Planning a LINAC Facility: What Each Stage Actually Requires

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The AERB eLORA licensing process for a new LINAC facility proceeds through five stages. Each is a prerequisite for the next. The total time from project initiation to first patient treatment runs to 20–36 months for a well-prepared team — and longer when any stage encounters documentation gaps, construction failures, or coordination breakdowns.

Studio Athenos, based in Jaipur, designed the LINAC bunker at Jeevan Raksha Hospital in Bikaner — navigating the process from Licence to Construct through to Licence to Operate. The stage-by-stage account below is drawn from that experience.

Stage 1 — Before Construction: Licence to Construct

The AERB Licence to Construct cannot be applied for until the shielding design report and architectural drawings are complete. The shielding design — prepared by a qualified medical physicist — determines wall thicknesses, which determine room dimensions, which determine the structural system. The medical physicist must therefore be appointed before the architect begins drawing.

The LC application requires room layout drawings, a shielding design report, equipment specifications from the LINAC vendor, and structural drawings confirming load capacity. AERB will review the submission and may raise design queries — each requiring a formal written response with revised drawings. A complete, well-prepared first submission reduces the number of query cycles. Each cycle adds weeks; multiple cycles add months.

Lock your machine vendor and specifications before submitting the LC application. If the machine model changes after LC approval, the shielding calculations may need revision and the LC may require re-submission.

Stage 2 — Construction: What Cannot Deviate

The AERB-approved drawing governs construction. Deviations must be formally reported — significant changes require re-submission and re-approval. The contractor must work only from the approved drawings, and the architect must be present during critical construction stages.

Primary barrier walls require staged concrete pours with designed vibration schedules. Honeycombing — internal voids caused by trapped air during pouring — is the most damaging construction failure in LINAC bunkers. In a standard wall it is a surface defect. In a shielded barrier it is a radiation path. Discovering it at the Licence to Install stage means the project stops for remediation. Prevention requires supervision discipline that most contractors have not applied to a hospital project before.

The oncology department surrounding the bunker matters as much as the bunker itself. AERB reviews the entire department — waiting area, changing room, control room, treatment planning room, mould room, CT simulator room. A well-designed bunker inside a poorly planned department will not pass review and will not function clinically.

Stage 3 — After Construction: Licence to Install

The LI application requires as-built drawings confirming the structure matches the AERB-approved layout exactly, concrete density test records, and ventilation commissioning reports. The machine cannot be installed until LI is granted. Any structural defect discovered at this stage must be remediated before the application proceeds. Coordinate the LINAC delivery schedule with LI approval — the machine should not arrive on site before LI is granted.

Stage 4 — Installation Through to Operation

After LI, the machine is installed and acceptance-tested by the medical physicist and vendor. The Licence to Commission application requires an acceptance testing report, radiation survey, and interlock verification. After LCom, the Licence to Operate application is possible. The LO is not the end of the regulatory relationship — it is the beginning of ongoing compliance. A dedicated Radiation Safety Officer, annual medical physics audits, and licence renewals are permanent obligations. Budget for them from day one.

Pre-Design Checklist

Before appointing your architect, confirm the following are in place. Our healthcare architecture practice can walk through each of these with your team before the first drawing is produced.