Radiation Oncology-External-Beam Radiation Therapy.

The application of structural shielding design techniques and goals as outlined in the National Council on Radiation Protection and Measurements Report 151, Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities (2005), continues to be the basis for treatment vault design in 2018 with some updated information. Treatment techniques have changed significantly with the dominant usage of intensity-modulated radiation therapy techniques today based on concurrent imaging. Some of the developments in linear accelerator technology over the past 15 y include flattening filter-free modes, which enable higher instantaneous dose rates; three-dimensional conformal radiation therapy resulting in potentially higher workloads since healthy tissue is spared; improved intensity-modulated radiation therapy treatment delivery systems with lower monitor units per centigray delivered than traditional step and shoot intensity-modulated radiation therapy; stereotactic body radiation therapy with higher treatment fractions and increased workloads; and increased use of stereotactic radiosurgery with conventional linear accelerators as well as robotic arm-mounted linear accelerators with higher treatment fractions. These new treatment units also incorporate multiple-energy x-ray beams (2 to 5 MV typical), which require a significant change in the specification of a workload to be used in each vault. As the equipment in radiation oncology departments has evolved to state-of-the-art modalities, the requirements for adequate radiation shielding for these modalities has become more rigorous. Architectural designs no longer depend on standard maze design rectangular rooms. Innovative layouts and utilization of multiple layers of shielding materials allow much greater flexibility in room designs. Maze-less rooms with direct-shielded doors are part of these challenging designs and are very common today. Use of multiple-density concrete blocks allows quicker construction of vaults and requires less space for the equivalent shielding provided. Combinations of high-density or normal-density concrete, steel, and lead are used in designs to make optimum use of available space and cost. Additional shielding needed at the edges of these single- or bi-parting sliding doors as well as baffle designs for heating, ventilation, and air conditioning systems and communication cable penetrations require detailed calculations. Examples of these designs will be given in this presentation. Consideration of the radiation levels around the planned vault must also include adjacent multistory buildings.