Cancer Care A Technology Overview

Transcription

1 Cancer Care A Technology Overview AIA Chicago Event # 3 Amy Kerkman Senior Associate - Matthei & Colin Associates Suraj Soudagar Senior Clinical Engineer KJWW Engineering Consultants

2 Presentation Overview Architectural and Technology Planning Amy Kerkman AIA of Matthei & Colin Associates Suraj Soudagar, MS, LEED AP of KJWW Engineering Cancer Care Overview Radiation Oncology Chemotherapy Cancer Centers Radiation Shielding Steven Johnston, PhD of Veritas Medical Solutions

3 Facts Each year 1.5 million people are diagnosed with Cancer in the U.S. It s the second leading cause of death in US. 5 year survival rate increased 49% in the 70 s and 68% in 2008 $201.5 billion overall cost of cancer. Predicted 66,000 new cases in IL alone in 2013

4 Facts

5 Trends (Male)

6 Trends (Female)

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8 How do cancer patients differ from other hospital patients in terms of their physical and emotional needs? A cancer patient keeps coming back. A heart patient or general surgery patient will most likely have a procedure go home and get on with their life. For cancer patients, its not an afternoon event.

9 Treatment Options Surgery Radiation Therapy Chemo/ Infusion Therapy Targeted Therapy Immunotherapy Stem Cell Transplant Photodynamic Therapy Hyperthermia* Molecular Targeted Therapy*

10 What is Radiation Therapy? Radiation therapy uses high-energy X-rays, electron beams, or radiaoactive isotopes to attack cancer. Radiation therapy causes cancer cell death by damaging the chromosomes in the cell so that the cells cannot multiply About half of all cancer patients receive some type of radiation therapy sometime during the course of their treatment.

11 Types of External Radiation Therapy Stereotactic Radiation (SRS) use a single or several stereotactic radiation treatments sessions by LINAC (Cyberknife, GammaKnife, Trilogy, Trubeam, etc.) Intensity-modulated radiation therapy (IMRT) is an advanced type of high-precision radiation using 3D treatment planning tools. Image-guided radiation therapy (IGRT) - utilizing imaging scans (CT, MRI or PET to plan the treatment by LINAC. Particle Therapy energetic protons or carbon ions are directed at the target tumor. Most commonly known as Proton therapy. Brachytherapy delivered by placing radiation source inside or next to the area requiring treatment. Delivered by Afterloader (HDR) Tomotherapy is a type of radiation therapy in which the radiation is delivered slice-by-slice, instead of one dose provided by LINAC.

12 Radiation Therapy Planning Oncologist develops a patient s treatment plan through a process called treatment planning, which begins with simulation. During simulation, detailed imaging scans show the location of a patient s tumor and the normal areas around it. These scans are usually computed tomography (CT) scans, but they can also include magnetic resonance imaging (MRI), positron emission tomography (PET), and/or ultrasound scans.

13 Treatment Plan After simulation, the radiation oncologist with physicist then determines: the exact area that will be treated the total radiation dose that will be delivered to the tumor how much dose will be allowed for the normal tissues around the tumor, and the safest angles (paths) for radiation delivery.

14 Treatment Plan-Immobolization Treatment team finds an appropriate position that patient can maintain for minutes. Vac-lok cushions (polystyrene beads in a vacuum) are customized per patient. A customized thermoplastic mask is used if the patient is receiving radiation to the head or neck.

15 Treatment Plan-Marking Treatment team marks the exact spot where the radiation should be aimed with either marker or tatoo.

16 Radiation Oncology Spaces Waiting Room Exam Rooms Simulator Physics Room Offices Staff Support Changing Rooms Linac Vault Linac Control Room Equipment Room

17 Linac Manufacturers Varian Elekta Siemens Accuray

18 Types of Linacs VARIAN Offering - Clinac Family (ix, 21EX, 2100 EC, etc.) Trilogy True Beam Silhouette Design Elekta Offering - Synergy Axesse Versa HD Compact

19 Linac Vault Locate equipment isocenter and lasers in room. Define Primary Beam Shielding Review with Physicist.

20 Dual Vault Design Location matters Energy Beam Level matters (6 MeV to 20 MeV) Thickness of Primary shielding determined by Physicist

21 Maze v/s Maze less Traditional Design Maze Radiation bounces off Three bounces looses 90% of the power Power Swing Door not too heavy

22 Maze v/s Maze less New Trend Mazeless Small vaults Thick Primary shielding wall Three bounces looses 90% of the power Heavy Sliding Door Need Fire Marshall Approval No studies yet on the benefit of maze less

23 Vault Penetrations - Mechanical

24 Vault Penetrations - Mechanical

25 Vault Penetrations - Electrical

26 Vault Penetrations - Electrical

27 Base Frame Pit Locates Linac machine. Baseframe arrives ahead of Linac so that it can be grouted in pit.

28 Lasers Align patient Currently smaller then in past Typically hidden in a cabinet.

29 Additional Technology BrainLAB ExacTrac Image Guided Targeting

30 REVIT Placement of ExacTrac

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32 Vendor Drawing Review Vendor does review drawings from the Design Team at DD and CD. Provide comments for corrections and re-issuance

33 Linac Vault Zones Patient Waiting TherapistWork Linac Device Storage Linac Spare Parts Linac Equipment

34 Changing Rooms & Sub Waiting Patient should be able to go directly from the changing room to the vault without going into a corridor to maintain privacy and dignity

35 Linac Equipment Room Support Equipment: Modulator, Power Conditioner, Computer Cabinets Can locate supplemental equipment at back of vault or in a separate room. Separate room needs to be adjacent to vault for cable lengths.

36 Linac Storage Needs What needs to be stored? Attachments for Linac Immobilization Devices No longer out of plaster, No need for mold room with sink/plaster trap Face Masks and Vac-Loks

37 Typical Room Storage Applicator Storage (Cones) 6 Cones 20 lbs each BlockTray Storage shelves Custom per patient FFDA Drawers drawers

38 Typical Room Storage General Storage Wedge Tray Storage 8 Trays 15 lbs

39 Storage Design Design Objectives Avoid views of unpleasant objects. Face Masks and Body molds can be frightening to patients. Face Masks and Vac-Loks have patients name. Make sure these are concealed.

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43 Distractions

44 Distractions

45 Distractions

46 Control Room Locate Computers, Keyboards, Linac Equipment, CCTV Counter Height 36, Stools

47 Monitor Mounting Monitor mounting options: Arms (allows up/down adjustment) Rails (allows horizontal adjustment, easily add monitors)

48 Control Room - CCTV Enables Tech to see patient. Mount below counter for patient privacy New TrueBeam sits on countertop to use controls on the monitor face.

49 What is Brachytherapy? Brachytherapy is an umbrella term used to describe three forms of radiation delivery: High Dose Rate (HDR) Low Dose Rate Pulsed Dose Rate These are all delivered via a machine frequently referred to as an afterloader.

50 Brachytherapy Space Planning The room must be shielded to prevent radiation exposure to the adjacent areas. (Walls, floor and ceiling).

51 Proton Therapy Uses a beam of protons to irradiate diseased tissue Advantage More precisely localize the radiation dosage. Studies suggest that proton therapy avoids usual side effects of standard x-ray radiation.

52 Proton Therapy Started 1950s with studies at particle accelerators used for physics research First Center at Loma Linda University Medical Center. Next Center at Massachusetts General Hospital in Currently in US - 10 centers in Operation, 8 in Development

53 Proton Therapy Large size High Cost: $150M-$250M (Nov 2008) The Cyclotron splits hydrogen atoms and then shoots them at the Gantry at 60% the speed of light. (= 4x around the Earth in 1 second.)

54 Chemo Therapy Treatment with an antineoplastic drug. Acts by killing cells that divide rapidly, cancer cells. Also harms cells that divide rapidly under normal circumstances: cells in the bone marrow, digestive tract, hair follicles. immuniosuppression inflammation of the lining of the digestive tract hair loss

55 Chemo Therapy Administered Intravenous (IV) infusion Injected into a body cavity as a shot Orally in the form of a pill

56 Chemo Therapy Hospital based programs Freestanding clinics

57 Chemo Therapy - Spaces Drop-off and pick-up areas Waiting Area Reception Education Area Nurse Station Nourishment Pharmacy Treatment Area Bed or recliner Supplies Support

58 Chemo Therapy Revit Model

59 Hope Children s Infusion Therapy Oak Lawn, IL

60 Chemo Therapy -Equipment

61 CANCER CENTERS

62 Cancer Center Front and side doors Outdoor areas Specialty shops Buy wigs Buy soft clothing Healthy Cafeteria Separate HVAC

63 West Michigan Cancer Center Kalamazoo, Michigan Joint venture between Bronson and Borgess Hospitals Harmonizes with the surrounding historic district. 44,350 square-foot center Center houses- 3 Linear Accelerator 1 HDR 2 Simulators Xray Facilities Pharmacy and Lab.

64 St. Joseph Regional Med Center Plymouth, Indiana 1 Linear Accelerator 1 Simulator Infusion Therapy and Exam Rooms

65 SUMMARY OF DESIGN CONCEPTS Radiation Therapy 1. Protect Patient Privacy 2. Hide Scary Equipment and Devices 3. Provide Visual Distractions

66 SUMMARY OF DESIGN CONCEPTS Chemo Therapy 1. Patient Convenience 2. Patient Choice where to receive treatments 3. Visual Distractions during treatment

67 SUMMARY OF DESIGN CONCEPTS Cancer Centers 1. One-Stop Shopping 2. Healing Environment Spa -like 3. Connection to Nature 4. Accessible/Convenient 5. Control of Environment: Noise, Temperature, and Light

68 Questions?