Design Do's for the Imaging Department

Technology, staff and patients have seeming divergent needs in a modern medical imaging facility. Whether in a hospital or an outpatient facility, advances in digital imaging have made the challenge the movement of people as well as the images. Blending “high tech” with “high touch” and being able to expand and change in the future becomes the opportunity. Understanding what has changed—and what has not—in both architecture and technology is essential to medical imaging departments that are safe, productive and comfortable. 

The design of the modern medical imaging department must meet several seemingly divergent needs: 

• Accommodate large, heavy, noisy technical medical equipment with extensive infrastructure and shielding requirements. 
• Create a safe, pleasant and efficient staff work environment. 
• Comfort patients who are likely to be anxious or uncomfortable, or a combination of both. 

New developments in medicine and architecture influence the design of medical imaging facilities. An understanding of what has changed – and what has not – is essential to developing safe, productive and comfortable imaging departments and outpatient centers.


Technology

Change in imaging technology accelerates, fueled by the development of digital information technologies. Imaging technology is developing in four ways: new technology, advances in specific modalities, convergence and functional imaging.
 

The first development with widespread clinical applications was computerized axial tomography, or CT scan, in the 1970s.

The variety of imaging modalities and equipment available make flexibility a key design factor. The suite’s space and infrastructure must support the latest technology, allowing for multiple upgrades.

Future upgrades may involve more than simply replacing old equipment. For example, some hospitals now have two or more CT scanners, not all located in the imaging department.

Imaging technologies have increased in number, speed and power. A patient’s full body can be scanned in less time that it takes to move the patient in and out, creating design implications for patient staging areas, dressing and staff work areas.

Radiologists use the digital information base to improve patient outcomes. The image of radiologist in a dark room is transformed to an integral information provider. As developments in digital technology continue, imaging becomes accessible and cost-effective. Scans are drastically increasing in volume and number, with shorter scan sessions and larger patient information sets.

Evidence-based medicine and, evidence-based design has spurred important research into the measurable impact of design on patient outcomes, staff performance and overall efficiency. Based on research, design includes increased natural light, appropriate materials and measurable design impacts on work performance are being incorporated into new hospitals and outpatient imaging centers. Natural light in imaging rooms of all types – MRI, CT, even R/F – will have the most significant impact on patient comfort and anxiety.

Patient changing and staging areas should be designed for privacy and dignity, avoiding the bullpen-style large waiting spaces that are unfriendly and unwelcoming. At the same time, individual dressing rooms that really allow the patient to change clothes and prepare, before and after the imaging exam, will go a long way.  Think about department store dressing rooms, and what works and what does not.  Family spaces can be designed for personal details and comfort, reasonably close to the exam spaces and facilitating a connection to daily activities. 

Staff work areas are designed to facilitate tasks and ergonomics to avoid repetitive drudgery, staff comfort and ease of access to patients, work products, radiologists and often the family, are all appropriate examples utilized in projects today.


Re-arranging the puzzle

As MRI equipment has increased in power from 0.5 Tesla (T) to 1.5T to 3.0T and even 7.0T, the magnetic fields emitted by these machines have increased.

The great benefit of digital imaging is that it allows the movement of information and images – not people. The design of any imaging department is based on workflow and patient satisfaction, not the physical movement of film. This fundamental change allows the imaging department to be patient focused, improve staff work habits and provide a supportive family model.

A full understanding of technology design and implementation is crucial, but it is only one piece of the imaging puzzle. As technology becomes more transparent, the organization of all functions becomes a major determinant. With the development of digital image systems, radiologists are often centralized for collaborative, specialized imaging interpretation.

The other piece is patients: the number of procedures and time required for each visit and requirements and average number of procedures is changing. More recent designs provide individual dressing rooms adjacent to the procedure room, where patients can change and wait with greater privacy and dignity. Modern imaging departments require patient prep and recovery spaces for interventional procedures.


Rules for planning and design

Besides having larger fields, higher-strength magnets impact shielding design in other ways.

Although much of today’s imaging equipment and healthcare construction is new, many of the rules for planning and design remain the same. The environment stresses the transparency of medical imaging technology and installation. Unfortunately, that thinking allows a lack of attention to details, fundamental requirements and even safety concerns. A good rule of thumb for basic imaging planning: Architecture (and architects) may be forgiving, but technology never is. For instance, while MRI installation has been accomplished in smaller rooms, the basic understanding of magnetic field placement or restrictions has not changed. Current-generation CT or R/F equipment still requires adequate radiation shielding and clean power, if not more so.


Current Determinants

Imaging technology is focused toward MRI, CT and PET, more often being combined with CT in PET/CT. It is timely to consider current design determinants:

• Space: For the dimensions and weight of the equipment, and to support appropriate clinical patient care and staff support.
   
• Vendor shop drawings: These critical planning tools provide baseline information for guiding templates and establishing critical utilities or services, but do not provide the level of design detail as architectural drawings.
   
• Establishing room size: Minimal room size does not adequately support patient care needs, appropriate line of sight to observe the patient or critical staff support.
   
• Upgrades: Complex spaces will be the standard. Digital imaging technology will not necessarily reduce room size.
   
• Magnet requirements: As MRI equipment has increased in power, magnetic fields have increased, too. Changes mean the increases are not directly proportional.
   
• CT speed: Influences the room and shielding design. The greater throughput of high-speed scanners can result in a more patients undergoing scans daily and planning must be done accordingly.
   
• Hospital requirements: Inpatients require more care than ambulatory care patients. This may limit the number of patients hospital radiology departments can assess daily.
   
• PET and PET/CT:  High radiation doses have a major impact on planning and shielding. Due to large exposure used for imaging, areas that do not require shielding with other imaging modalities require protection.
   
• Soundproofing: An essential and often overlooked component of MRI suites is soundproofing.
   
• Vibration: This is a crucial issue for MRI and CT. This can be controlled by isolated slab design and special anchorage details.
   
• Digital reading room: Incorporating image interpretation, PACS and radiology information systems are carefully designed for physical space demands, lighting and ergonomics. Lighting must be placed to avoid glare on the monitor.  Individual work spaces must be designed to allow privacy and collaboration at the same time. Work surfaces and seating must consider flexibility for height and physical comfort which supports work performance.

Safety standards and guidelines

Larger magnets are less susceptible to interference from moving metal objects. Extra shielding may be needed in this situation to protect the environment and the people who work there from the additional radiation involved in operating the equipment more frequently. This is generally more of a concern for outpatient imaging centers than hospital settings.

Patient safety in radiology is a growing concern. Safety standards and guidelines are significant for architects and owners. Carelessness in planning and design is often the result of taking basic criteria for granted. Adopted safety guidelines should be referenced in planning standards or regulations.

For ionizing radiation, shielding characteristics are based on the National Council on Radiation Protection and Measurements (NCRP) Report 147: Structural Shielding Design for Medical X-Ray Imaging Facilities. The information has been updated, including new modalities not previously discussed.

Expect more safety standards and planning questions for radiology.


Healing environments for imaging

While imaging equipment and technology planning concerns are important, these considerations should not override those of employees and patients. Patients and staff are in a stressful situation, no matter the quality of technology. The requirements of the technology should be dealt with transparently, so that individuals can focus on the environment.

Patients are concerned about privacy and the unknown. Imaging can be a sterile, restricted environment. Thus it makes good sense to utilize design to stress communication flow, involvement and empowerment whenever and wherever possible. Let’s face it; imaging for the patients involves waiting and abandonment, two difficult factors to overcome without some help in the design.

Staff are concerned about technical performance and patient accommodation, while performing highly repetitive tasks. The design of staff spaces that focus on work flow and improved job performance will result in patient and staff satisfaction, less errors, and likely improved work.

In both cases, the result will be a tangible step to deal with increased work demand and ever faster technology. Shorter imaging exams due to less patient anxiety and improved staff performance can be expected. Another side benefit of happier patients and staff is the long-term relationship, another step to confront the anonymity of the medical care process.

An evidence-based consensus emerges that the design of care environments helps patients feel safe, comfortable and facilitates the healing process, the trend toward healthy design and its compelling benefits is too powerful to ignore for imaging spaces.  Evidence suggests design can improve patient, family, and staff satisfaction, provide a positive return on investment and even directly impact image quality.


Trends

A survey in the October 2006 issue of Health Imaging and IT magazine revealed that the top three trends in imaging are:

• Improving workflow
• Increasing procedure volumes
• Adding/improving information systems and IT

Improvement of the environment was not explicitly mentioned in any of the top 20 responses, yet all of these goals can be accomplished through a design process.

No matter what the technology, it has a fundamental relationship with planning and design. While technology density and patient volume might be of the greatest concern, the environment may have the biggest impact on improving the imaging experience.

 
Teamwork

Due to the complexities of designing for modern medical imaging, design teamwork is ever more important. Everyone involved in the design—architects, radiologists, equipment vendors, patients and their families—all contribute to the design that successfully meet the needs of advanced imaging technology while supporting the people who use it.

 

An essential, if often overlooked, component of the design of MRI suites is soundproofing.  MRI equipment is very noisy during operation. As the magnet’s gradient power increases, so does the noise, making this an even more vital issue when designing for higher-strength magnets. Double-layer walls with air space and insulation can help lessen the noise of the machinery. Insulating the ceiling and isolating the construction can also reduce noise. Windows for control rooms should be double-glazed glass to minimize sound. Additional sound mitigating materials, finishes, and design solutions are also recommended.

The evidence suggests design can improve patient, family, and staff satisfaction, provide a positive return on investment, and even directly impact image quality.