Expanding Proton Therapy Market Demands Innovative, Collaborative Solutions

Picking the right team is the critical first step in setting a project up for success.

A highly skilled AEC team will work early on with the owner to help them select the proton equipment vendor and to “right-size” their facility to meet community and patient needs.

On their current project in Connecticut, Proton International sought a CM that would bring an onsite project management team armed with strong technical construction expertise and mass concrete expertise, due to the extensive amount of technical concrete work involved.

“It’s not just having the right people; it’s the right mix of people, from the project manager to the superintendent to the project engineer,” Carbone said.

Paula Williams, principal with the global design firm Stantec, has worked with DPR teams on several proton therapy projects, including those currently underway in Connecticut and South Florida, among others. As a recognized leader in the design of proton therapy facilities for many years, Stantec has completed 19 operational proton therapy facilities in the U.S. and globally, with another dozen currently in design or construction.

“A GC’s ability to bring not only the construction subject matter experts to the table but also to bring their local market expertise and understanding of the client to the team is really valuable,” Williams commented. “They bring expertise in logistics and partnering processes, and their ability to use all the latest tools to deliver these projects in as collaborative a fashion as possible is key.”

Engaging key team members early in the design and preconstruction process and employing every tool at their disposal to ensure constructability, to maximize planning, and to minimize changes or rework is another critical success factor for the proton therapy facility project.

One of the most important early decisions the owner must make is what vendor and system will be used in their facility, as the entirety of the facility’s design and construction revolves around this selection. The vendor is integrated into the team to provide critical input from day one.

“From both a design and a construction perspective, digesting and understanding the vendor’s interface document is critical to ensuring we avoid any scope gaps,” said Williams.

Bringing key trade partners on board in a design-assist capacity can be extremely helpful, Williams said. “To have the key trade partners on board to assist in the design decision making process and evaluation of systems really helps with budgeting, constructability and early coordination.” Early involvement can also help identify and mitigate supply chain issues and long lead items that could disrupt the schedule.

Successful preconstruction engagement sets the project up for a successful execution of work, Ashcroft added. “It is critical to help manage first cost versus final cost, to identify risks in the execution, being ready to accommodate any advances in technology that might come between the start of design and the facility turnover. You want to have some flexibility built into your plan.” He continued, “Making sure you are dialed in on what the vendor requirements are and what that looks like in the built environment is critical.”

Collaboration is the heart of any successful cancer center facility, and perhaps no factor plays a bigger role in the success of proton therapy projects than a highly integrated team that works collaboratively from the earliest design phase until project closeout to deliver solutions.

One prime example of how a collaborative approach can help drive success is the now completed Carolinas Medical Center Levine Cancer Proton & Advanced Radiation Center project in Charlotte, NC.

This project added a state-of-the-art, 34,500-sq.-ft. addition that was the first in the Carolinas to offer proton therapy, gamma knife therapy and radiopharmaceutical treatments. It included a three-story proton vault accommodating a rotating proton gantry weighing 300,000 pounds, Gamma Knife, CT, clinical area, support spaces and a pedestrian bridge. Manufactured by Mevion, this is the world’s first gantry-mounted proton accelerator.

The project team’s collaborative approach helped shape design solutions, material sourcing and logistics strategies that maximized value and provided cost certainty amid a volatile market. Utilizing target value delivery and an integrated approach, the project team overcame major challenges including a complex site location intersecting two of the busiest roads in Charlotte.

The project’s unique, future-focused design allowed for flexibility in the building to grow both vertically and horizontally while also allowing for another vault to be added. Working collaboratively from start to finish, the team was able to ensure completion on time and within budget.

Leveraging all the VDC tools at their disposal, the most successful proton therapy project team will build on lessons learned from one project to the next and foster an environment of continuous improvement.

Developing a highly detailed BIM model is critical, given the technical complexities of ensuring all the systems and components embedded within the massive concrete structure are positioned in exactly the right location. The model offers a roadmap for the precise construction to be executed in the field, helping avoid mistakes and rework, according to Carbone.

“The negative of these projects getting smaller is you still have a lot of the same technology as you did in the four-or-five-room facilities, but you’re pushing it together,” he said. “So, there are a lot of places where systems overlap more than they used to. BIM has really helped and is key to delivering these proton projects.”

Early collaboration to develop the BIM model by the design team, CM/GC and key trade partners is also vital to project success, according to Williams. “The ability for us to collaborate with trade partners in the BIM model, when they are brought on during design, allows that coordination to happen early, which certainly helps us meet/beat the schedules,” she said. “The construction team can hit the ground running when the documents are fully done because they have already started to do their shop drawing level of detailing while the design team is just finishing up design.”

In addition to leveraging BIM, prefabrication can also play a role helping drive schedule efficiency on proton therapy projects, according to Ashcroft. He notes there are many opportunities for using prefab, depending on the size and scale of the project and the interest in it from the owner.

“It can be as simple as the electrician racking conduit banks that will end up being cast into the beam line lid. Or in areas where there is lot of repetitive work that would add weeks of tying rebar and threading conduit, instead you can fly in racks of conduits that have been prefabbed off site and just hoist them into place,” he said. “That can cut a ton of time in your pour sequence and in the make ready. That’s where the opportunities are for the GC team, trade partners, the design team and all the stakeholders to really find ways to be smarter and more efficient.”