RESEARCH ARTICLE | DECEMBER 10 2019
Evaluation on requirements of nuclear medicine facility
building
Anita Nur Mayani; Basari
AIP Conf. Proc. 2180, 020049 (2019)
https://doi.org/10.1063/1.5135558
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04 December 2023 09:23:02
Evaluation on Requirements of Nuclear Medicine Facility
Building
Anita Nur Mayani1,a) and Basari1,2, b)
1
Biomedical Engineering Course Program, Departement of Electrical Engineering, Faculty of Engineering,
Universitas Indonesia, Kampus UI Depok, West Java 16424, Indonesia
2
Research Center for Biomedical Engineering, Faculty of Engineering, Universitas Indonesia,
Kampus UI Depok, West Java 16424, Indonesia
a)
[email protected] b)
[email protected] Abstract. Nuclear medicine is one of medical fields that uses ionizing radiation sources for therapeutic and diagnostic
imaging for cancer. The number of nuclear medicine services in Indonesia is 17 hospitals, which only 10 is active in
conducting nuclear medicine services because it doesn’t meet the requirements. Regulations about the standards of
nuclear medicine services Indonesia are regulated by KMK number 008/MENKES/SK/I/2009 but it have not yet been
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discussed the requirements in details for building design and layout design as reference. For this reason, the author did
study about the requirements of a nuclear medical service facility referring to KMK number 008/MENKES/SK/I/2009
and the International Health Facility Guidelines to create layout design of nuclear medicine facility. This study is done by
comparing national and international regulation for planning criteria and construct layout design of nuclear medicine
facility as recommendation to accomplish the regulations in Ministry of Health decree, Republic of Indonesia number
008/MENKES/SK/I/2009 regarding nuclear medical requirements.
Keywords: Building Design, Medical Service Facility, Regulation Analysis, Nuclear Medicine.
INTRODUCTION
Cancer is second rank cause of human death in the world. According to the World Health Organization
(WHO), 9.6 million people have died because of cancer in 2018 [1]. In Indonesia, based on the results of the Basic
Health Research by the Ministry of Health, Republic of Indonesia, cancer prevalence in Indonesia has reached
363,654 in 2018 [2]. To discuss the problem of cancer in Indonesia, the Ministry of Health launched a Cancer
Management Commitment in Indonesia (KPKI) by increasing cancer treatment according to the common standards
in diagnosis, curative therapy and palliative therapy [3]. One of the healthcare facilities that supports cancer
treatment is Nuclear medicine facility.
The Nuclear medicine facility is a support and/or therapy service in hospitals that uses open radiation sources
from the disintegration of the radionuclide nuclei. Nuclear medicine services related to in-vivo and in-vitro
diagnostic services through physiological processes, internal radiation monitoring and therapy. Medical services are
essentially medical actions that prioritize in safety, effective, orderly and humane based on medical science that uses
radionuclides and/or radiopharmaceuticals [4]. The amount of nuclear medicine facility in Indonesia is 17 and only
10 hospitals are active in conducting medical service activities. This is because the requirements is needed to fulfill
the requirements of nuclear medicine to medical services and this amount is need to be increased to fulfill nuclear
medicine services throughout Indonesia [5].
KMK number 008/MENKES/SK/I/2009 regulates the Standards for Nuclear Medicine Services in Health
Service Facilities in Indonesia. In implementing the principle of nuclear medicine services, it is necessary to fulfill
the standard requirements of the Nuclear medicine facility including: organizational and administrative structure
The 3rd International Conference on Nuclear Energy Technologies and Sciences (ICoNETS) 2019
AIP Conf. Proc. 2180, 020049-1–020049-6; https://doi.org/10.1063/1.5135558
Published by AIP Publishing. 978-0-7354-1927-8/$30.00
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standards, standards of facilities and equipment, staffing standards, policy and procedure standards, staff
development and educational programs, radiation safety standards, monitoring and evaluation standards, service
quality guarantor standards and standard recording and reporting systems [4].
Safety in hospital environment is one of core function a clinical engineer as facilities design and project
management to assisting in the design of new or renovated clinical facilities specific on medical technologies,
including operating rooms, radiodiagnostic imaging & radiotherapy centers and nuclear medicine facility [6]. Safety
in the Nuclear medicine facility services is the main requirement that must be achieved considering the use of open
radiation sources and radionuclides which can be dangerous if not controlled properly. Radiation safety standards
are very important things that are directly related to the standards of facilities and equipment. Both of these
standards need to be carefully well planned before the construction of a nuclear medicine service facility building by
making a nuclear medicine design layout. Layout facility is very important to build an effective and efficient
building [7] for convenience, comfort, productivity and safety [8]. However the standard of nuclear medicine
services in Indonesia has not been regulated in detail regarding building specifications and layout design facility as
reference such as the radiology facility building guidelines.
Therefore, we are interested to compare national and international regulation for planning criteria and construct
layout design of nuclear medicine facility based on the safety requirements regulated by the Ministry of Health
Republic of Indonesia and internationally applicable nuclear medicine requirements. The results of this study are
expected to be able to provide an overview of the description of the design of the Nuclear medicine facility based on
the Nuclear Medicine Service Standards in Health Service Facilities.
DESIGN REQUIREMENTS FOR NUCLEAR MEDICINE FACILITY
Nuclear medicine facility is a unit of healthcare facilities in hospitals. In the Nuclear medicine facility,
doctors and other health workers work together to utilize ionizing radiation sources to produce radiopharmaceuticals
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that are injected into the patient's body as therapeutic and diagnostic and diagnostic measures. Nuclear medicine can
join the radiology facility, therapy, or stand alone.
The layout of the Nuclear medicine facility needs to be designed effectively. Nuclear medicine facility is
better located on the ground floor with consideration of the ease of access and placement of instrumentation.
Radiation shielding requirements need to be considered to ensure patients, officers and families of patients are not
adjacent to the patient's area where there is radiation or the scanning room. The location of the nuclear medicine
facility is better adjacent to radiology, emergency room and has easy access to ambulances.
The design of the layout of the Nuclear medicine facility is divided into three main areas including
radioisotope rooms that are not visited by patients, patient areas and administrative areas of officers. The division of
this area is regulated based on the active dose of the room where the administration room has the lowest active dose
[9]. The principle of active dosage is an important area applied in the Nuclear medicine facility, active doses of low
areas to high areas taking into account interrelated spaces. The interrelated room layout in nuclear medicine is
arranged close together to ensure that the officers do not get much exposure from patients who have received
radioisotope injections. Therefore, the work flow in the Nuclear medicine facility is important in the design of the
design [10]. The work flow in the Nuclear medicine facility is explained in Figure 1.
Administration room Patient preparation room Radiopharmaceutical
Patient registration and Consult a doctor room staff prepare
medical record radiopharmaceuticals
Therapy room (isolation according to the dosage
room) the patient waits for that needs to be given to
dose adjustment the patient
Patients wait for the dosage Image interpretation by a
The patient's diagnostic
in the body to be safe to go doctor
room goes to the SPECT
home
FIGURE 1. Work flow in the Nuclear medicine facility (reprocessed from [11])
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The construction requirements that need to be considered in the Nuclear medicine facility include floors and
walls must be made of material that is easily decontaminated if there is a radioactive spill. On the walls there are
medical gas installations, vacuum gases and gas vents for radioactivity. Minimum ceiling height of 3 meters,
recommended lay-in type ceiling for ease of installation, service and future renovation [12]. In a room using
radioisotope dose monitoring equipment is needed with its calibration. Doors and aisles must allow the patient to
transfer beds [13]. In a room with an active dose that utilizes radioisotope gas it is necessary to regulate ventilation
of the room with negative pressure. While in the radiopharmaceutical laboratory positive air pressure is needed as a
supply of fresh air for officers [14].
In Nuclear medicine facility, there is a diagnostic room, a therapy room and other supporting rooms. Table 1
provides a list of room requirements in the Nuclear medicine facility.
TABLE 1. Room requirements in the Nuclear medicine facility [4]
Rooms Requirements (m2)
Administration room 12
Waiting room for patient’s family 12
Waiting room (preparation room) 12
Isolation room 12
Hot lab room 24
Decontamination room 6
Radiopharmaceutical injection room 4
Post injection room 12
Radio assay room (hot lab) 21
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Gamma probe room (uptake thyroid) 9
Gamma camera room According to the needs
Consultation room 12
Expertise room 12
Medical record room 12
Staff room 12
Warehouse 6
Warehouse of radioactive waste 6
Specific requirements for the SPECT room include, floor structures capable of supporting instrumentation,
power supply with UPS, good grounding installation, temperature and humidity control, lighting not shining directly
into the patient's eyes, radiation protection, patient bed access. Some of the equipment that must be included
includes an ECG, Pb apron, CCTV camera, medical gas and an emergency button. The ceiling above a gamma or
SPECT camera must not be used for hydraulic installations or air conditioners to avoid damage to equipment from
leakage. It is needed to prevent the occurrence of Crystal faults on gamma cameras. In the restricted area in the
Nuclear medicine facility there is a negative pressure with 15% exhausting exceeding the air supply [15].
METHOD
This research was carried out by conducting conceptual studies relating to the requirements of the room and
nuclear medicine facilities based on national and international regulations. From the conceptual results of the studies
by documents review and then comparative analysis is done by comparing national and international regulations to
get the planning elements and criteria [16]. Afterward layout design of nuclear medicine facility is constructed using
3D SketchUp software based the result of planning criteria.
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RESULT AND DISCUSSION
Nuclear Medicine Facility Requirements and Layout Design
Based on the results of national and international standardized regulations studies of the requirements of the
room and nuclear medicine facilities, the design layout of the Nuclear medicine facility is shown in Figure 2. In the
proposed layout design, we do pay attention to the dose level of each room. For active doses the room should be
placed close together. In this design example, the active dosing room is behind the Nuclear medicine facility [13].
The design of the nuclear medicine facility has an area of 22m × 21.5m or 473 m2. This design can be used
for type-A hospitals according to the existing standard references, namely the Indonesian KMK number
008/MENKES/SK/I/2009 and the requirements that apply internationally. The drawbacks to this design include: not
taking into account the location of the hospital, the site and land contour; have not considered the aspect of
earthquake resistance and have not taken into account costs. Room requirements from the design results of the
Nuclear medicine facility are described in Table 2.
TABLE 2. Design requirements for the design of a nuclear medicine room
Rooms Requirements
Lobby and waiting room (26m2) General
Administration room (9m2)
Staff room (28m2)
Physician room (32m2) Work station and imaging screen is needed to see the
medical records
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Staffs preparation room (8m2) Provided head cap, footwear and clothes (disposable)
for staffs
Radiopharmaceutical room (9m2) The ceiling, wall and door are coated by Pb
Radioactive waste room (15m2) Provide a place for decontamination
There is monitor detector for the radiation exposure
rate of the room
Densitometry room (20m2) Wall and door are coated by Pb
Post injection room Provided drinking water facility and special toilet
Isolation room (20m2) There is medical gas outlet and emergency button for
calling the staff
There is monitor detector for the radiation exposure
rate of the room
Uptake thyroid room (12m2) There are medical gas outlets and emergency
Gamma camera room (42m2) equipment
SPECT room (50m2)
Main corridor There is monitor detector for the radiation exposure
rate of the room
* Processed from references [4], [12], [17], [15], [18]
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Several essential points must be considered in the room requirements in the Nuclear medicine facility such
as the division of area officers, patients and radioisotopes. In the patient area and the work area of the officer who
interacts directly with the radioisotope, the exposure rate detector is displayed on the monitor to see the dosage of
the room so that officers can anticipate when working in the room. This is related to radiation safety. In addition, the
floor and ceiling walls with solid structures are required and easily cleaned from contamination. The Pb layer in this
area is also very important to protect the officers and the surrounding environment.
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FIGURE 2. Layout design of Nuclear medicine facility
1. Outside area of Nuclear medicine facility 12. Decontamination place
2. Lobby and waiting room 13. Decontamination place
3. Corridor 14. Densitometry room
4. Receptionist and Administration room 15. Patient isolation room
5. Staffs room 16. Toilet for patient isolation room
6. Toilet for staffs 17. Patient waiting room
7. Physicians room and discuss room 18. Toilet for patient post injection
8. Staff’s preparation room 19. Radiopharmaceutical injection room
9. Radiopharmaceutical room 20. Uptake thyroid room
10. Disposal room 21. Gamma camera room
11. Radioactive waste room 22. SPECT room
Staffs area
Patient area
Staffs workflow
Patient workflow
Radioactive material workflow
CONCLUSION
After conducting a conceptual review and proposing spatial planning for facilities at the Nuclear medicine
facility, existing nuclear medicine facility regulation in Indonesia is deficient beside international regulatory of
nuclear medicine facility. Therefore it is necessary to add some regulations in Ministry of Health decree, Republic of
Indonesia number 008/MENKES/SK/I/2009 regarding nuclear medical requirements, which are more details for
building requirements.
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ACKNOWLEDGEMENT
This study was conducted according to the knowledge in Medical Instrument Regulation and Design, and
Planning of Building Health Service Facilities of Biomedical Engineering Master Program, Universitas Indonesia.
We thank to Dr. Ahyahudin Sodri who has provided a lot of advices. We would like to thank PIT9 Grant 2019 for
partly supporting fund from Universitas Indonesia.
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