Atom Indonesia

1 Nuclear Medicine Facility Design Based On

2 National Regulation And International Guidelines
3 Authors
4
5
6A RTICLE INFO ABSTRACT
7
AIJ use only: Nuclear medicine is one of the fields of medical science that utilizes ionizing
Received date radiation sources for diagnostic imaging and therapy in cancer patients. The
Revised date number of nuclear medicine services that Indonesia has so far has 17 hospitals
Accepted date and only 10 are actively operating in carrying out nuclear medicine services. To
support the KPKI program by the minister of health, it is necessary to add a
nuclear medicine department in Indonesia. Regulations regarding the standard of
Keywords:
Indonesian nuclear medicine services are regulated by the RI KMK number 008 /
Building Design MENKES / SK / I / 2009 but have not attached any specific building design
Service Facilities requirements. For this reason, the authors conducted a literature review on the
Regulatory Studies requirements for the design of nuclear medicine service facilities which refers to
Nuclear Medicine the KMK RI number 008 / MENKES / SK / I / 2009 and the International Health
Facility Guidelines to produce the design plans for the building of the nuclear
medicine department.

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8

9 INTRODUCTION
10
11 The nuclear medicine department is a
12 supporting and / or therapeutic service in a hospital
13 that utilizes an open source of radiation from the
14 disintegration of the radionuclide core. Nuclear
15 medicine services include in-vivo and in-vitro
16 diagnostic services through monitoring of process
17 physiology, metabolism and internal radiation
18 therapy. Nuclear medical services are essentially
19 medical actions that prioritize safety, effectiveness,
20 order and humanity based on medical science using
21 radionuclides and / or radiopharmaceuticals. In
22 implementing the essence of nuclear medicine
23 services, it is necessary to fulfill the standard
24 requirements of the nuclear medicine department
25 including: organizational and administrative
26 structure standards, facilities and equipment
27 standards, labor standards, policy and procedure
28 standards, staff development and educational
29 programs, radiation safety standards, monitoring
30 and evaluation standards, service quality assurance
31 standards and recording and reporting system
32 standards.
33 Safety in the service of the nuclear medicine
34 department is a major requirement that must be met
35 given the use of open sources of radiation and
36 radionuclides which can be dangerous if not
 66 are expected to be able to provide an overview of
Corresponding author.
E-mail address:type your email address here
DOI: provided by AIJ
37 controlled properly. Radiation safety standards are
38 very important matters that are directly related to the
39 standard of facilities and equipment. These two
40 standards need to be carefully planned before the
41 construction of a nuclear medicine service facility
42 building. The number of nuclear medicine
43 departments in Indonesia to date is 17 and only 10
44 hospitals are actively carrying out nuclear medicine
45 service activities. The ten hospitals are Dr.
46 CiptoMangunkusumo Hospital Jakarta, Harapan
47 Kita Hospital Jakarta, GatotSoebroto Hospital
48 Jakarta, Pertamina Jakarta Central Hospital,
49 Dharmais Cancer Hospital Jakarta, GadingPluit
50 Hospital Jakarta, dr.HasanSadikin Hospital
51 Bandung, dr. Soetomo Surabaya, M. Djamil Padang
52 Hospital and Marta Fiesta Hospital Medan. This
53 number can be said to be very insufficient to meet
54 nuclear medicine services throughout Indonesia,
55 considering that the location of nuclear medicine
56 service facilities is not evenly distributed throughout
57 Indonesia.
58 Based on these data, it is necessary to add
59 nuclear medicine service facilities in Indonesia to be
60 able to fulfill nuclear medicine services evenly
61 throughout Indonesia. Therefore, researchers are
62 interested in designing the design of the nuclear
63 medicine department based on the safety
64 requirements regulated by the Ministry of Health of
65 the Republic of Indonesia. The results of this study
67 the design of the nuclear medicine department based
 Atom Indonesia

68 on Nuclear Medicine Service Standards in Health 124 Hussein S. Kartamihardja in 2011 who discussed
69 Service Facilities. 125 nuclear medical equipment that was currently used
70 126 in 12 hospitals in Indonesia which had nuclear
71 THEORY 127 medicine facilities, but discussed in more detail
128 about the gamma camera. (Kartamihardja, 2011).
72 The research entitled Designing of High-
129 The nuclear medicine department is one of the
73 Volume PET / CT Facility with Optimal Reduction
130 health service facilities in the hospital. In the
74 of Radiation Exposure to the Staff, was conducted
131 nuclear medicine department, doctors and other
75 by Ashish Kumar Jha, Abhijith Mohan Singh, et al.
132 health workers work together to utilize ionizing
76 in 2015 in India which discussed the design of PET /
133 radiation sources to produce radiopharmaceuticals
77 CT room facilities to optimize the reduction of
134 that are inserted into the patient's body for
78 radiation exposure to officers. In this study, taking a
135 therapeutic and therapeutic and diagnostic measures.
79 sample of hospitals in India that have nuclear
136 Nuclear medicine can join diagnostic, therapeutic,
80 medicine facilities then discusses the dose exposure
137 or standalone radiology departments.
81 received by officers as data used to design PET / CT
138 The layout of the nuclear medicine department
82 room facilities so as to reduce the dose exposure
139 needs to be designed effectively. It is preferable for
83 received by officers (Jha et al., 2015).
140 the nuclear medicine department to be on the ground
84 The research entitled Improving Processes of
141 floor with regard to ease of access and placement of
85 Design and Construction of Nuclear Medicine
142 instrumentation. Radiation shielding requirements
86 Facilities, was researched by Galina Malykha, Igor
143 need to be considered to ensure that patients,
87 Dorogan and NadezhdaTesler in 2016 which
144 officers and their families are not close to the
88 discussed the design and construction process of
145 patient's area where there is still radiation or the
89 nuclear department facilities in Russia. This
146 scanning room (scanner). The location of the
90 research describes the stages of design design, one
147 nuclear medicine department is preferably close to
91 of which is by looking at the specifications of the
148 radiology, ER and has easy access to ambulances.
92 equipment to be used so that the construction
149 In the design of the layout of the nuclear
93 activities of nuclear medical facilities can be more
150 medicine department is divided into three areas
94 optimal (Malykha, Dorogan, &Tesler, 2017).
151 including radioisotope rooms that are not visited by
95 The study, entitled Regulatory requirements for
152 patients, patient areas and administrative areas of
96 designing PET-CT facility in India, was researched
153 officers. The division of this area is arranged based
97 by PankajTandon in 2010 which discussed the
154 on the active dose in the room where the
98 requirements for PET-CT facility design starting
155 administration room has the lowest active dose
99 from construction, equipment installation, radiation
156 (Padovani, 2011). Important area active dose
100 protection requirements and safety of personnel
157 principle is applied in the nuclear medicine
101 while working referring to Atomic Energy
158 department, low area active dose to high area taking
102 Regulatory Board (AERB), an Indian government
159 into account the interconnected space. The layout of
103 agency that regulates atomic energy. The study also
160 the interconnected rooms in nuclear medicine is
104 discusses the stages that need to be prepared before
161 arranged close together to ensure that personnel do
105 designing a PET-CT facility, especially in the aspect
162 not get much exposure from patients who have
106 of radiation safety (Tandon, 2010).
163 received radioisotope injections. Therefore, the
107 The study, entitled Hospital Facility Design,
164 workflow in the nuclear medicine department is
108 was researched by Mr. Anh Pham in 2015 who
165 important in designing designs (Tandon, 2010). The
109 discussed the design of public hospitals in Vietnam.
166 workflow in the nuclear medicine department is
110 This research was conducted by reviewing various
167 described in Figure 1.
111 aspects of hospital construction. The method used is
168
112 to review existing hospitals in Vietnam and national
169
113 and international regulations related to the design of
170 Table 1. Room requirements at the Department of
114 hospital facilities (Pham, n.d.).
171 Nuclear Medicine (Ministry of Health, 2009)
115 The research entitled Problems of Nuclear Room
116 Medicine Services in Indonesia was researched by No. Room requirement
117 A. Hussein S. Kartamihardja in 2012 who discussed (m2)
118 the problems of nuclear medicine services in 1. Administration room 12
119 Indonesia as a whole, from technical to non- 2. Waiting patient’s family room 12
3. Patient waiting room 12
120 technical aspects that caused nuclear medicine in
4. Isolation room 12
121 Indonesia to not develop (Kartamihardja, 2012 ). 5. Radiopharmacy room 24
122 A research with the title Instrumentation for 6. Decontamination room 6
123 Nuclear Medicine Imaging was researched by A. 7. Injection room 4
 Atom Indonesia

8. Patient waiting room post injection 12 220 mix method research is used to produce
9. Radioassay room (hot lab) 21 221 requirements and design of nuclear medical
10. Gamma probe room (uptake thyroid) 9
222 facilities (room layout, mechanical electrical and
11. Camera gamma room Adjusted
12. Consultation room 12 223 equipment). This method is used to develop a pre-
13. Interpreting room 12 224 designed project based on the requirements in
14. Medical record room 12 225 accordance with the regulatory requirements of
15. Staffs room 12
226 nuclear medicine. In this study, the method
16. Warehouse room 6
17. Radioactive waste warehouse 6 227 employed is illustrated in Figure 2.
172 228 The research method used in this study is to use
173 Specific requirements for the SPECT room 229 three methods, namely:
174 include, floor structure capable of supporting 230 1. Literature review: reviewing national and

175 instrumentation, power supply with UPS, good 231 international regulations and standards relating to

176 grounding installation, temperature and humidity 232 the design of the nuclear department building, and
177 control, lighting does not shine directly into the 233 of books and articles related to the topic. Then make
178 patient's eyes, radiation protection, access to the 234 a list of requirements for the nuclear medicine

179 patient's bed. Some of the equipment that must be 235 department building in the form of a checklist as
180 available includes an EKG, Pb apron, CCTV 236 research instrumentation when conducting field

181 camera, medical gas and emergency officer buttons. 237 observations.

182 The ceiling above the gamma and SPECT cameras 238 2. Qualitative research: making observations about
183 should not be used for hydraulic or air conditioning 239 the design of the nuclear medicine department
184 installations to avoid damage to equipment from 240 buildings in ten hospitals that have nuclear medicine
185 leaks. Addition of air conditioning required to 241 department facilities and are actively operating.

186 prevent crystal fracture on the gamma camera. In a
187 restricted area in the nuclear medicine department,
188 negative pressure with exhausting exceeding 15% of
189 the air supply (Department of Veterans Affairs,
190 2008).
191
242 Then conduct interviews with doctors, radiographers
243 and patients to be able to answer research questions.
244 3. Comparative analysis: conduct an analysis of
245 building requirements for the nuclear medicine
246 department based on a literature review of national,
247 international standards and the results of qualitative

192 Things that need to be considered in the room 248 research conducted in the field. The results of this
193 requirements in the nuclear medicine department 249 analysis are used to create the initial design layout.
194 include the division of areas for officers, patients 250 From the results of the initial design layout, a
195 and radioisotopes. In the patient area and the work 251 review and FGD were carried out with experts in the

196 area of officers who interact directly with 252 field of the nuclear medicine department. The
197 radioisotopes, an exposure rate detector is added 253 results of the review and FGD were then rearranged

198 which is displayed on the monitor to see the dose of 254 to become the layout design for the nuclear
199 the room so that the officer can anticipate working 255 medicine department. The research stages and

200 in the room. This has to do with radiation safety. In 256 methods are depicted in Figure 2.

201 addition, this area also requires floor and ceiling 257 The research data uses primary and secondary
202 walls with a solid structure and easy to clean from 258 data. The primary data in this study is data on
203 contamination. Pb layer in this area is also very 259 nuclear medical facilities in Indonesia. Primary data
204 important to protect the officer and the surrounding 260 were taken from ten nuclear medicine in Indonesia

205 environment. 261 using a non probability sampling technique.

206 262 Data collection methods in planning are as

207 263 follows:

208 264 1. Literature study: Looking for data, regulations

209 265 and guidelines relating to the department of

210 METHODOLOGY 266 nuclear medicine in Indonesia.
211 267 2. Translation: Prepare the requirements for

212 This study combines engineering and 268 nuclear medical facilities from the results of the
213 architectural research methods using a mixed 269 literature review to produce research
214 methods research approach. This research is 270 instruments in the form of questionnaires and
215 included in the research for planning and designing 271 observation checklists.
216 health facilities which contains a discussion of 272 3. Documentation: Documentation is done by

217 building design & requirements based on security & 273 conducting interviews with officers in the
218 safety; and necessity factors in the nuclear medicine 274 nuclear medicine department; filling out
219 department (Voordt, 2002). The research method 275 questionnaires by patients & visitors; and view
 Atom Indonesia
276 the design documents for the nuclear medicine
277 department building.
278 4. Field survey: Conducting direct surveys to the
279 nuclear medicine department, accompanied by
280 officers responsible for technical matters in the
281 nuclear medicine department.
282 5. Analysis: Analyze the results of the four stages
283 above to produce a planning design for the
284 nuclear medicine department.
285 6. Design: Making design of nuclear medical
286 facilities.
287 7. Validation: To validate the results of the design
288 of nuclear medical facilities to respondents.
289 Respondents selected were officers who were
290 active in the nuclear medicine department, including
291 nuclear medicine specialists, radiopharmacists,
292 medical physicists and radiographers and
293 supervisors from the nuclear medicine department
294 appointed by the hospital to assist researchers in
295 conducting observations and surveys.
296
297 RESULTS AND DISCUSSION
298
299 Review Of Nuclear Medicine Requirements In
300 Indonesia
301 This research was conducted in August -
302 December 2019 using primary data and secondary
303 data. Primary data was collected in the field from
304 November to December 2019 after licensing for the
305 ten hospitals was completed. Observations,
306 interviews and filling in the checklist are carried out
307 together with a supervisor appointed by the hospital
308 (experienced nuclear medicine facility officers). Ten
309 nuclear medical facilities were used as samples for
310 observation and research surveys.
311 The author conducted a review of nuclear
312 medicine standards and regulations in Indonesia
313 namely KMK RI number 008 / MENKES / SK / I /
314 2009 concerning Nuclear Medicine and Perka
315 Medical Standards Number 17 of 2012 concerning
316 Radiation Safety in Nuclear Medicine. Based on the
317 results of the review of the national nuclear
318 medicine requirements, then the authors conducted a
319 review based on international guidelines regulated
320 by the IAEA regarding nuclear medicine in the
321 IAEA Nucler Medicine Resource Manual and added
322 references related to the requirements for building
323 construction of health facilities, namely the
324 International Health Facility Guideline (IHFG).
325 To review the national nuclear medicine
326 requirements based on international guidelines, the
327 authors coded the data to be analyzed quantitatively.
328 From the variable data requirements, the researcher
329 did the data scoring based on the room availability
330 requirements. The value "0" represents the
331 unavailability of room requirements and the value
332 "1" represents the availability of room requirements.
333 From these data, the researcher conducted a
334 statistical analysis using the SPPS version 25
335 program by testing the Compare Means - One
336 Sample T Test. The T-test is used because the
337 sample data is <30 and the standard deviation value
338 is not known. Based on the statistical test, the
339 resulting t value is -1.793, the value of p (t) = 0.083
340 and the CI Difference is -0.21 ≤ D ≤ 0.01. Because
341 CID passes through the zero point, the average
342 compared is not significant or H0 is accepted. In
343 addition, seen from the sig of (t two tail) 0.083> α
344 0.05, H0 is accepted and Ha is rejected. Thus it can
345 be concluded that at the 95% confidence level the
346 requirements for the availability of nuclear medicine
347 rooms in Indonesia are in accordance with
348 international guidelines.
349 The review of nuclear medical facilities in
350 Indonesia was carried out by direct observation and
351 surveys of ten nuclear medical facilities. Facility
352 assessment was carried out using a questionnaire
353 checklist instrument based on the results of a
354 literature study on national and international nuclear
355 medicine requirements. The research questionnaire
356 consists of room requirements, construction related
357 to safety, utility and instrumentation / equipment.
358 Filling in the questionnaire checklist is carried out
359 by the researcher together with the field supervisor
360 to ensure that the data written on the questionnaire
361 matches the reality in the field.
362 Researchers do data scoring based on
363 availability and conformity with national and
364 international requirements. The value "0" represents
365 the unavailability of the requirements, the value "1"
366 represents available but not in accordance with the
367 requirements and the value "2" represents available
368 and in accordance with the requirements. The results
369 of the assessment of the ten nuclear medical
370 facilities in Indonesia were taken for the mean value
371 for statistical analysis using the SPPS version 25
372 program with the Compare Means - One Sample T
373 Test.
374 In terms of utility and instrumentation in
375 nuclear medical facilities in Indonesia, it is in
376 accordance with national and international
377 requirements. However, nuclear medicine room and
378 construction facilities in Indonesia do not comply
379 with national or international requirements.
380 Construction is an aspect that is closely related to
381 the room. The availability of nuclear medicine room
382 facilities in Indonesia is quite good, reaching 76%
383 of the 32 room requirements assessed based on
384 national and international nuclear medicine
385 requirements. This is related to the discussion of the
386 first problem formulation regarding the regulation of
387 nuclear medicine in Indonesia in accordance with
 Atom Indonesia
388 international guidelines in regulating the availability
389 of rooms in nuclear medical facilities. However,
390 KMK RI number 008 / MENKES / SK / I / 2009
391 and PerkaBapeten number 17 of 2012 have not
392 regulated in detail the construction requirements
393 related to safety for officers, patients and visitors as
394 in international guidelines. Nuclear medicine in
395 Indonesia only fulfills 57% of the 14 assessed safety
396 aspects. This is an important concern considering
397 that nuclear medicine utilizes open ionizing
398 radiation given to patients, so it is necessary to pay
399 attention to the facilities used by patients after
400 nuclear safety medical treatment is carried out to
401 officers and the surrounding environment or
402 visitors. Matters related to safety in nuclear
403 medicine can have detrimental effects if not
404 implemented properly, due to invisible radiation
405 exposure that can accumulate in the body.
406 According to the results of interviews with
407 respondents, buildings that have been built for a
408 long time are one of the obstacles to the
409 development of nuclear medical facilities.
410 Therefore, it is necessary to have regulatory
411 guidelines governing the specifics of nuclear
412 medicine construction to create nuclear medical
413 facilities that prioritize safety for officers, patients
414 and the surrounding environment / visitors.
415 The review of nuclear medicine requirements is
416 carried out based on the results of a literature study
417 of national and international nuclear medicine
418 requirements and the results of survey observations
419 of nuclear medicine facilities in Indonesia. This
420 review focuses on the aspects of space availability
421 and construction related to safety in accordance with
422 the problems found by the researcher. The results to
423 provide recommendations for improvements to the
424 regulation of nuclear medical facilities in Indonesia,
425 especially in KMK RI number 008 / MENKES / SK
426 / I / 2009.
427
428 Design of Neclear Medicine Facility
429 The design of nuclear medical facilities
430 includes room layouts, mechanical electrical and
431 equipment. This design is based on the results of a
432 literature study and analysis of national nuclear
433 medicine requirements, international guidelines and
434 survey observations in ten nuclear medicine
435 facilities in Indonesia. In making this design the
436 authors conducted an expert judgment method with
437 5 experts in the field of nuclear medicine including
438 nuclear medicine specialists, medical physicists,
439 radiographers, radiopharmasis and hospital
440 architects.
441 Based on the results of the expert's assessment
442 of the final design, a room layout recommendation /
443 recommendation was re-designed. In the results of
444 the room layout design as a recommendation in
445 Figure 2, it is separated between the diagnostic
446 room, the therapy room and the radioimmunoassay
447 laboratory. Isolation rooms are better separated
448 because patients get high lecturers for radiation
449 safety and security as well as avoid radiation
450 exposure to staff, patients and visitors. A separate
451 radioimmunoassay laboratory to avoid radiation
452 exposure to the sample so as not to interfere with the
453 resulting diagnostic process. The
454 radiopharmaceutical room which is essential in
455 nuclear medicine facilities is positioned centrally
456 but still reaches several rooms supplied by
457 radiopharmaceuticals. The results of the design
458 recommendations were assessed by experts using
459 the scoring method and then analyzed using
460 Compare Means - One Sample T Test for the test
461 value of 4 out of 5 scoring. The test results show
462 that the recommendations for designing a room
463 layout for nuclear medicine facilities are stated well
464 based on the results of the questionnaire to five
465 nuclear medicine experts. Detailed specifications
466 regarding essential rooms in nuclear medical
467 facilities are described in the mechanical electrical
468 section.
469
470 Mechanical Electrical in Nuclear Medicine
471 Engineering
472 Mechanical Electrical in a hospital is an
473 important thing that must be considered because it is
474 related to the safety and security of staff, patients
475 and the environment around the facility. In nuclear
476 medicine using equipment that requires the support
477 of special mechanical electrical facilities such as
478 operating rooms and radiology. In addition to safety,
479 adequate mechanical electrical facilities can extend
480 the life time of the equipment so that it can optimize
481 operational and maintenance costs. The following is
482 an explanation of mechanical electrical in the core
483 room of the nuclear medicine department including
484 the scanning room, patient dose room, and
485 radiopharmaceutical space. Mechanical electrical
486 that is explained includes architectural aspects,
487 lighting, electricity, communication systems,
488 ventilation & medical gases.
489 General things that need to be considered in
490 electrical in nuclear medicine include a stable and
491 uninterrupted power supply which is essential with
492 regard to patient safety and security. In special tools
493 such as gamma cameras, SPECT, laboratory
494 equipment that must be active 24 hours must be
495 protected from disturbances such as power outages,
496 voltage fluctuations and frequency fluctuations.
497 Therefore we need a power stabilizer and UPS.
498 Essential rooms in a nuclear medical facility
499 that need attention including: scanning rooms;
 Atom Indonesia
500 Patient Injection Room, Post Injection &
501 Decontamination; and the radiopharmaceutical
502 room.
503 The scanning room at a nuclear medical
504 facility consists of radiation recording equipment
505 emitted by a patient who has been subjected to
506 radiation including a PET, SPECT and gamma
507 camera. The floor plan of the mechanical electrical
508 scanning room in nuclear medicine is shown in
509 Figure 4.
510 Lighting
511 General: fluorescent lighting up to 300 lux during
512 patient transfer to and from the table, equipment
513 arrangement, room cleaning and equipment
514 maintenance.
515 Special: The dimmer-controlled incandescent
516 luminaire will provide a lower level of illumination
517 during scanning to avoid glare and patient comfort.
518 Electrical
519 General: Equipment location, dimensions and
520 wiring requirements must comply with the pre-
521 installation guidelines of the manufacturer. The
522 electrical supply shall provide the necessary
523 channels allowing proper connection of the scanner
524 equipment and associated accessories.
525 Emergency: UPS required for scanning, control, and
526 outlet equipment connected to essential equipment
527 in nuclear medicine.
528 Note: Special outlets for UPS units; outlet
529 requirements, coordinated configuration with
530 equipment
531- Data communication system: Yes
532- Telephone: Yes
533- PACS: Yes
534- Ventilation Room temperature 21 ° C - 24 ° C
535- Humidity 30% - 60%
536- 6 times the air change / hour
537- 100% Exhaust: Yes
538- 100% Outside Air: No.
539- Room Air Balance: Negative
540- Occupancy: 3
541- AC Load - Equipment: 2,750 W
542- AC Load Lighting: 1.4 W / SF (15 W / M²)
543 Note: Pay attention to the appliance cooling
544 requirements recommended by the manufacturer
545- Plumbing and medical gas Chilled water: Yes
546- Sanitary Drain: Yes
547- Medical Air: Yes
548- Gamma Camera Equipment, SPECT, PET,
549 Injector, Infusion pump.
550 Some of the essential rooms in nuclear
551 medicine include patient injection, post injection
552 and decontamination rooms. Patient injection and
553 post injection rooms are often neglected in nuclear
554 medicine facilities in Indonesia, whereas in these
555 rooms there is often radiation exposure between
556 patients and officers. The decontamination room is a
557 security and safety requirement that must be
558 available to anticipate if there is a contamination in
559 nuclear medicine. However, in Indonesia this space
560 is often overlooked because it is considered never to
561 be used. The mechanical electrical floor plan for the
562 patient injection room, post injection and
563 decontamination is described in Figure 5.
564 Architectural construction
565 Ceiling height: 3.5 m (according to the needs of
566 tools from manufacturing)
567 Wall lining material: non-porous (vinyl)
568 Corner between wall and floor: Integral Cove Base
569 Note: Pb
570 Lighting
571 General: fluorescent lighting up to at least 100 lux
572 Electrical
573 The electrical supply must provide the necessary
574 channels to allow proper connection of the available
575 equipment.
576- Nurse Call system communication: Yes
577- Ventilation
578- Room temperature 21 ° C - 24C °
579- Humidity 30% - 60%
580- 6 times the air change / hour
581- 100% Exhaust: Yes
582- 100% Outside Air: No.
583- Room Air Balance: Positive Dedicated (injection
584 room)
585- Exhaust System: No.
586- Occupancy: 3
587- AC Load - Equipment: 250 W
588- AC Load Lighting: 20 W / m2
589 Note:
590 Pay attention to the appliance cooling requirements
591 recommended by the manufacturer
592- Plumbing and medical gas Chilled water: Yes
593- Hot water: Yes
594- Sanitary Drain: Yes
595- Equipment Transfer box, Pb syringes, personal
596 protective equipment (google, Pb apron, thyroid
597 apron)
598 The radiopharmaceutical room is the core
599 room of the nuclear medical facility. In this room,
600 radionuclides are generated to be given to patients.
601 The radiopharmaceutical room needs to be designed
602 optimally to produce optimal nuclear medicine
603 treatment for patients. In addition, the
604 radiopharmaceutical room needs to be designed with
605 attention to radiation safety for the officers working
606 in the room considering that the officers work
607 directly with radionuclides every day. The
608 radiopharmaceutical room floor plan is described in
609 Figure 6.
610 Architectural construction
 Atom Indonesia

611 Ceiling height: 3.5 m (according to the needs of 667 not set the details regarding construction
612 tools from manufacturing) 668 requirements related to safety.
613 Wall lining material: non-porous (vinyl) 669 2. The results of research in ten nuclear medical
614 Corner between wall and floor: Integral Cove Base 670 facilities in Indonesia show that only 57% of the
615 Note: Pb 671 construction aspects related to safety have been
616 Lighting 672 fulfilled by nuclear medical facilities in Indonesia.
617 General: fluorescent lighting up to at least 100 lux 673 3. This research resulted in the design of a major
618 and additional desk lighting is required. 674 nuclear medical facility consisting of room layouts,
619 Electrical 675 mechanical electrical and equipment based on the
620 General: Mains power as shown is for use as a guide 676 study results of nuclear medicine requirements from
621 only. Equipment location, dimensions and wiring 677 national regulations, international guidelines and
622 must match the requirements of the 678 survey observations in 5 nuclear medical facilities in
623 radiopharmaceutical equipment. 679 Indonesia.
624 Emergency: Emergency power for selected 680 4. The results of the room layout design for nuclear
625 equipment, controls and outlets as determined by the 681 medicine facilities are declared valid with expert
626 Hospital. 682 judgment from ten experts in the field of nuclear
627 Note: 683 medicine.
628 1. Fridge outlet with emergency power 684
629 2. Bio-safety cabinet outlet with emergency power 685 ACKNOWLEDGMENT
630 3. Connection to the exhaust fan on the roof with 686
631 emergency power 741 This paper is partly supported by Thesis
632 - Telephone system communication: Yes 742 Research Grant 2020, Ministry of Research and
633 - Data: Yes 743 Technology/National Research and Innovation
634 - Intercom: Yes 744 Agency. We also thank to Dr. Ahyahudin Sodri who
635 - Security: Yes 745 has provided a lot of advices for improving the
636 - Ventilation Room temperature 21 ° C - 24C ° 746 research.
637 - Humidity 30% - 60%
747
638 - 6 times the air change / hour
748 AUTHOR CONTRIBUTION
639 - 100% Exhaust: Yes
749
640 - 100% Outside Air: No.
750 Authors equally contributed as the main
641 - Room Air Balance: Negative
751 contributors of this paper. All authors read and
642 - Exhaust System: No.
752 approved the final version of the paper.
643 - Occupancy: 3
753
644 - AC Load - Equipment: 900 - 1800 W
754
645 - AC Load Lighting: 20 W / m2
755 REFERENCES
646 Note:
756
647 Pay attention to the appliance cooling requirements
757 1. Bapeten. (2017). Kuliah Umum terkait Aspek
648 recommended by the manufacturer
758 Keamanan Nuklir. Retrieved from Berita
649 Pay attention to the availability of exhaust on the
759 Bapeten website:
650 work table
760 https://www.bapeten.go.id/berita/kuliah-umum-
651 - Plumbing and medical gas Chilled water: Yes
761 terkait-aspek-keamanan-nuklir-
652 - Hot water: Yes
762 134829?lang=en
653 - Laboratory Air: Yes
763 2. BAPETEN. (2012). Peraturan Kepala Badan
654 - Laboratory Vacuum: Yes
764 Pengawas Tenaga Nuklir Nomor 17 Tahun
655 - Sanitary Drain: Yes
765 2012 tentang Keselamatan Radiasi dalam
656 Equipment
766 Kedokteran Nuklir. 2–3.
657 Processing boxes, radioactivity gauges, Laminar
767 3. Carr, R. F. (2017). Whole Building Design
658 fume hoods, needle cutters, emergency kits, quality
768 Guide a program of the National Institute of
659 testing kits.
769 Building Sciences. Hospital. Retrieved July 30,
660
770 2019, from
661
771 https://www.wbdg.org/design/hospital.php
662 CONCLUSION
772 4. Department of Veterans Affairs. (2008).
663
773 Nuclear Medicine Design Guide. (April), 1–28.
664 1. Nuclear medicine standards and regulations in 774 5. Depkes, R. (2015). Menkes Canangkan
665 Indonesia are in accordance with the international
775 Komitmen Penanggulangan Kanker di
666 standard nuclear medicine requirements, but have
776 Indonesia. 4 Februari, p. 2. Retrieved from
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777 http://www.depkes.go.id/pdf.php?id=15020400 833 MATEC Web of Conferences, 106, 08054.

778 003 834 https://doi.org/10.1051/matecconf/2017106080
779 6. Dispersion, S., Distribution, P., Model, P., 835 54
780 Society, R., & Teng, C. M. (2011). Data , Data 836 18. Menkes RI. Pedoman teknis bangunan rumah
781 , Everywhere. 837 sakit ruang gawat darurat. , Direktorat Bina
782 7. Health, I., & Guidelines, F. (2014). Part B – 838 Pelayanan Penunjang Medik dan Sarana
783 Health Facility Briefing & Design. 1(May). 839 Kesehatan (2012).
784 8. Hofmeister et al. (2007). A General Model of 840 19. Menteri Kesehatan Republik Indonesia. (2008).
785 Software Architecture Design Derived From 841 Peraturan Menteri Kesehatan Republik
786 Five Industrial Approaches. The Journal of 842 Indonesia No.780/Menkes/Per/VIII/2008.
787 System and Software 80 (2007) 106-126. 843 Penyelenggaraan Pelayanan Radiologi.
788 doi:10.1016/j.jss.2006.05.024 844 Retrieved from
789 9. IAEA. (2006). Nuclear Medicine Resources 845 http://www.hukor.depkes.go.id/uploads/produk
790 Manual. October, 188–200. 846 _hukum/PMK_No._85_ttg_Pola_Tarif_Nasion
791 10. Jha, A., Singh, A., Mithun, S., Shah, S., 847 al_Rumah_Sakit_.pdf
792 Agrawal, A., Purandare, N., … Rangarajan, V. 848 20. Nowakowski, A. (2006). Biomedical
793 (2015). Designing of High-Volume PET/CT 849 engineering handbook (Vol. 2). In The
794 Facility with Optimal Reduction of Radiation 850 Biomedical Engineering Handbook. Medical
795 Exposure to the Staff: Implementation and 851 Devices and Systems (Third edit).
796 Optimization in a Tertiary Health Care Facility 852 https://doi.org/doi:10.1201/9781420008340.ch
797 in India. World Journal of Nuclear Medicine, 853 7
798 14(3), 189. https://doi.org/10.4103/1450- 854 21. Padovani, R. (2011). Radiation Protection in
799 1147.163252 855 Medical Physics. 1, 123–131.
800 11. Kartamihardja, A. H. S. (2011). Instrumentasi 856 https://doi.org/10.1007/978-94-007-0247-9
801 Untuk Pencitraan Kedokteran Nuklir. Annual 857 22. Pham, T. A. (2015). Hospital facility design: A
802 Scientific Meeting 2011 The Indonesia Society 858 guide to space planning for a new general
803 of Nuclear Medicine A The Indonesia Society 859 hospital in Vietnam. Illinois Institute of
804 of Nuclear Medicine and Biology 860 Technology.
805 Radioisotopes, Radiopharmaceutical and 861 23. Rezaalipour, M., Tajasob, S., Dehyadegari, M.,
806 Cyclotron, 0–21. 862 & Bojnordi, M. N. DrAx: An automatic
807 12. Kartamihardja, A. H. S. (2012). Permasalahan 863 approach to designing more precise and
808 Pelayanan Kedokteran Nuklir Di Indonesia. 864 energy-efficient approximate adders. , CSI
809 23–25. 865 International Symposium on Real-Time and
810 13. Kemenkes. (2012). Pedoman Teknis Bangunan 866 Embedded Systems and Technologies, RTEST
811 Rumah Sakit Ruang Rawat Inap [Technical 867 2018 (2018).
812 Guidelines for Hospital infrastructure]. In 868 24. RI, K. K. (2012). Pedoman Teknis Bangunan
813 Direktorat Bina Pelayanan Penunjang Medik 869 Rumah Sakit Ruang Rawat Inap. 1–25.
814 dan Sarana Kesehatan. 870 Retrieved from
815 14. Kemenkes. Keputusan Menteri Kesehatan 871 aspak.buk.depkes.go.id/beranda/download/7.-
816 Republik Indonesia Nomor 872 Pedoman-Teknis-Instalasi-Rawat-Inap.pdf
817 008/MENKES/SK/I/2009 Tentang Standar 873 25. Ryan, J. (2014). Australasian Health Facility
818 Pelayanan Kedokteran Nuklir di Sarana 874 Guidelines - Health facility briefing and
819 Pelayanan Kesehatan. , Menteri Kesehatan 875 planning. (February). Retrieved from
820 Republik Indonesia § (2019). 876 http://www.healthfacilityguidelines.com.au/Au
821 15. Kementerian Kesehatan RI. (2012). Pedoman 877 sHFG_Documents/Guidelines/aushfg_b_520.p
822 Teknis Bangunan Rumah Sakit Instalasi 878 df
823 Sterilisasi Sentral (CSSD). Retrieved from 879 26. Strzelczyk, J. (Jodi). (2006). Safety Reports
824 https://aspak.yankes.kemkes.go.id/ 880 Series No. 40, Applying Radiation Safety
825 16. Kementrian Kesehatan RI. (2019). Hari Kanker 881 Standards in Nuclear Medicine. Health
826 Sedunia 2019. Kamis, 31 Januari, p. Rilis 882 Physics, 91(3), 270–271.
827 Berita. Retrieved from 883 https://doi.org/10.1097/01.hp.0000228933.678
828 http://www.depkes.go.id/article/view/19020100 884 83.43
829 003/hari-kanker-sedunia-2019.html 885 27. Tandon, P. (2010). Regulatory requirements for
830 17. Malykha, G., Dorogan, I., & Tesler, N. (2017). 886 designing PET-CT facility in India. Indian
831 Improving Processes of Design and 887 Journal of Nuclear Medicine, 25(2), 39–43.
832 Construction of Nuclear Medicine Facilities. 888 https://doi.org/10.4103/0972-3919.72684
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889 28. World Health Organization. (2018, September 891 https://www.who.int/news-room/fact-

890 12). Cancer. Retrieved from 892 sheets/detail/cancer
893
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895 If you find difficulties in placing figures or table in the text above, please insert them in this page!
896
897 Fig. 1. Workflow in the nuclear medicine department (compiled from (Jha et al., 2015))

898
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900
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901 Fig. 2. Workflow of Nuclear medicine design method

902
Designing Nuclear Medicine
Literature Study Field Observation
Facility

Literature Study

Indonesia Regulations
KMK RI
PERKA BAPETEN

International Guidelines
IAEA Nuclear Medicine
IHFG Requirements

Observation at 10 hospitals

Observation
Questionnaire
Checklist

Nuclear Medicine
Observation Field Requirements
Result

Nuclear Medicine
Facility Designing

Design

Design Validation
Expert Judgment

Design
Recommendation

903
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904 Fig. 3. Nuclear Medicine Facility Design Recommendation

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908 Fig. 4. Mechanical Electrical Nuclear Medicine Scanning Room

909
910
911
912
913
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915
916
917
918
919
920
921
922
923
924
925
926
927
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929
930
931
932
933 Fig. 5. Mechanical Electrical Injection Room, Post Injection Room And Decontamination Room
934

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936

937

938

939
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941
942
943
944 Fig. 6.Mechanical Electrical Radiopharmacy Room

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946
947 Annex
948
Symbol Description Symbol Description
Duplex receptacle Nurse call duty station

Duplex receptacle – mounted above Emergency nurse call

counter top

Duplex receptacle with Ground Fault Nurse call staff station

Interrupter

Duplex receptacle with GFI – mounted Volume control – wall mounted

above counter top

Weatherproof duplex receptacle with Junction box

GFI

Quadraplex outlet – mounted above Supply air diffuser

Quadraplex outlet Thermostat

Quadraplex outlet with Ground Fault Humidistat

Interrupter

Quadraplex outlet with Ground Fault Vacuum

Interrupter – mounted above counter
top
Television outlet Medical air

949
950