MANCHESTER, NH Linear accelerators used to treat patients with cancer are incredibly intricate machines, requiring not only adequate space for the equipment itself, but also highly specialized vaults for their operation. Inherent to the size and complexity of the technology, full replacement of a linear accelerator or the addition of a new vault constitutes a formidable undertaking for any hospital. Suspending operations risks interruption of patient treatment: with potential negative long-term effects for both patient outcomes as well as hospital patient volumes.

In designing and implementing these high-stakes renovations, many design parameters are similar across each specific case: highly complex machinery which produces intense radiation and requires substantial coordination, staff considerations for LEAN workflow and managing heavy equipment, and perhaps most importantly patient comfort.

Rutland Regional Medical Center (RRMC) in Vermont was acutely aware of these concerns when they chose Lavallee Brensinger Architects to lead the renovation to their vault for a full replacement of the existing linear accelerator. The goals of the project, as mandated by RRMC, were to: develop a cost effective plan to replace the existing linear accelerator, maintain current patient volumes, prevent impact to treatment schedules, enhance the patient's experience, and address staff concerns about work flow efficiencies and material management.

After researching and evaluating multiple options, the Hospital and Lavallee Brensinger chose to embark on a rapid installation process. This process, offered by Varian Medical Systems, was the first of its kind executed in the country, and only second worldwide. Through carefully scheduled design, long-term coordination of patient scheduling, highly coordinated documents, and round-the-clock construction scheduled down to 15-minute increments by Engelberth Construction Inc., RRMC, and Lavallee Brensinger were able to shut down and renovate the existing vault and replace the equipment within a three week time period: a full two and a half months short of the three-month precedent.

Toward the second and equally important goal, RRMC was highly aware of the patients' medical condition and chose to use this renovation to create the best possible patient experience. Lavallee Brensinger's design sculpted the space using warm tones, natural materials and night sky imagery. Concealed storage was artfully implemented to minimize the clinical aspects and "feel" of the space. These aesthetic storage options not only improved the patient atmosphere, but also served staff concerns surrounding material management.

Southwestern Vermont Medical Center (SVMC) is also undertaking the rapid installation process, and chose to engage the Lavallee Brensinger team that successfully completed RRMC's replacement. Similarly at Exeter Hospital, Lavallee Brensinger designed an entirely new vault installed almost completely underground, which started treating its first patients this spring.

"It is inherently difficult to create a positive environment inside a vault required to be tightly enclosed in every way. We work very hard to create a space that feels open and comforting, despite the design challenges this work presents," said Jeff Galvin, Senior Associate at Lavallee Brensinger. "Pulling it off successfully requires a full team effort between patients, staff, equipment vendors and builders. This equipment saves lives and we feel honored to be able to assist in that process."

As more health care facilities look to enhance their linear accelerator technology, advances made by New England hospitals are setting precedence for the future of treating patients.