STANFORD’S STATE-OF-THE-ART CANCER CENTER NEARING COMPLETION BY RUDOLPH AND SLETTEN

FOSTER CITY, CA (April 29, 2003)—Rudolph and Sletten, Inc., general contractors, announced that construction on the state-of-the-art Center for Cancer Treatment and Prevention at Stanford University Medical Center is nearing completion. Rudolph and Sletten initiated the $85 million project in 2001. The Center is scheduled to open in early 2004.

The facility will rank as one of the nation’s most comprehensive cancer treatment centers, and one of the few to offer a complete array of services under one roof. The 225,000 square foot ambulatory care facility is devoted entirely to cancer care, including radiation oncology, surgery, and outpatient services as well as housing research and diagnostic facilities. The building will contain seven sophisticated linear accelerators to deliver intensity-modulated radiation. Only a handful of cancer centers in the U.S. have such a large number of linear accelerators.

Rudolph and Sletten’s track record as one of the West Coast’s premier builders of state-of-the-art hospitals is tailored to the building’s demand for high-tech health care construction expertise. The company brings extensive health care experience to this project, including the construction of Lucille Packard Children’s Hospital at Stanford, Kaiser Permanente in Fremont and Roseville California, and Children’s Hospital in Los Angeles.

To add to their unparalleled health care experience, Rudolph and Sletten is presently working on a number of new hospital projects, including the University of Southern California Healthcare Consultation Center, Phase II; Kaiser Foundation Health Plan, Los Angeles and Santa Clara; and the City of Hope Replacement Hospital in Duarte, California.

“Rudolph and Sletten’s team has been indispensable in delivering this vastly important hospital project. They have demonstrated an extreme propensity to detail and proactive planning which has translated into reliable budgeting and scheduling. In addition, they have demonstrated their ability and desire to go the extra mile,” said John Gaston, project manager for Stanford. “With Rudolph and Sletten’s assistance, nearly 6% of the construction budget was trimmed without any significant adverse impact on the project’s functionality or aesthetics.”

The building has four floors, including a basement, which houses the radiation oncology department. The first and second floors house clinical and administrative areas, exam rooms, and offices. The third floor contains 16 operating rooms and the associated pre-operative and recovery suites. A below grade, basement-level tunnel connects the Cancer Center to the adjacent Lucille Packard Children’s Hospital, while a bridge connects the new building to the third level of the nearby Stanford Hospital.

The facility was designed by Bobrow/Thomas and Associates of Los Angeles, and won a design award from Modern Healthcare, whose judges said it “epitomizes patient-focused care.”

Because of the dramatic needs of the building, Rudolph and Sletten faced several challenges in building the facility, including the installation of seven sophisticated linear accelerator vaults and coordination of the high-tech mechanical and electrical systems to service the linear accelerator vaults, 16 operating rooms, radiology, radiation oncology as well as the rest of the building. Site logistics were particularly problematic because the building site is surrounded on all sides by occupied and operational buildings, including two hospitals. Congestion at the site made deliveries of materials and staging of cranes and other equipment difficult, and resulted not only in special coordination needs, but also in some of the work being completed at night so that the neighboring hospitals and medical office buildings would not have their day-to-day operations interrupted.

“We had to use larger cranes than normal due to limited access around the perimeter of the building,” said Marcus Staniford, project executive for Rudolph and Sletten. “For example, to accommodate installation of pre-cast concrete panels on the building skin, we had to utilize a crane that could reach from one side of the building to the other, since we had limited, or no access for a crane on the north, east or south sides of the structure.”

The proximity of Children’s Hospital to the new Cancer Center required design of the shoring system to resist any seismic loads that the existing hospital could potentially place on the soil restraint system. This entire operation and the associated design was permitted and implemented in conjunction with the Office of Statewide Health Planning and Development (OSHPD). “We worked very diligently to minimize the inconveniences, associated with such a large construction project, to the adjacent facilities and their occupants. One of our primary objectives on this project was to not impact the neighboring facilities, and I strongly believe we have achieved this,” states Marcus Staniford.

One of the biggest challenges at the site was the installation of the seven linear accelerators vaults and all the scopes associated with these structures. Rudolph and Sletten subcontracted the installation of 1.6 million pounds of lead bricks on the walls, ceilings and decks above the linear accelerator vaults to act as a radiation shielding system. Lead lined sheetrock and plywood was also installed throughout the Radiation Oncology area in the basement and Radiology on the first level. With the installation of the lead came many safety considerations.

Part of the expertise that Rudolph and Sletten brought to the project included training and implementation, as well as support, for all safety requirements related to the cutting and installation of lead. “Safety associated with lead installation was addressed for all workers on site as well as the general public, not only those installing the lead systems,” said Marcus Staniford. “It was of paramount importance to address the safety considerations of the entire lead shielding process, including material handling, cutting, installation as well as air cleanliness.”

Construction workers who were installing the lead were regulator fit tested to make sure their personal protective respirator equipment was worn and operated safely. Lead was cut within a specially constructed booth that was equipped with HEPA filters and continuous exhaust to remove the lead particles from the shed and clean the air before it was emitted into the atmosphere. Rudolph and Sletten continuously monitored the air, both inside the linear accelerator rooms, as well as outside, to make sure particulate levels were maintained below allowable limits.

Construction Overview
Rudolph and Sletten’s work included:

• Self-performing all the concrete work on the project, including concrete for the foundation and the linear accelerator vaults. Almost 18,000 cubic yards of concrete were placed in and around the building.
• Coordination of the 2,500 tons of steel that went into the building.
• Installation of an on-site thermal fluid steam generation system within a very limited floor space in the basement to avoid the expense of tying into a central steam plant that was some distance away. The self-contained steam system delivers steam for heating hot water to support the nearly 300 supply-air VAV boxes, to the air handler units for humidification and  to the Sterile Process area for sterilizing purposes.
• Construction of seven linear accelerators vaults, including the installation of approximately 200,000 pounds of lead to act as a shielding system for each linear accelerator. The lead shielding system was supplemented by concrete walls up to 4’-11” thick, a maze wall design inside the vaults, as well as ten feet of soil outside the vaults, on the building perimeter.
• Coordination of a unique foundation system, including spread footings, mat slabs and grade beams. The foundation system was designed to respond to extreme building loads, including the 1.6 million pounds of lead installed in the building, and the large lateral design loads associated with the linear accelerator vault walls.
• Coordination of the construction affiliated with all architectural design features, specifically, the complexities of the exterior skin system, the basement level tunnel, a sunken courtyard, and a three-story atrium, which allows light from the roof level into all three floors, including the lobby.
• Installation of four 90-foot long trusses that span and support the third floor light court and extend over the drive-through area and the lobby. Each of the trusses weigh 16 tons apiece.
• Coordination of several different materials on the exterior skin, including a custom colored pre-cast concrete panel system, metal panels, plaster, and curtain and window wall systems. A majority of the exterior skin system was performed on a design/build basis.
• Design of a shoring system to resist the forces of the perimeter soil and to resist the entire force of Children’s Hospital in the event of an earthquake. The shoring system enabled the construction of the foundation systems without interrupting the continued operation of the adjacent facilities.
• “Not only was the shoring system design and configuration coordinated with adjacent buildings, but a tremendous amount of pre-planning and research was done to ensure that neither public safety, nor the myriad of existing and operational utilities were impacted by the shoring system installation,” stated Marcus Staniford.

Building the Linear Accelerator Vaults

A linear accelerator produces a high-energy radiation beam that is directed into specific locations within the body, wherever tumors are identified. Even though radiation beams are shot at a specific angle from a linear accelerator, a shielding system must be put in place to deflect all primary and secondary radiation beams from leaving the room. Rudolph and Sletten, working in tandem with both Stanford University, BTA and radiation shielding consultant and physicist Nisy Elizabeth Ipe, Ph.D., shielded each room to accommodate the operation of the linear accelerators. The linear accelerator vaults are located in the basement, so that the earth itself also acts as a shielding source.

Shielding is frequently done with concrete, but because of limited space, Rudolph and Sletten used a combination of concrete and lead for the lateral walls and the ceilings. The concrete walls are approximately five feet thick, with an additional eight inches of lead used in conjunction with the concrete. Approximately 200,000 pounds of lead brick were installed in and around each linear accelerator vault. In addition to lead that is placed on the walls, there is also lead installed along the ceiling, to make sure no radiation beams penetrate through the concrete to the floors above. “As a physicist, I can design the shielding, but if there is no follow through by the contractor, I have no guarantee that what I designed is what was built,” said Dr. Ipe. “Rudolph and Sletten are very conscientious about follow through and making sure that everything is done correctly.”

About Rudolph and Sletten, Inc.
Rudolph and Sletten (www.rsconstruction.com) is one of the leading general contracting firms on the West Coast. As a pace setter in the construction industry, Rudolph and Sletten has provided quality-oriented general contracting and construction management services for over four decades. Rudolph and Sletten’s expert professionals manage each job comprehensively, from site selection and preconstruction services through project completion. With its corporate headquarters in Foster City, the company also has regional offices in Roseville, Irvine, and San Diego, California.

Rudolph and Sletten’s building expertise includes virtually all types of projects with an emphasis on those markets where their technical expertise and quality excel: corporate campuses and office buildings, biotechnology and pharmaceutical research and manufacturing, health care, electronics, semiconductor, and high-tech research. Other areas of expertise include parking structures, educational institutions, housing, public attraction, and retail facilities. Rudolph and Sletten’s current clients include Hewlett-Packard, Genentech, and Kaiser Permanente, Stanford University, Monterey Bay Aquarium, Chiron, eBay and the University of California.

About The Center for Cancer Treatment and Prevention/Ambulatory Care Pavilion at Stanford University Medical Center
The state-of-the-art center will bring under one roof all of Stanford’s resources for diagnosing and treating cancer, thereby enhancing patient care and improving access and convenience for patients and physicians. The vision for the new center began in the early 1990’s. Definitive planning efforts began in 1996 and the permit was received in 2001. The 225, 000 square foot center will double the space currently dedicated to cancer programs in the main hospital complex. Cancer remains one of the major health focuses of the Medical Center. Currently, just 80,000 square feet at Stanford Hospital is dedicated to cancer treatment. In addition to a radiation therapy suite, the center includes a mammography and diagnostic radiology unit, 80 exam rooms, 16 operating rooms, 50-plus chemotherapy stations, social and nutritional services, and a clinical research suite.

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