August 8, 2019

One of the most formidable weapons in the war on cancer is an almost inconceivably tiny particle known as the proton. Approved by the FDA as a treatment for cancer in 1988, proton therapy is a precise radiation therapy that destroys cancer cells without extensive damage to the surrounding healthy tissue. Side effects to patients are typically minimal and less severe compared to standard radiation therapy, and treatment is painless and quick. Once considered cost-prohibitive, proton therapy is now one of the most promising cancer treatments available—particularly for brain, breast, prostate and ocular tumors, and for certain pediatric cancers.

As a healthcare designer specializing in oncology design, I have been involved in integrating proton therapy technologies into both new and existing cancer treatment centers during my 30-year career. If experience has taught me anything, it’s that a client needs to have a good grasp of the ins and outs of proton therapy treatment delivery and the associated design considerations before embarking on what can be a complex venture. In this post, I explore a few of these.



Cyclo or Synchro?

A key question you need to ask yourself when thinking about proton therapy as a service line is what kind of accelerator are you going to use to generate the proton? Two main types of particle accelerators are considered the workhorses of proton therapy treatment—the cyclotron and the synchrotron. Each deliver the proton therapy differently to patients.

Because of these two different approaches, vendor selection is critical as it will inform the design of your proton therapy facility. It’s also vital that you determine your business objectives, including how many patients you plan to treat annually. This will help you decide which treatment modality and equipment is the best choice for your practice. Other key considerations are the beam delivery system (nozzle and gantry), patient-positioning systems, in-room imaging capabilities and equipment access.


You’ve Got to Know Your Stuff

It’s interesting to note that each one of the equipment vendors has what’s called an equipment building interface—or an EBI. So, in theory, any architect with this manual should be able to design a proton therapy center. In reality, however, proton therapy facilities pose some unique design challenges, with the layout, materials and equipment requiring meticulous attention to detail as well as in-depth technical knowledge on behalf of the architect. Unless you know what questions to ask, or how a beamline may be impacted for example, then you don’t necessarily know if you’re getting the design right—or wrong for that matter!



Designing for the Patient & Staff Experience

Most people are in a state of shock when they receive a cancer diagnosis, so it’s extremely important from a healing environment perspective to put the patient at ease. Proton therapy differs from chemotherapy in that a chemo patient can be situated by a window that brings in natural light and perhaps has soothing views to a lake or other natural features.

When you’re receiving radiation, for safety purposes, you’re essentially being treated in a concrete bunker with no daylight at all. On top of that, a patient has to make their way through a concrete maze that’s between 4- to 8-feet thick just to get to the machine. Because it’s so dangerous, no staff are allowed in the vault itself, and everything is carried out remotely via cameras and robotics.

There are, however, some design techniques that can help create positive distractions for patients within the treatment vault. These include mosaics in the ceiling that are integrated into the top of the equipment, as well as the use of colors and tones to help subdue the senses. Even though we can’t bring access to light or nature into the vault itself, we can certainly bring it into the non-treatment spaces and staff work areas. For instance, skylights in the service corridor directly in front of the treatment vaults are a wonderful way to introduce daylight into a space.



The Startup is the Hardest Part!

It often comes as a surprise to clients that the design and construction of a proton therapy facility isn’t actually the hardest part—it’s the testing and startup of the equipment. This has been true of every project I’ve been involved with in my career. The amount of time I’ve spent designing a building has always been less than the amount of time dedicated to calibrating, testing and validating the equipment itself. And this is almost always underestimated in a project. So, if you’re deciding what to worry about, be more concerned about your implementation and testing because that is going to span a longer duration than your design and construction schedule.


Not Your Typical Design

Another important factor to be aware of when designing a proton therapy facility is that is it requires several highly specialized systems requirements that you don’t typically find in a hospital. Therefore, there are special design considerations involved. For example, reinforcing the massive concrete walls of the proton vault requires close coordination with electrical conduit placement to avoid degrading the efficacy of the shielding design. For this reason, working with engineering partners who are just as experienced in these types of systems as the architect is another critical aspect.


Proton Therapy Treatment_Dr. & Patient


Seeing the Big Picture

Before beginning design, I encourage clients to look beyond simply getting into the business of proton therapy treatment but rather explore the bigger picture of how it complements a comprehensive cancer care program. And that’s where Gresham Smith comes in. We take a holistic look at a client’s entire cancer care delivery program and how proton therapy fits within that—from both an operational and facility standpoint. As healthcare designers, we are ever mindful of the wide range of journeys cancer patients experience, which helps inform our design of spaces and places that effectively support the ongoing fight against cancer.