primary barrier wall thickness becomes close to (but cannot be less than) that required for secondary barriers.

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43. MAZE A restricted access passageway leading to room termed maze. Reduce radiation dose near entrance. Ideally - As long as and with as small a cross-section as possible. A maze ensures that photon radiation can only exit room after multiple scattering has attenuated it. Reduces need for heavy shielding door. Another advantage of a maze is a route for ventilation ducts and electrical conduits without compromising shielding.

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46. DUCTS AND CONDUITS Cables necessary to control treatment unit heating and ventilation ducts, ducts for physics equipment & other service ducts should only penetrate through secondary barriers. No duct with a diameter > 30 mm should penetrate primary shielding. No duct should run orthogonally through a radiation barrier. It could either run at an angle through barrier or have one or more bends in it. Lead or steel plates are suitable materials to compensate for displaced shielding.

47. To shield the scattered radiation that passes along the duct, it is better to place the additional shielding outside the treatment room, Treatment machine cables are usually run below the floor level under the primary or secondary barriers, before bending up to reach the treatment control area. 03-05-2024 49

48. LIST OF ITEMS IN A TREATMENT ROOM

49. THANK YOU 03-05-2024 51