Design, Layout and Shielding of

Medical Facilities

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International Atomic Energy Agency Day 8 – Lecture 1
 Objective

• To become familiar with the safety requirements for

the design of medical facilities
• To understand the principles of shielding and other
radiation safety measures.

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 Contents

• Controlled and supervised areas;

• Design criteria:
• Radiotherapy;
• Nuclear Medicine;
• Diagnostic and Interventional Radiology;

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 Basic Concepts

Locating and siting sources (GSR Part 3, 3.51)

“When choosing a location to use or to store a radiation
generator or radioactive source, registrants and licensees shall
take into account:
a) factors that that could affect the safe management of and control
over the radiation generator or radioactive source;
b) factors that could affect occupational exposure and public
exposure due to the radiation generator or radioactive
source; and
c) the feasibility of taking the foregoing factors into
account in engineering design.”
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 Basic Concepts (cont.)

Controlled area
• “A defined area in which specific protection measures and
safety provisions are or could be required for controlling
exposures or preventing the spread of contamination in normal
working conditions, and preventing or limiting the extent of
potential exposures.” (GSR Part 3 Definitions).

Example: radiotherapy, controlled areas include:

• all treatment rooms;
• brachytherapy source preparation rooms;
• source storage areas.

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 Basic Concepts (cont.)

Supervised area
• “A defined area not designated as a controlled area but for
which occupational exposure conditions are kept under
review, even though no specific protection measures or safety
provisions are not normally needed..”
(GSR Part 3 Definitions).

Example: radiotherapy supervised areas include:

• operator consoles (shielded);
• locations where calculated exposure rates through barriers may
result in doses of 1mSv per year (IAEA TECDOC1040, 1998).

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 Basic Concepts (cont.)

Controlled and Supervised areas

Require:
• restricted access;
• warning signs;
• staff monitoring;
• interlocks, where appropriate;
• written work and emergency
procedures.

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 Radiotherapy

• Radiotherapy
• Design criteria
• Shielding
• Barriers
• Secondary radiation sources
• Neutrons
• Sky shine
• Construction follow-up
• References

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 Design criteria

• In radiotherapy, potentially lethal doses of radiation are

delivered to patients.
• In order to avoid misadministration and to minimize the
exposure of other individuals (staff, visitors, general public)
a radiotherapy facility must be appropriately designed.
Shielding is an essential part of this design process.

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 Radiotherapy facility

The radiotherapy facility is likely to comprise:

• reception areas;
• clinic rooms – to assess and review patients;
• waiting areas;
• diagnostic area - e.g. CT scanner, simulator, dark room;
• treatment units – e.g. 60Co, linacs, superficial / orthovoltage,
HDR brachytherapy;
• treatment planning and mould room;
• dosimetry, physics and electronics areas;
• office space and storage.

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 Brachytherapy treatment area

A brachytherapy treatment area is likely to comprise:

• a shielded room (for manual or remote afterloading

treatments);
• dosimetry and physics area;
• source preparation area may be required (e.g. 192Ir wire
cutting);
• source storage (including emergency storage
arrangements);
• nurses’ station with patient intercom (audio and visual
preferable).
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 Design criteria for new facilities

Some design criteria for new facilities

• When planning a new facility the assumptions made (i.e.
workload, types of treatments, sources etc) must be clearly
stated.
• The licensee must plan for the future and consider expansion
and an increase in the workload.
• Size matters. The area allocated to treatment rooms should be
generous (inverse square law).
• Effective and inexpensive shielding can be obtained by locating
megavoltage treatment rooms in the basement.
• Bunkers should be placed together to make use of common
shielding walls.
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 Design criteria –
External beam therapy

Some design criteria – external beam therapy

Carefully consider:
• the placement of the treatment unit;
• the direction(s) of the primary beam;
• the location of the operator;
• surrounding areas to ensure low occupancy.
• costs:
 can be reduced through careful design;
 of extensions can be large (i.e. consider the provision
for expansion during the initial building phase).
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 Design criteria – external
beam therapy (cont)

Some design criteria – external beam therapy (cont)

• Clear warning signs are required in areas leading to
treatment units.
• Patient and visitor waiting areas should be positioned so
that no person is likely to enter a treatment area
accidentally.
• Patient change areas should be located so that the patient
is unlikely to enter a treatment area accidentally.
• Appropriate shielding must be provided to comply with the
public dose limits and any additional public dose
constraints.
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 Design in treatment rooms

Features of good design in treatment rooms

Interlocks
The possibility of accidental exposure can be minimized by
measures such as interlocks involving (possibly in
combination):
• a door;
• a gate (barrier);
• light beams (that trigger alarms, stop exposures, return
sources to a shielded condition, etc);
• audible alarms.

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 Design in treatment rooms (cont)

Features of good design in treatment rooms (cont)

Emergency “off” buttons

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 Shielding

Aim: To restrict radiation doses to staff, patients, visitors

and the public to acceptable levels.
Different considerations apply to:
• superficial / orthovoltage x-ray units ;
• simulators (see diagnostic and interventional radiology course);
• 60Co units;
• linear accelerators;
• brachytherapy.

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 Shielding (cont)

• must be designed with the advice of a qualified expert.

The regulator’s role is to:
• verify the assumptions and design criteria (e.g. the use of
appropriate occupational and public dose limits and values) are
appropriate;
• ensure that the design has been checked by a qualified expert;
• approve the design (assuming it is satisfactory).
Assumptions must be based on justifiable estimates. Conservative
assumptions should be used as under-shielding is significantly
worse (and more costly) than over-shielding.
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 Shielding (cont)

Types of shielding materials

• Low energy gamma and x-rays - lead; compare with diagnostic

applications.
• High energy (> 500 keV) gamma and x-rays - concrete
(cheaper and self supporting), high density concrete.
• Electrons - usually shielded appropriately if photon
shielding is appropriate.

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 Barriers

Primary
barrier
Maze

Secondary
barrier

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 Secondary radiation sources

Secondary radiation sources – external beam therapy

Leakage:
• depends on equipment design; typically limited to 0.1 to
0.2% of the intensity of the primary beam;
• originates from the radiation source.
Scatter:
• is assumed to come from the patient although patient scatter
may be less than 0.1% of the intensity of the useful beam at
1 metre;
• may be difficult to calculate (use the largest field size and
a scatter phantom for measurements).
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 Neutrons

Determining neutron doses is a complex issue requiring

the services of a qualified expert.
• Neutrons are produced by (γ,n) production from high
energy accelerators (E > 10 MV)

Example:
“A measurement of neutron dose at an accelerator voltage
of 18 MV gave an estimate of 4 mSv per therapy Gray at a
distance of 1 meter from the target.”
Radiation Protection. A Guide for Scientists, Regulators and Physicians.
J Shapiro. 4th edition, 2002.
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 Neutrons (cont)

Neutron activation following the use of high energy

photons will contribute to the radiation dose received by
persons entering the treatment room.
The typical half life of activation products is short with the
most likely elements to be activated being oxygen and
nitrogen i.e. 16O (photon,n) 15O, t1/2 = 2 minutes; 14N (photon,n)
13
N, t1/2 = 10minutes.
A waiting period of about one minute will reduce the activated
radiation levels to approximately one-half.

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 Sky shine

Sky shine is a term given to radiation scattered from the air above
the treatment room.
• If the roof of a treatment facility is not occupied (and if there are
no adjacent structures for which protection is required),
licensees may be tempted to minimize the roof shielding.
• However, this source of scattered radiation can substantially
increase the exposure to persons in adjoining areas.
• When assessing applications for linear accelerators, the
potential contribution of sky shine to occupational and public
doses should be considered.

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 Construction follow-up

• It is essential to verify that construction proceeds as

planned and approved by the Regulatory Authority. The
integrity of the shielding must be assessed during
construction (through inspections by the qualified expert
and RPO) and after installation of the treatment unit (by
radiation surveys).
• Flaws may be in the execution rather than the design.
• Assumptions used in the design must be verified and
regularly reviewed.

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 References

• IAEA TECDOC 1040

• NCRP Report 49
• NCRP Report 51

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 Nuclear Medicine

• Nuclear Medicine
• Defense in depth
• Facilities
• Categorization of the Hazard
• Floors
• Ventilation
• Patient Toilet
• Layout of a Nuclear Medicine Department
• Safety Equipment

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 Nuclear Medicine

Defence in Depth
Source
Shielded container
Work area
Radiopharmaceutical laboratory
Nuclear Medicine Department
Hospital

Weak points?

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 Facilities

• The design of facilities should take into consideration the

type of work and the radionuclides and their activities
intended to be used. The concept of ‘categorization of
hazard’ should be used in order to determine the special
needs concerning ventilation, plumbing, materials used in
walls, floors and work benches.
• The radiation protection officer (RPO) should be consulted
as soon as the planning process commences for
construction or renovation of a nuclear medicine facility or
other hospital radioisotope laboratory.

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 Categorization of Hazard

Categorization of the hazard should be based on:

• calculation of a weighted activity using weighting

factors according to radionuclide used and the type of
operation performed.
Weighted activity Category
< 50 MBq Low hazard
50 MBq - 50 GBq Medium hazard
> 50 GBq High hazard

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 Categorization of Hazard (cont)

Weighting factors according to type of operation

• Type of operation or area Weighting factor
• Storage 0.01
• Waste handling, imaging room (no injection),
• waiting area, patient bed area (diagnostic) 0.10
• Local dispensing, radionuclide administration,
• imaging room (injection), simple preparation,
• patient bed area (therapy) 1.00
• Complex preparation 10.0

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 Categorization of Hazard (cont)

Areas not frequented by patients

High hazard
• Room for preparation and dispensing radiopharmaceuticals.
• Temporary storage of waste.

Medium hazard
• Room for storage of radionuclides.
Low hazard
• Room for measuring samples.
• Radiochemical work (RIA).
• Offices.

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 Categorization of Hazard (cont)

Areas frequented by patients

High hazard
• Room for administration of radiopharmaceuticals.
• Examination room.
• Isolation ward.
Medium hazard
• Waiting room.
• Patient toilet.
Low hazard
• Reception.

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 Floors

• Impervious material.
• Washable.
• Chemical-resistant.
• Coved to the walls.
• All joints sealed.
• Glued to the floor.

No carpet!

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 Ventilation

Sterile room
negative pressure
filtered air

Injection
Laminar air room
flow cabinets

Work bench
Passage
Dispensation
negative pressure

Fume hood

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 Patient Toilet

• A separate toilet room for the exclusive use of injected

patients is recommended.
• A sign requesting patients to flush the toilet
well and wash their hands should be
displayed to ensure adequate dilution of
excreted radioactive materials and minimize
contamination.
• The facilities shall include a wash-up sink as
a normal hygiene measure.

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 Layout of a Nuclear Medicine Department

From high to low activity

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 Safety Equipment

• Shields.
• Protective clothing.
• Tools for remote handling of radioactive material.
• Containers for radioactive waste.
• Dose rate monitor with alarm.
• Contamination monitor.
• Decontamination kit.
• Signs, labels and records.

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Diagnostic and Interventional Radiology

• Diagnostic and Interventional Radiology

• Sources of Potential Exposure

• A Typical X-Ray Room

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 Sources of potential exposure

It is a fundamental assumption that x-ray equipment and its

associated facilities will be designed and installed so as to
minimize the risk of staff and the public (other than patients)
being exposed to the unattenuated primary (useful) x-ray beam.

The remaining two radiation sources against which users and

the public must be protected are:
• leakage radiation from the x-ray tube assembly;
and
• scattered radiation (primarily from the patient).
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 Sources of potential exposure (cont)

The potential radiation dose that might be received by users and

the public depends on:
• the effectiveness of the shielding between them and the
radiation source;
• their distance from the source; and
• the nature and volume of the x-ray workload.
Note: The potential for individuals to receive a radiation dose from more than
one source or at more than one location should be considered i.e. in
determining the effectiveness of shielding it should not be assumed that
the facility under review is the sole facility possibly contributing to an
individual’s exposure.
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 Sources of potential exposure (cont)

Limits on leakage radiation are prescribed in standards e.g.

• for diagnostic x-ray tube assemblies (including collimators)
is 1 mGy in 1 h at 1 m at every power rating specified by the
manufacturer;
• for dental intraoral x-ray tube assemblies (including
collimators); 0.25 mGy in 1 h at 1 m is recommended; and
• for mammography x-ray tube assemblies (including
collimators), an additional limit of 0.01 mGy per 100 mAs at
0.30 m from the side of the assembly facing the patient;

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 Sources of potential exposure (cont)

Scattered radiation
• arises from any object within the x-ray beam (including, but
to a very limited extent in diagnostic radiology, the air
through which the primary x-ray beam passes);

• the intensity of scatter is dependent on a number of factors,

including the intensity of the primary (useful) x-ray beam, the
area of the x-ray beam incident on the patient and the angle
from the primary beam at which scatter is assessed.

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 A Typical X-ray Room

An x-ray room should:

• have adequate safety provisions
to minimize the probability of
Toilet
accidental exposures;
• be designed so that safety
Dark
systems or devices are inherent
Room
X-ray
to the equipment or the room;
Room • take into account the working
Control area required; be appropriate to
the types of examinations to be
performed and the type of x-ray
equipment to be used.
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