the architecture of medical imaging

The Architecture of Medical ImagingDesigning Healthcare Facilities for

Advanced Radiological Diagnostic and Therapeutic TechniquesUniversity of Kansas – Architecture 731 – Systems and Components of Healthcare Facilities

Bill Rostenberg, FAIA, FACHA, NCARB Principal and Director of Research - Anshen + Allen901 Market Street San Francisco, CA, USA 94103

[email protected] 415 / 281-5459Page: 9

MRI Safety Planning Implications

MRI suite with 3 scanners

21

Future 4th Scanner

3

Imaging Department

© 2008 Anshen+Allen

ZONE 1



21ZONE 2

Future 4th Scanner

3

Imaging Department


ZONE 1



21ZONE 2

Future 4th Scanner

3

Imaging Department


ZONE 1

ZONE 3



21ZONE 2

ZONE 4

Future 4th Scanner

3

Imaging Department


ZONE 1

ZONE 3


Secure MRI suite boundary (Zones 3 & 4)



Secure MRI suite boundary (Zones 3 & 4)Secure MRISecure MRI suite door







Secure MRI suite boundary (Zones 3 & 4)Secure MRISecure MRI suite door

Through-traffic does not enter MRI suite





One Tech can see 2 MRI rooms




Both TechsBoth Techs can see entrance to “Security Vestibule”




Both TechsBoth Techs can see entrance to “Security Vestibule”

Security-controlled Corridor


Direction of Door Swing Into Scan Room During a quench, cryogenic gas fills the scan room and depletes 02







If the door swings in, i dincreased room pressure can make it difficult to exit quickly.



If the door swings in, i dincreased room pressure can make it difficult to exit quickly.

If the door swings out it will be easier to exit.


“Handed” vs. “Mirrored” Rooms “Handed” Inpatient Rooms

Designed for safety because everything is in the same place

Do providers get disoriented (which patient)?patient)?

Need to provide distinguishing visible landmarks

Where is the evidence?


“Handed” X-ray Rooms

Designed for safety because everything is in the same place

Do providers get disoriented (which patient)?patient)?

Need to provide distinguishing visible landmarks



“Mirrored” X-ray Rooms

Designed for safety because one technologist can supervise multiple rooms

Staff travel distancesStaff travel distances tend to be shorter than with “handed rooms”







“Mirrored” CT Rooms


“Mirrored” MRI Rooms

Visibility from one shared control room

Shared electronics room

Restricted access vestibule

Emergency resuscitation area


Improperly designed reading environments contribute to:

Evidence for Better Reading Room Design

Reduced radiologist accuracy (misdiagnoses)

Reduced radiologist productivity (inefficiency)

Increased workplace injuries (hands, neck, eyes, headaches)

Non-designed Film Reading Room

Typically, the reading room is not designed

Often specified as an office work space, with inappropriate lighting, materials and finishes

Reading activities appear to be misunderstood

Transition from Film to Soft Copy

Reading activities become more intense

3D & 4D images; reading is more interactive

Room design becomes more critical

Reading Room Prototype





1200

Reading Room Prototype – “COTS”(Commercially off-the-shelf)

Questions??

Convergence of Imaging Convergence of Imaging and Surgeryand Surgery44

Does Form Follow Function?

Surgical and interventional radiology procedures have changed dramatically in recent decades and in many ways are

iconverging

Why do the designs of “surgical” suites and “interventional” suites remain so different?


Minimal surgical incisions

Redefinition of “Sterile Field”

Increased reliance on

Surgery Has Become Less Invasive

image guidance

Many surgical procedures similar to interventional radiology and interventional cardiology

Historic IR room utilization: 60-70% = diagnostic procedures

Many diagnostic IR procedures now replaced by less-

IR Has Become More Interventional

p yinvasive modalities (CTA, MRA, SPECT, PET, Hybrids, etc.)

Future IR room utilization will focus on more interventional procedures





Surgical-quality Heating, Ventilation and Air Conditioning (HVAC) requirements

“Surgical-like” restricted workflow requirements

IR Requires a Surgical-like Environment

Increased Prep / Recovery needs


Operating Rooms often have sub-optimal lighting conditions

Surgeons may need to view & interact w/ medical images

Design Implications

Surgery Relies on Image Guidance

from a distance

As image guidance become more complex new personnel (radiology techs, IT specialists, etc.) will need to participate in procedures without entering the OR

Design Implications

PACS and Image Guidance in the OR

Green theatrical gels placed over ambient lighting tubes

Information Technology in the OR

Design Implications

MRI in the OR

Design Implications

MAGNET TYPES

StationaryPivoting TravelingPortable

ROOM TYPES

Single RoomDual Room Many Rooms

Design for MRI safety (ACR safety guidelines)

Locate MRI for either “scrubbed” or “ t t l th ”

MRI in the OR

Design Implications

“street clothes” access

Protect against RF and/or magnetic interactions with adjacent occupants

Increase structural, air and cooling capacities






ORs With Control Rooms




Supplies

Scrubbed TeamSupport Team Patient


Control Room

Sub-sterile


Definition: The consolidation of various interventional services within a common area and operated as an integrated program.

The Integrated Interventional Suite

Endoscopy IR / Cath Surgery

Level 2Recovery

PACU

Intake/Prep

Shared prep/recovery


Kingdom of

Surgery

Kingdom of

Imaging

Kingdom of

Cardiology

Challenges:


Collective vision to minimize turf battles

Differing protocol for infection control in Surgery, Interventional Radiology and Interventional Cardiology

Lower middle image, courtesy of: Center for Integration of Medicine and Innovative Technology / Massachusetts General Hospital - Operating Room of the Future (ORF) Reuben Mezrich, MD, PhD; Nat Sims, MD

Interventional Cardiology

Contiguous space for multiple services

Cross-training for some support staff

Cost of excess infrastructure capacity for future areas of change

ORsORsIR / CCL / IR / CCL / EP / ShellEP / Shell

Level 2 – IR: 2; EP: 1 Cath Labs: 2; Shell: 1 ORs: 12; Endo: 3; Prep / PACU beds: 53 (2.5:1)


EP / ShellEP / Shell

Endo

Endo PrePre-- Op / Op /

PostPost--OpOp

© 2008 Anshen+Allen Associated Architects for Palomar Pomerado Health





Approach: Flexible Planning ModulesThe Integrated Interventional Suite


Room Size:

Room Configuration:

Universal vs. Dedicated:

<600 NSF; 600-750 NSF; > 750 NSF

Square; rectangular; “handed” vs. mirrored

A question of flexibility

Design Considerations:Universal Procedure Rooms

Table Orientation:

Orientation of patient’s head:

Room “zoning” and workflow:

Parallel; perpendicular; diagonal to corridor

Head to corridor; feet to corridor; head to side

Sterile; circulation; anesthesia; documentation zones


Approach: Flexible Planning Modules



Approach: Surgery - Clean Core / IR - Staff Core



Approach: Collaborative Cath/IR Staff Core




Approach: “Virtual” Red Line


OR OR OR

OR OR OR

EP

CATH

IR

IR

OR OR OR

OR OR OR


OR OR ORCATH IR

OR OR OR





Approach: Flexible Pre-op / PACU



Approach: Flexible Pre-op / PACUThe Integrated Interventional Suite


Design and ExperienceDesign and Experience55

Intra-operative and Diagnostic MRI Suite

IntraIntra--operative operative MRIMRI (1)(1)

Diagnostic Diagnostic MRIMRI (7)(7)


Intra-operative MRI


Diagnostic MRI






Diagnostic MRI


Interventional Radiography & Cardiology


Interventional Radiography & Cardiology


Computed Tomography


Radiological Society of North America (RSNA) Questions??

the architecture of medical imaging

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