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HEALTHCARE TECHNOLOGY


or more heat exchangers to remove heat while in standby and with beam-on conditions. This process load is independent of external factors such as weather, occupancy fluctuations, and time of day.


Sizing the equipment for peak load is


recommended, but provisions for turndown must be considered. Standby mode may represent 40 per cent to 50 per cent of the full load. The load while in treatment is for a very short duration and may last only one to two minutes. The other operational consideration is that while the beam is on the load is a function of the beam size. Equipment specs identify the largest beam configuration as the peak load. The second system at Barnes-Jewish Hospital has the capability of generating a 20 cm by 20 cm beam. It is possible, but not probable, that the beam will be operated at its maximum dimensions during treatment. Although this condition is unexpected, the design needs to accommodate this operating condition for the calibration of the equipment. Calibration durations of 30 minutes continuous operation can be expected and represent the largest load on the utilities. It is highly recommended to include detailed BAS trending of chilled water temperatures during setup and calibration. The frequency of trending during operations should be at one-minute intervals until the system profile is demonstrated to adequately maintain temperatures between acceptable limits established by the manufacturer. The data trending should continue but can be at much wider intervals to avoid overwhelming the BAS with data storage. Although large central cooling plants


located on many hospital campuses may have the capacity and efficient operations to support a proton therapy centre, there are many risks in servicing the installation from a central plant. The proton therapy loads are relatively small when compared to a large hospital complex and could be overlooked when maintenance or energy saving modifications are proposed. Mazzetti initially tied our process loads into the main hospital plant and some anomalies in temperature control resulted in clinic shutdowns. The decision to add a


dedicated plant for the proton therapy centre was made at the time a second treatment room and vault were added. The new system is stand-alone, has redundant pumps, chillers, and service heat exchangers. An air handling unit with


redundant fans and redundant computer room units comprise


52 Heat exchanger skid.


Cable tray.


the remaining cooling equipment. These units provide temperature control and ventilation for the occupied areas of the clinic as well as equipment spaces not easily served by direct heat exchange to water. Exhaust fans operate to maintain space pressurisation and are also utilised for clean agent purge upon resolution of the fire or other event that resulted in a release.


Plumbing considerations Hard water can damage the proton therapy equipment and water softeners are necessary to protect the process equipment. Sub-vault drain lines must be sized for all operating parameters and include adequate volume management if a city water backup is implemented for emergency shut down upon loss of cooling. Vaults below grade allow for a less imposing structure from the exterior but can introduce groundwater issues. Sump pumps with duplex or redundant pumps are required to remove groundwater and protect the vault contents. Monitoring of


the sump pumps on the BAS is required and additional water sensors on the floor of the vault are recommended so any events can be attended to rapidly.


Lessons learned Coordination, coordination, coordination! All disciplines involved in the construction of a proton therapy centre must work together with the owner and manufacturers to provide the most reliable and cost-effective solution. Any change to equipment or pathways


to support the treatment must be vetted by all parties during design to determine if the impact is manageable within the project constraints (space, budget, schedule). Educating the owner on the design intent and the operational profiles of the equipment is necessary to instill a complete understanding of the risks associated with under-performing systems and how to maintain operations. Expansion of an existing installation can be disruptive to ongoing treatment in earlier completed phases and great care must be taken to evaluate any disruption to services while adding loads.


The future Proton therapy facilities are increasing in numbers as the real estate and financial burden decreases and demand increases. Meanwhile, patient costs are becoming more likely to be covered by insurance. Fees for service, value-based payment, and alternative payment models are continuously being updated to allow increased access to this crucial treatment option and it will likely expand considerably soon as these considerations are addressed.


IFHE DIGEST 2021


IFHE


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