Proton therapy centers are popping up across the country, as the cancer treatment—which uses proton beams to precisely target tumors without damaging surrounding tissue—continues to gain in popularity, especially for tumors in sensitive areas of the body or in children.

Rick Kobus, senior principal, Tsoi/Kobus & Associates (TK&A; Cambridge, Mass.), has been involved in designing proton therapy centers for two decades and notes that major changes have been seen in equipment becoming smaller, lighter, and more accurate, while operating software has become more sophisticated and capable. And he expects that the already-accurate treatment to be even more effective within the next two to three years.

But proton therapy comes with plenty of challenges. To start, there’s a much more intense equipment demand than a traditional radiology suite, requiring a massive amount of shielding, with concrete vaults at points reaching up to 18 feet in thickness, says Jim Eaton, vice president–healthcare division leader, Haskell (Jacksonville, Fla.).

This requires a well-thought-out approach to integration of systems, conduit, etc., into the structure. “All of that has to be coordinated very meticulously—you can’t go back and change it. The amount of preparation that goes into that is even more intense than what we’ve done on a normal acute care campus,” Eaton says.

Building and running a facility is no inexpensive endeavor, either, meaning designers are charged with creating a space that’s as efficient as possible to achieve the necessary throughput to start generating revenue immediately and continue to sustain operations.

“Lean design comes in to eliminate waste in time, energy, medicine, or just turnaround time for patients to get on to the treatment,” Kobus says, adding that a simple reduction in turnaround times can translate to millions of dollars in savings each year.

Often built as freestanding facilities, due to the equipment requirements and large footprint, proton therapy centers require a focus on patient-centered design to soften the potentially intimidating environment, through spa-like amenities and access to natural light where possible.

Eaton recommends a focus on the journey, from the patient’s approach to the building to how they reach the core of the structure for treatment, adding that a tight design around that core boosts efficiency while it decreases patient anxiety.

“Intimacy is key, not being overwhelming in the physical scale of the building and the interior spaces,” he says.

Another challenge facing designers when it comes to proton therapy is the specific modifications that must be made for children, especially since the treatment is gaining in popularity for pediatric cancer cases.

“Everything is smaller. Children need to be anesthetized or sedated for their treatments—it’s not enough to immobilize them. The whole process of bringing a patient in, preparing them for treatment, delivering the treatment, and then recovering them from sedation or anesthesia adds a level of complexity to the design that you don’t run into with adult patients very often,” notes Alan Fried, associate principal, TK&A.

And while adjustments continue to be made to how these facilities are planned and designed, Eaton says he thinks they’re here to stay.

“As technology continues to improve, I think we’ll continue to see more and more of these projects. The scale of those may be what changes—can it be delivered in a smaller environment? It’s a constant analysis of the cost of the facility, patient care, reimbursement, and can it be done in a model that works,” he says.

For an in-depth report on trends in cancer treatment and their influence on the design of care centers, please see "Cancer Center Design Supports Hopeful Healing." Jennifer Kovacs Silvis is managing editor of Healthcare Design. She can be reached at