You may apply the guidelines; attached

Design Guide for Nuclear Substance Laboratories and Nuclear Medicine Rooms

Canadian Nuclear Safety Commission (May 2010)

In my extensive answer on a previous question you posed on radiation protection, I already referred to some literature that addresses you quenstion. I will not repeat that list.

One issue however is rarely mentioned: The design should include the complete in-door pathway from the unloading dock to the camera-rooms:

Can the floor withstand the loads? :

[a PET/CT typically is 4500 kg and the heaviest module [important for transport] may weight 2500 kg]

A shielded cabinet with 50 mm Pb shielding for FDG-dispensing / FDG-synthesis may weight 6500 kg resting on a square meter.

Can the elevator carry the load ?

Can the camera pass through all doors etcetera. ?

These are issues that must be taken into account early in the design.

Retrofitting a new floor in a hospital while keeping a department up and running can be quite expensive.

Camera's will be replaced several times during the life-time of a building, and closing a department typically costs several thousand euro's per day per camera.

These are issues that a structural engineer can address, but you need to tell him/her about it in a very early phase of the design, else a major cost increase is likely.

Less expensive to retrofit, but equally important:

- Is the electrical power supply adequate ?

- Is a conditioned power supply needed ?

- Is the airconditioning suited to handle the heat load ?

- Is the airconditioning system of a non-recirculating type.

- For the radiopharmacy part: look at the GMP regulations with respect to air pressure, direction of flow, requirements for filtering i.e. HEPA filters

- for the radiopharmacy and any radioiodine therapy units: design of the air exhaust

- depending on local laws and regulations: any requirements to temporary store sewage / wastwater, or to sample it, taking into account the high radiotoxicity of radioiodine

But all of these details can only be filled in, when a list of requirements is given: how many camera's / procedures. How are radio-isotopes made available. What strength generators are anticipated.

The document Mushtaq Ahmad uploaded from the Canadian Nuclear Safety Commission is very usefull for many aspects, but unfortunately  inadequate for the needs of the structural engineer actually designing th econstruction of the building.

Making adjustments of this type to structural designs after the first concrete is poured is VERY expensive.

What must be settled before a structural design is made is:

- number and type of anticipated procedures

- amounts of specific isotopes that may be present

- number and type of anticipated camera's

- cyclotron + synthesis units

- a full radiopharmacy, or just a room to receive prefilled syringes

- a rough basic floorplan

- a rough basic shielding plan

- a list of weignts of all significant equipment

- a requirement for wastwater processing or decaying exists

Then and only then should the full structural desing commence, while a refined floorplan and shielding plan is produced.

Once you know how many patients per day will arrive, you know the required number of camera-rooms, and so on,the  next thing is to consider the lay-out of your department.

This demands a good understanding of practical radiation protection, but also of what types of procedures are going to be performed. Some details may strongly depend on local radiation protection regulations, but also on local customs. All of this is best explained using examples.

Example -1- Assume you are to perform myocardial perfusion scintigraphy studies [MPS] in large numbers: Some hospitals prefer a one day schedule where the rest part is performed in the morning using i.e. 375 MBq of MIBI or tetrofosmine and the exercise part in the afternoon utilizing 750 NBq. This is practical if patients must travel long distances. Otherwise it may be more convenient to schedule both halves of the procedure on separate days.

This has consequences also for the workflow. In the first case larger numbers of patient may stay longer waiting in the department so you must accomodate them while simultaneously ensure that these patients do not add to the radiation burden of your staff. ==> extra waiting room situated so that staff is not exposed

Example -2-  only a single nuclear doctor will run a small department: it is not acceptable that he/she is involved in the exercise procedures as part of MPS, if the exercise room with the ergometer is situated outside the department [i.e. at Cardiology] [medical responsebilities issue]

Example -3- If you choose a working schedule where a single technician follows a patient hroughout a procedure as opposed to a a working schedule where during a time slot one technician gives all i.v injections, while another performs the camera procedures and a third performs the post-processing. In the first scheme, loss of efficiency [staf] and camera-occupance is difficult to avoid unless there is an abundance of equipment, or patient with similar time schedules are cleverly pooled and rigid control over timing is enforced.

I know of a department with 3 SPECT/CT's where technicians 'follow the patient'. The average workload per camera is lower than is possible using the second scheme. But you likely need less waiting room. If too much pressure is put on timing, keeping all work synchronous is difficult, resulting a further loss in efficiency.

This translatetes to waiting room / room for staff requirements.

Example -4- Do you anticipate PET/CT procedures? If yes: only run-of-the-mill FDG, or a mix, i.e. with some 124I, Na18F, 18F-choline between all the FDG-scans.

Do you expect oncology only ? Or all kinds of patients.

Do you anticipate clinical patients, severily ill, i.e. on a respirator, for FDG-PET/CT? [in our hospital it is now 9% of the workload and increasing]

The combination of all of these answers affect the number and the lay-out of all ancillary rooms needed.

To show you how things could evolve:

In our hospital in 2003 we started PET [not PET/CT] in a trailer. We used 2 SPECT-rooms to prepare patients. When PET was performed, the SPECT camera s had to be closed.

In 2008 we obtained a PET/CT housed in a sheelded facility with 3 small prepration rooms, one of which could accomodate a [large & wide] hospital bed with ancillary equipment.

In september we will move to a new building with 2 camera rooms each prepared for a PET/CT and with 8[!] preparation rooms. We are already close to the point where a secont PET/CT is unavoidable. Until that time we will use the second PET/CT room as a large and flexible preparation room for preparing ICU patients on respirator [this additional size is absolutely necessary to avoid large radiation dosages to ICU staff members.

Another aspect of the design: Since 2008 we have a dedicated toilet very closeby the PET/CT area, especially for PET/CT patients.

Now that I mention toilets: even in The Netherlands it can be hardt to convince hospital directors that nuclear medicine staff should have their own staff toilets and should be forbidden to share toilets with patients undergoing nuclear medicine procedures.

-example 5- Every department needs equipment such as a hand and foot monitor so staff can check for contamination. Although such tool takes little space, its placement is quite important. How consistent it will be used depends on its relative position along the normal routing on the department.

Its utility however depends on how wel it is shielded from the increased background levels that are normal in a nuclear medicine department. Remember: each patient is a moving radioactive source.

-example 6 - The work on a nuclear medicine department can be split among specific subgroups of workers, each with a different profile of exposure. Once I gave advise for staff for a new to build PET/CT centre in a former Sovjet Republic. There [and as I understood alse in other former Sovjet-states] common nurses positioned patients for each study, whereas so called dosimetrists did all the more technical things. There a regimen was adhered to, that the dosimetrist had to check after each procedure, to ensure that the patient was 'safe to handle' for the nurses. This resulted in a very considerable loss of efficiency, and led to dose increases to staff-members . It was a difficult topic to discuss then, as it involved scarce jobs. A number of differences in specific choices for the layout of the department could be explained by the [by western standards] .

- example 7- In some countries the work in the radiopharmacy is performed by fully qualified pharmacists or chemists, whereas in other most activities in the radiopharmacies are performed by specially trained technologists while the pharmacist only has a [n important]  supervising role. In The Netherlands it is quite common that a technologist prepares syringes during the first few ours of the morning while doing 'camera-work' for the remainder of the working day.

This can be possible by cleverly designing the labeling process in such a manner that many of the supervising requirements from GMP can be dealt with by software instead of a second person actually present inside the radiopharmacy.

Here the layout of the radiopharmacy should follow the requirements for working under GMP-rule while using a single person.

Such choices can only be made properly if a knowledgeable person guides you, as marked differences exist between countries in this regard. 

The bottom line: involve EXPERIENCED people, both docters, pharmacists and technicians in the design. Often physical radiation protection and procedural radiation protection measures interact and some interchange is possible.

A nuclear medicine department should never be designed by a physicist alone, or a doctor alone, or a pharmacist alone. And technicians should have more than a single opportunity to have their say.

Even the calculation of the required shielding cannot be done by a physicist alone, without risking wasting precious resources.

Seek advice from people with practical understanding and practical experience, preferably acquired on several departments. Be aware of local customs, habits and laws,  don't just copy a design that worked abroad.

This is not a scientific discussion anymore, but an engineering one.

If you're looking for some design guidance on the composition of departments, and the sizes of individual rooms, you might find the VA's Nuclear Medicine Design Guide a helpful starting point - https://www.wbdg.org/ccb/VA/VADEGUID/nucmed.pdf

We helped write the design criteria for this several years ago, and while it doesn't really touch on production facilities, it is hopefully a good start for you with regard to space needs and planning.

In my experience, in  The Netherlands, no consultancy firm exists, that combines knowledge of the operational size AND of the legal side AND of the radiation protection side. So it is extremily important to find a few experienced professionals [not just physicists, but also physicians] to monitor any such project on the sidelide.

Take for example the impact that the introduction of PET and PET/CT has had on the design / radiation protection requirements.

In 2004 I had the [College Bouw Ziekenhuis Voorzieningen] (Dutch Governmental Advisory committee for hospital building visit our place, because we judged that their rules and regulations were not compatible with modern radiation protection standards. [At that time our government had a large say in these matters, as the government financed hospital buildings. This system has been abandonded.]

Any rules and advises should be judged from the perspective of the time frame in which these were formulated. And most certainly, one should think ahead. When we finalized our plans for a new department in 2008, we based it on a prognosis for 2025.

I totally agree with Farshid Salehzani that architects are a risk factor rather than a source of good advice. I have dealt with three designs, 2 full departments and one PET/CT centre and know for certain, we have avoided a financial catastrophe each time, by insisting on full participation in the design loop.

In the beginning we were considered a nuisance. But once the concrete was poured for the foundation, we started inspections. This led to a number of costly findings, causing serious delays. Several things had to be redone. We explained our the board of directors that we would apply for our licens because we considered the findings so serious that it was not worth the effort of writing the application for a license. The board of directors acted promptly and since then we were timely  invited to comment on all major design issues and at various stages we were activily invited to inspect the details, i.e. of how the issue of shielding was solved arond the plumbing, piping and wiring. The constructor was very keen on giving us an opportunity to inspect BEFORE details were hidden by concrete whereever possible.

That no experienced architect can be found in most countries is no surprise. In The Netherlands, only 1 or 2 hospitals are built each year. Assume 5 consortia that build hospitals, no single architect can acquire the experience needed and at the same time keep up with the legal stuff and the radiation protection stuff and also maintaining an up to date overview of what contemporary nuclear medicine is about.

You might seek help from the IAEA in Vienna, where the expert advise is available through the technical co-operation projects. Check also their publication web-site, where all the pdf downloads are free:

http://www-pub.iaea.org/books/IAEABooks/7708/Operational-Guidance-on-Hospital-Radiopharmacy-A-Safe-and-Effective-Approach

@ Dmitry Soloviev: The IAEA is an excellent starting point, but unfortunate not sufficient. Local legislation, compatebility with other rule-making and local practices do enter the design equotation.

For example, the rules and regulations for keeping patients in isolation in Germany after radioiodine therapy necessitate over 2000 dedicated hospital beds, whereas The Netherlands can do with less than 100 beds. This extreme difference can not be explained by population size. Both countries have to apply the same rules under the EurATOM rules. This is a clear example that the IAEA is an excellent, but not sufficient and that large local differences exist.  

The Atomic Energy Regulatory Board has a safety guide published for those planning a nuclear medicine department. Of course the info will be of regulatory nature but since use of radioactivity in all countries are regulated, this guide is useful.

http://www.aerb.gov.in/AERBPortal/pages/English/t/publications/CODESGUIDES/SC-MED-02R.pdf

Also see http://www-pub.iaea.org/books/IAEABooks/7038/Nuclear-Medicine-Resources-Manual

(Quoted from the above site): This manual provides comprehensive guidance at an international level in many aspects of nuclear medicine practice, including education, training, facilities and equipment, quality assurance and control systems, and radiopharmacy and clinical practice. The manual has been written with routine clinical practice in mind and therefore provides advice on many practical points that should help both new and also more developed nuclear medicine centres. The new centres will find specific information essential for setting up the provision of the service, and the more developed centres will find numerous updated protocols and suggestions on improving operational performance. The manual will be of interest to nuclear medicine physicians, radiologists, medical educationalists, diagnostic centre managers, medical physicists, medical technologists, radiopharmacists, specialist nurses, clinical scientists, laboratory scientists, and those engaged in high quality systems in public health.

Dear Dr Rajan

thanks for your perfect references