IPEM Report 75, 2nd Edition
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Design and Shielding of Radiotherapy Treatment Facilities IPEM Report 75, 2nd Edition
Series in Physics and Engineering in Medicine and Biology Editorial Advisory Board Members Frank Verhaegen Maastro Clinic, the Netherlands Carmel Caruana University of Malta, Malta Penelope Allisy-Roberts formerly of BIPM, Sèvres, France Rory Cooper University of Pittsburgh, USA Alicia El Haj Keele University, UK John Hossack University of Virginia, USA About the Series Series in Physics and Engineering in Medicine and Biology will allow IPEM to enhance its mission to “advance physics and engineering applied to medicine and biology for the public good.” Focusing on key areas including, but not limited to: clinical engineering diagnostic radiology informatics and computing magnetic resonance imaging nuclear medicine physiological measurement radiation protection radiotherapy rehabilitation engineering ultrasound and non-ionising radiation.
Design and Shielding of Radiotherapy Treatment Facilities IPEM Report 75, 2nd Edition Patrick Horton Royal Surrey County Hospital, Guildford, UK David Eaton Mount Vernon Cancer Centre, London, UK IOP Publishing, Bristol, UK
ª Institute of Physics and Engineering in Medicine 2017 IPEM Report 75 2nd Edition is an update of IPEM Report Number 75, a report produced by the Institute of Physics and Engineering in Medicine Whilst every attempt is made to provide useful and accurate information, neither IPEM, nor the members of IPEM nor any other persons contributing to the content of this publication make any warranty, express or implied, with regard to the accuracy or completeness of the information contained in it. Nor do any such parties assume any liability with respect to the use, or consequences of use, of the information contained in this publication. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher, or as expressly permitted by law or under terms agreed with the appropriate rights organization. Multiple copying is permitted in accordance with the terms of licences issued by the Copyright Licensing Agency, the Copyright Clearance Centre and other reproduction rights organisations. Permission to make use of IOP Publishing content other than as set out above may be sought at permissions@iop.org. Patrick Horton and David Eaton have asserted their right to be identified as the authors of this work in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. ISBN ISBN ISBN 978-0-7503-1440-4 (ebook) 978-0-7503-1441-1 (print) 978-0-7503-1442-8 (mobi) DOI 10.1088/978-0-7503-1440-4 Version: 20170701 IOP Expanding Physics ISSN 2053-2563 (online) ISSN 2054-7315 (print) British Library Cataloguing-in-Publication Data: A catalogue record for this book is available from the British Library. Published by IOP Publishing, wholly owned by The Institute of Physics, London IOP Publishing, Temple Circus, Temple Way, Bristol, BS1 6HG, UK US Office: IOP Publishing, Inc., 190 North Independence Mall West, Suite 601, Philadelphia, PA 19106, USA
Contents Preface xiii Acknowledgments xv Author biography xvi Contributors xviii 1 The design and procurement process 1.1 1.2 1.3 Introduction Strategic proposal and business case for a new development Design team 1.3.1 General 1.3.2 Minor capital schemes 1.3.3 Major capital schemes 1.3.4 Public private partnership Process, tenders and contracts 1.4.1 Minor capital schemes 1.4.2 Major capital schemes 1.4.3 Public private partnership Construction Acceptance and handover 1.6.1 Buildings and services 1.6.2 Radiotherapy treatment facilities Commissioning 1.7.1 Clinical services 1.7.2 Equipment commissioning Project evaluation References 1.4 1.5 1.6 1.7 1.8 2 The design of radiotherapy facilities 2.1 2.2 2.3 2.4 2.5 2.6 General Linear accelerators Cobalt-60 units Kilovoltage units Brachytherapy Particle therapy References 1-1 1-1 1-3 1-5 1-5 1-5 1-6 1-8 1-8 1-8 1-9 1-11 1-11 1-13 1-13 1-13 1-15 1-15 1-15 1-15 1-15 2-1 2-1 2-1 2-9 2-9 2-10 2-14 2-15 v
Design and Shielding of Radiotherapy Treatment Facilities 3 Radiation protection requirements 3.1 3.2 Introduction Quantities and units 3.2.1 Radiation exposure and dose 3.2.2 Operational quantities 3.2.3 Dose rate 3.3 System of radiation protection 3.4 Regulatory framework in the UK 3.5 Basic radiation protection principles in radiotherapy 3.5.1 Justification 3.5.2 Optimisation 3.5.3 Dose limitation 3.6 Controlled areas 3.7 Optimisation in the design process 3.7.1 The radiation protection working year 3.7.2 Occupancy factors 3.7.3 Annual dose constraints 3.7.4 Time averaged dose rate 3.7.5 Instantaneous dose rate 3.7.6 Other dose constraints/time averaging 3.8 Engineering controls 3.9 Prior risk assessment 3.10 Additional regulatory requirements 3.10.1 Investigation level and personal dose monitoring 3.10.2 Critical examination 3.10.3 Warning signs 3.10.4 Quality assurance and maintenance 3.10.5 Incidents 3.10.6 Contingency plans References 4 Clinical practice, treatment room and control room design 4.1 Clinical practice 4.1.1 General 4.1.2 Treatment modalities 4.1.3 Information required for shielding calculations Treatment room design 4.2 vi 3-1 3-1 3-2 3-2 3-3 3-4 3-4 3-5 3-7 3-7 3-7 3-8 3-8 3-9 3-9 3-9 3-11 3-11 3-11 3-12 3-12 3-14 3-15 3-15 3-17 3-17 3-19 3-19 3-20 3-21 4-1 4-1 4-1 4-2 4-10 4-15
Design and Shielding of Radiotherapy Treatment Facilities 4.3 4.2.1 Introduction 4.2.2 Internal dimensions 4.2.3 Site access 4.2.4 Lintels, baffles and nibs 4.2.5 Room access arrangement—last person out (search button) 4.2.6 Emergency stops 4.2.7 Lighting arrangements (including alignment lasers) 4.2.8 Services 4.2.9 Gating interfaces 4.2.10 Motion management systems 4.2.11 Storage solutions 4.2.12 Finishes and fittings Control room design 4.3.1 Introduction 4.3.2 Control room dimensions 4.3.3 Patient access arrangements 4.3.4 Treatment room door operation 4.3.5 Warning lights/signs 4.3.6 Equipment status notification 4.3.7 Lighting arrangements 4.3.8 Electrical services and IT connectivity References 5 Empirical shielding calculations for treatment rooms with linear accelerators 5.1 5.2 General principles Primary barriers 5.2.1 General 5.2.2 Annual dose 5.2.3 Dose rate measures and verification of shielding 5.2.4 Primary barrier width Secondary barriers 5.3.1 General 5.3.2 Annual dose 5.3.3 Dose rate measures and verification of shielding Roofs and skyshine Groundshine 5.3 5.4 5.5 vii 4-15 4-15 4-16 4-17 4-17 4-18 4-19 4-19 4-21 4-22 4-22 4-24 4-24 4-24 4-24 4-25 4-26 4-26 4-27 4-27 4-27 4-27 5-1 5-1 5-2 5-2 5-4 5-6 5-7 5-8 5-8 5-12 5-13 5-15 5-16
Design and Shielding of Radiotherapy Treatment Facilities 5.6 5.7 Obliquity factor X-ray scatter down the maze 5.7.1 Scatter of the primary beam from the bunker walls 5.7.2 Scatter of the primary beam by the patient 5.7.3 Scatter of head leakage radiation by the bunker walls 5.7.4 Transmission of head leakage radiation through the inner maze wall 5.7.5 Total x-ray dose rate and annual dose at the maze entrance 5.8 Neutron scatter down the maze 5.9 Maze doors and lining 5.10 Direct doors 5.11 Laminated walls and roofs 5.12 Spreadsheet approach for primary and secondary shielding References 5-16 5-18 5-20 5-25 5-28 5-29 5-31 5-32 5-35 5-37 5-38 5-40 5-40 6 Monte Carlo methods 6-1 6.1 6.2 6.3 Introduction Available Monte Carlo codes and deciding which one to use Using the MCNP code 6.3.1 Specification of the source characteristics 6.3.2 Specification of the room geometry and materials to be simulated 6.3.3 Description of the tally volumes and types 6.3.4 Other input cards 6.3.5 Executing the problem in a reasonable time 6.3.6 Validating the simulations 6.3.7 Results and their interpretation 6.3.8 Enhanced particle track visualisation capabilities Using the FLUKA code MCNP, induced neutrons and particle therapy Calculation of whole-body doses Summary References 6-1 6-2 6-4 6-4 6-5 6.4 6.5 6.6 6.7 6-6 6-6 6-7 6-7 6-8 6-9 6-10 6-13 6-14 6-15 6-16 7 Shielding materials and construction details 7-1 7.1 Introduction 7.1.1 Poured concrete 7.1.2 High density concrete 7-1 7-2 7-3 viii
Design and Shielding of Radiotherapy Treatment Facilities 7.2 7.3 7.1.3 Blocks 7.1.4 Steel sheet 7.1.5 Lead 7.1.6 Sandwich construction 7.1.7 Earth Materials with unspecified TVLs Construction details 7.3.1 Formwork, shuttering, tie bolts and reinforcement for poured concrete 7.3.2 Block construction 7.3.3 Nibs in bunkers 7.3.4 Lintels 7.3.5 Ducts and cableways 7.3.6 Direct doors 7.3.7 Wall fixings 7.3.8 Warning lights References 8 Specialist applications: Gamma Knife , TomoTherapy and CyberKnife 8.1 The Gamma Knife 8.1.1 Introduction 8.1.2 Sources and source loading 8.1.3 Treatment room design considerations 8.1.4 Shielding considerations TomoTherapy 8.2.1 Introduction 8.2.2 Basic operation 8.2.3 Machine calibration 8.2.4 Shielding considerations 8.2.5 Workload 8.2.6 Leakage 8.2.7 Scatter 8.2.8 Primary beam 8.2.9 Summary of practical considerations for shielding 8.2.10 Case study: installation into an existing cobalt-60 bunker Acknowledgements 8.2 ix 7-4 7-5 7-5 7-5 7-6 7-6 7-8 7-8 7-10 7-10 7-12 7-13 7-15 7-16 7-16 7-18 8-1 8-1 8-1 8-2 8-4 8-6 8-11 8-11 8-13 8-13 8-14 8-14 8-16 8-18 8-19 8-21 8-21 8-25
Design and Shielding of Radiotherapy Treatment Facilities 8-25 8-25 8-26 8-30 8-31 8-32 8-33 8.3 CyberKnife 8.3.1 Introduction 8.3.2 CyberKnife specification 8.3.3 Typical CyberKnife bunker features 8.3.4 Worked example: primary barriers 8.3.5 Worked example: secondary barriers References 9 Kilovoltage therapy and electronic brachytherapy 9.1 9.2 Superficial and orthovoltage therapy 9.1.1 Introduction 9.1.2 Superficial therapy 9.1.3 Orthovoltage therapy 9.1.4 Example of superficial/orthovoltage room protection Electronic brachytherapy and intra operative radiotherapy 9.2.1 Intraoperative (x-ray) radiotherapy 9.2.2 Superficial x-ray brachytherapy 9.2.3 Small animal irradiators 9.2.4 Intraoperative (electron) radiotherapy (IOERT) References 9-1 9-1 9-1 9-3 9-4 9-6 9-6 9-7 9-9 9-9 9-10 10 Brachytherapy 10-1 10.1 Treatment modes 10.2 Regulatory considerations 10.2.1 Use of radioactive material 10.2.2 Work with ionising radiation 10.2.3 Patient protection 10.3 Room design 10.3.1 General considerations 10.3.2 Engineering controls 10.3.3 Security 10.4 High dose-rate afterloading 10.4.1 Workload 10.4.2 Room layout 10.4.3 Calculation of shielding thickness 10.4.4 Maze/door calculations 10.4.5 Engineering controls x 9-1 10-1 10-6 10-6 10-6 10-6 10-6 10-6 10-7 10-7 10-7 10-7 10-8 10-9 10-11 10-12
Design and Shielding of Radiotherapy Treatment Facilities 10.5 Pulsed dose-rate afterloading 10.5.1 Workload 10.5.2 Layout 10.5.3 Shielding calculations 10.5.4 Engineering controls 10.6 Permanent implants: iodine-125 seeds 10.7 Eye plaques References 11 Radiation shielding and safety for particle therapy facilities 11.1 11.2 Introduction Sources of extraneous radiation 11.2.1 Beam interactions within the accelerator during the acceleration process 11.2.2 Beam interactions with the beam extraction system or deflector 11.2.3 Beam interactions with the energy selection system 11.2.4 Beam interactions in the beam transport line 11.2.5 Beam interactions with the treatment nozzle 11.2.6 Beam interactions in the patient 11.3 Design and build process considerations 11.4 Regulatory requirements and design criteria 11.5 Workload, use and occupancy factors 11.5.1 Beam energy 11.5.2 Beam use 11.5.3 Orientation factor 11.5.4 Occupancy factors 11.5.5 Work patterns and staff positioning 11.5.6 Future-proofing 11.5.7 Uncertainties 11.6 Construction materials 11.7 Theory of radiation transport: solving the Boltzmann equation 11.8 Practical shielding calculations 11.9 Monte Carlo calculation methods 11.10 Mazes and ducts 11.10.1 Mazes 11.10.2 Ducts xi 10-14 10-14 10-14 10-15 10-16 10-17 10-18 10-19 11-1 11-1 11-4 11-4 11-5 11-5 11-7 11-7 11-10 11-10 11-14 11-15 11-16 11-18 11-18 11-18 11-19 11-19 11-20 11-20 11-21 11-22 11-25 11-29 11-29 11-31
Design and Shielding of Radiotherapy Treatment Facilities 11.11 Room interlocks and monitoring 11.12 Radiation hazards resulting from activation 11.12.1 Solid material activation 11.12.2 Water and air activation 11.12.3 Risks from activation 11.12.4 Radioactive solid waste 11.13 Measuring and monitoring techniques and instrumentation 11.14 Summary References 12 Shielding verification and radiation surveys 12.1 12.2 12.3 Introduction During construction Post construction radiation survey—detailed shielding integrity testing 12.4 Preliminary safety assessment 12.5 Critical examination 12.6 Radiation surveys 12.6.1 Radiation monitoring equipment 12.6.2 Linear accelerator bunker checks 12.7 Surveys of kilovoltage equipment 12.8 Surveys of brachytherapy facilities 12.9 Surveys of CT scanners 12.10 Validation of results References 11-32 11-34 11-34 11-35 11-37 11-38 11-38 11-39 11-40 12-1 12-1 12-2 12-3 12-4 12-4 12-6 12-6 12-7 12-9 12-10 12-10 12-10 12-11 13-1 Glossary xii
Preface Soon after the discovery of x-rays, it became clear that these ‘healing rays’ could also cause harm. Early pioneers of radiology and radiotherapy gave little thought to radiation protection, and their own health paid the price. Current units are governed by strict legislation, which in the UK requires the involvement of a radiation protection advisor (RPA) in the design and verification of radiation facility shielding. National and international guidance on best practice supports the RPA in these endeavours, and the publication of IPEM Report 75 in 1997 provided a solid foundation for many years of safe and effective shielding. However, there have been significant developments in treatment techniques and room design recently, which have provided one impetus for this updated report. Other international reports are available (NCRP 2005, IAEA 2006), but these are not always comprehensive in their scope and also lack the latest developments. In particular, the introduction of intensity modulated radiotherapy (IMRT), with longer radiation beam-on times, has directly affected greater secondary bunker shielding, and flattening-filter-free (FFF) beams with higher dose rates have questioned the need for increased primary barrier protection. Variable use of instantaneous and time-averaged dose rates gives the potential for shielding to be excessive. Specialist applications have altered the usual proportion of primary and secondary shielding. At the same time, new and reliable higher density shielding materials have come onto the market, and new bunker designs using doors instead of mazes have been built based on the desire to save space and cost, as popularised in North America. Finally, the increase in the accuracy and speed of Monte Carlo simulation makes it an attractive complement, or even replacement, for empirical calculation for shielding design and visualisation. Specific updates in this report include: radiation protection requirements, related to current and successor legislation based on the European Community Basic Safety Standards, the effect of modern treatment techniques such as IMRT, volumetric intensity modulated arc therapy, stereotactic body radiotherapy and FFF linear accelerators on the radiation protection of facilities, Monte Carlo simulation and visualisation of x-ray and neutron scatter in linear accelerator bunkers for comparison with established shielding calculation methods, current brachytherapy techniques, new shielding materials and bunker designs, specialised techniques such as TomoTherapy , Gamma Knife and CyberKnife , current kilovoltage practice, including novel electronic brachytherapy devices and shielding for particle therapy (proton and carbon ion) facilities, since such facilities are becoming increasingly widespread, including in the UK. xiii
Design and Shielding of Radiotherapy Treatment Facilities The concept of updating IPEM Report 75 first originated from an IPEM Scientific Meeting in 2009 entitled Current Developments in the Design of Radiotherapy Treatment Room Facilities, and showed even then how much treatment techniques and bunker design had developed since Report 75. The second impetus for a new report was to capture the extensive experience gained by medical physicists in the UK through the expansion of NHS radiotherapy facilities through the National Opportunities Fund and subsequent initiatives. The original IPEM working party for this report comprised P W Horton (chair), E G Aird, W P M Mayles, D J Peet and R M Harrison. With the help of IPEM’s Radiotherapy Special Interest Group, the number of contributors has been expanded considerably in order to achieve a comprehensive scope. In addition to writing their original contribution, everyone has played a part in developing the overall report. Almost all the contributors are from the UK, but the breadth of the scope, and depth of the detailed worked examples, will hopefully be of benefit to those in all countries. The report is primarily intended for Qualified Experts in radiotherapy physics and radiation protection, such as RPAs, but will also be of use to administrators, planners, architects, constructors and others involved in the design of radiotherapy facilities. P W Horton Perth February 2017 D J Eaton London xiv
Acknowledgments A full list of contributors is given. The editors are most grateful to them for their contributions and the time and effort they have put into reviewing all parts of the report. The editors are also extremely grateful to the two external general referees, Dr D Temperton and Mr J Thurston, and the specialist external referee for chapter 11, Dr R Lüscher, for their thorough reviews and constructive comments which enhanced the final report. The editors and contributors are also grateful to Accuray Incorporated, Elekta Instruments AB and Varian Medical Systems for permission to use their illustrations and diagrams. (PWH) Many thanks to my wife, Roberta, who has been living with this project almost as long as I have. (DJE) Many thanks to Pat, my co-editor, for persevering with this project since its inception seven years ago. Thank you to Rosie, my wife, for correcting my errant ideas on radiation protection, and to my beautiful children, Deborah and Jonathan, for making me smile every day. Soli de gloria. xv
Author biography Patrick Horton Professor Horton has a BSc in Physics from Imperial College, London and a PhD from the University of Manchester. He began his medical physics career in the Department of Clinical Physics and Bio-engineering of the West of Scotland Health Boards, initially as a Senior Physicist in Radiotherapy and latterly as a Principal Physicist in Nuclear Medicine, both at the Western Infirmary in Glasgow. He was next appointed as the first Head of Department of the Department of Medical Physics and Bio-engineering at the Riyadh Armed Forces Hospital in Saudi Arabia, where he established a new department which played a key role in the introduction of radiotherapy, nuclear medicine and complex radiology. He returned to the UK to become Head of the Department of Medical Physics at the Royal Surrey County Hospital, Guildford and Honorary Professor of Medical Physics at the University of Surrey. He was also Quality Assurance Director of the NHS Breast Screening Service in the South East (East) Region, for 14 years, responsible for the breast screening centres in Kent, Surrey and Sussex. Since retiring from the NHS he has worked as a consultant to construction companies building new cancer centres in the UK and abroad, on projects for the European Community and the International Atomic Energy Agency and lectured at the European School of Medical Physics on installation shielding in radiotherapy. Publications include one book, several book chapters and 115 scientific papers and reports on medical physics topics. He is a Fellow of the Institute of Physics and Engineering in Medicine, the Institute of Physics and the Institution of Engineering and Technology. He is also a member of the British Institute of Radiology and the American Association of Physicists in Medicine. David Eaton David Eaton received his undergraduate degrees (MA MSci) in natural sciences (physical) from Gonville and Caius college, Cambridge in 2003, returning to collect his PhD in intraoperative radiotherapy physics several years later. He trained as a clinical scientist at Addenbrooke’s hospital, Cambridge, then worked as a radiotherapy physicist at the Royal Free Hospital in London. Currently, he is the lead clinical scientist for the UK radiotherapy trials quality assurance group (RTTQA), based at Mount Vernon hospital in London. He has published widely on intraoperative radiotherapy, kilovoltage dosimetry and clinical trials QA, with about 30 papers and book chapters, and 50 conference abstracts. As well as writing and reviewing for a range xvi
Design and Shielding of Radiotherapy Treatment Facilities of journals, he is an associate editor for the British Journal of Radiology and the Indian Journal of Medical Physics. He is a fellow of the Institute of Physics and Engineering in Medicine (IPEM), a recipient of their president’s prize and founders’ award, and chair of the IPEM radiotherapy special interest group, who commissioned this report. xvii
Contributors Edwin G Aird Mount Vernon Cancer Centre, Northwood, UK Richard Amos University College Hospital, London. UK Mary Costelloe Oxford University Hospitals, UK David J Eaton Mount Vernon Cancer Centre, Northwood, UK Francesca Fiorini CRUK and MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, UK Zamir Ghani Neutron and Gamma Diagnostics, UK Atomic Energy Authority, Culham Centre for Fusion Energy, Abingdon UK Stuart Green Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK Tony Greener Guys and St Thomas’ NHS Hospital Foundation Trust, Cancer Centre, Guys Hospital, London, UK Mark J Hardy Radiotherapy Physics Group, Christie Medical Physics and Engineering The Christie NHS Foundation Trust, Manchester, UK xviii
Design and Shielding of Radiotherapy Treatment Facilities Roger M Harrison University of Newcastle, UK Patrick W Horton Medical Physics, Royal Surrey County Hospital, Guildford, UK Colin J Martin University of Glasgow, UK Richard Maughan University of Pennsylvania, Philadelphia, USA W Philip M Mayles Clatterbridge Cancer Centre NHS Foundation Trust, UK Debbie J Peet Medical Physics Department, Leicester Royal Infirmary, Leicester, UK David Prior Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Jill Reay Aurora Health Physics Services Ltd, Didcot, UK Tracey Soanes Medical Physics and Clinical Engineering, Sheffield Teaching Hospitals, UK Michael J Taylor Division of Molecular and Clinical Cancer Sciences, The University of Manchester, Manchester, UK Chris Walker Northern Centre for Cancer Care, Newcastle upon Tyne, Hospitals NHS Foundation Trust, UK Lee Walton Medical Physics and Clinical Engineering, Sheffield Teaching Hospitals, UK xix
12 Shielding verification and radiation surveys 12-1 12.1 Introduction 12-1 12.2 During construction 12-2 12.3 Post construction radiation survey—detailed shielding integrity testing 12-3 12.4 Preliminary safety assessment 12-4 12.5 Critical examination 12-4 12.6 Radiation surveys 12-6 12.6.1 Radiation monitoring equipment 12-6
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