by
Gus Iversen, Editor in Chief | October 16, 2020
From the October 2020 issue of HealthCare Business News magazine
In-situ poured structural concrete is available all over the world at relatively low cost, any high-density material option can quickly cost 3-10x as much and may have to be shipped in. For shielding calculations, it is not relevant if a material is installed in blocks, or poured in situ; from a cost perspective there is a substantial difference; from a schedule perspective this difference may not be easily measurable.
Underground Construction of the Proton Therapy Vault in very tight site on the campus of King Chulalongkorn Hospital, Bangkok. Courtesy of: Business Alignment PCL, Bangkok
A cost and construction-savvy shielding consultant should review the initial design in the early schematic design phase, and in interactive discussions with key stakeholders come up with an optimized best-guess-design for the stakeholder’s needs (e.g. regulatory, safety, cost, footprint, schedule, etc.). This design should start with conservative wall thicknesses, so that the structural engineers and architects do not have cumbersome change requests later. A complete shielding validation for conventional and future FLASH therapy should start with this best guess design and can take between 3 weeks and 6 months. Ideally the shielding consultant also works with 3D BIM models, so that results can be imported automatically into the architect’s design, and misunderstandings of 2D drawings can be avoided.
HCB News: Back in 2016 you highlighted some of the key performance indicators (KPIs) of a new proton therapy facility. Have there been any major changes in the KPIs in the last four years?
JM: The article in 2016 has sparked many requests from project developers how to define KPIs more relevant to the specific project they were working on. The main process to develop the KPIs is still valid today. For a good tracking of the project’s success, it is necessary to generate detailed KPIs and ensure that they are measurable. Some will focus on design; others will focus on construction execution. KPIs need to be set up by experts of the respective trade and it takes a collaborative effort to set up all KPIs for a project.
HCB News: From start to finish, how long does it take before a proton therapy facility can start receiving patients?
JM: With the right team, and with the willingness of the project developer to move some of the already planned expenditures to the early design phases, the time to first patient can be significantly influenced. An experienced design team can have construction drawings ready three to four months after vendor selection. In many countries, foundation permits can be applied for separately from the main building permit. With this, the construction part can be ready for equipment installation in 10 – 14 months, depending on construction organization and size of the facility. From installation start until handover of the first treatment room to the customer, 10 months seem to be a good estimate from past experience. A typical two to three-month clinical validation period by the user will follow before treatment can begin.
It is unlikely that all phases run smoothly for a project, hence an overall optimistic estimate would be 2.5 – 3 years starting at proton therapy vendor selection until first patient.
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