Facility Requires Flexible Planning

By Lisa Doyle | September 28, 2010

When it comes to technology, staying ahead of the curve can be difficult in the medical field. New facilities can plan to offer the most up-to-date treatment options, but advancements in those treatments can occur in less time than it takes to erect the bones of the new building. Getting the latest and greatest in medical technology in a new facility means managing a complex construction process. The new ProCure Treatment Center in Oklahoma City, Okla., is one example of a facility that requires close management and open lines of communication between the owner, medical equipment manufacturer, contractor, and subcontractor.

Owned by ProCure Treatment Centers, Inc. and their physician partners, the project broke ground in April and is scheduled for completion in 2009. The $95-million, 55,000-square-foot facility will be one of seven proton therapy treatment centers in the country, and will offer revolutionary cancer treatment for up to 1,500 patients annually. ProCure's hospital partner, INTEGRIS Health, the largest hospital system in the state of Oklahoma, will provide complementary services to proton therapy patients in their campus surrounding the center. Proton therapy uses a controlled beam of protons to halt the growth of cancer cells in a tumor. Nearly 50,000 cancer patients have taken advantage of this technology to effectively treat the most common types of cancer, including head and neck, prostate, breast, lung, colorectal, and brain tumors. The procedure is non-invasive, painless, and destroys tumors more effectively than traditional forms of radiation therapy, while greatly reducing damage to the surrounding healthy tissue. Proton therapy's ability to precisely target tumors makes it ideal for treating tumors near vital organs, particularly in children, who are more sensitive than adults to the effects of radiation.

"One of the complexities of this project is that the technology for the equipment that is being used here, is still being refined in design," says Craig Fredrickson, vice president, client executive for Linbeck, construction manager for the project. "We have meetings every week to see if we have any updates for confirmation of what we have planned."

Changes to the project have run from relocation or addition of electrical conduits to modifications that will allow the use of robotics in the treatment area, for placement of patients. The nature of the building itself can complicate these changes, as thick concrete walls are necessary to shield areas outside of the treatment area from radiation. Concrete walls and ceilings are in excess of 6 feet in some areas, a density that is necessary when shielding from protons.

"Many of the conduits are imbedded in the concrete," says Fredrickson. "In addition, we have to pay attention to the spacing and routing of the conduits, so that we do not affect the integrity of the shielding."

Robotics, which have only been used in a few facilities, have also been added to the equipment for the ProCure Treatment Center. Robotics for the facility are still in the design stage. They will be suspended from steel plates imbedded into the ceilings and walls. Additions like this require constant tweaking during the construction process to make certain that the facility will accommodate this equipment.

Fredrickson says that, although Linbeck has managed the construction of a proton therapy treatment center in the past, the equipment is always changing. "Accommodating the equipment is something the team has to be disciplined and diligent about. We get updates and comments on a weekly basis.

"We can't make a mistake. When we put something in place, it's not like a door or a wall where someone says 'I don't like that, I want to change it.' It really can't be changed. There are things that you might be able to do to address the need, but it is not practical to move them once the concrete is in place."

As the project moves forward, Fredrickson says there are limits in what can be changed in engineering of the new equipment. "We're trying to accomplish a building that will give them the flexibility to provide the latest and greatest, but at the same time we have a schedule, and we have a building that must be built. Once we put (the concrete) in place, it diminishes what they can change."

Fredrickson says costs are minor for repositioning or adding the conduit, compared to the cost of having a retrofit fix after the concrete pour.

A Pecco SK 225 tower crane was leased from Morrow Equipment for use on the site. "A tower crane for this project is a little unconventional," says Fredrickson. The team felt a tower crane would work better for reaching all points of the concrete structure. Using the tower crane also allowed them to mitigate some of the effects of the inordinate amount of rainfall they've experienced so far on the project. Oklahoma City saw nearly 30 inches of rainfall between April 23rd and July — almost as much rainfall as the area experiences in an entire year.

"If we hadn't had the tower crane there would have been many days we would have been down on the site," says Allen Oller, Linbeck project manager. Using the tower crane eliminated the need for moving and matting a crawler crane, which would have been disastrous during the rainy weather. "So far we've completed our basement level," says Oller. "We are preparing to install our first floor slab on the entire first floor, and that will be 100-percent finished in the next three weeks."

Oller says a beam corridor will be constructed along the north end of the building for the proton beam to travel from the cyclotron, the equipment that generates the beam, to the therapy rooms. Other infrastructure is added to support the beam corridor, such as chillers for cooling the magnets that direct and redirect the beam for treatment.

The building will be two stories and will house four treatment rooms. One treatment room will be larger, so that a 360-degree gantry will allow more flexibility in treating difficult tumors. The building is slated for completion June 2008. At that time, Ion Beam Applications, Inc. (IBA), manufacturer of the equipment, will install and make operational the new equipment. The facility will open to treat patients in November 2009.

Subcontractors on the project include Shawver & Sons as electrical subcontractor, Concrete Enterprises Inc. as concrete subcontractor, and United Mechanical as the mechanical and plumbing subcontractor. The architect Tsoi Kobus and Associates, MEP consultants BR+A, and structural engineer Goldstein Milano, along with Linbeck continue to collaborate with ProCure representatives and their equipment manufacturer IBA to ensure the successful delivery of the first private proton therapy center.