Designed for Imaging
Practices have a lot to consider when designing a new facility or renovating an existing imaging center.
When Radiology Imaging Associates, a private practice with offices in Maryland and Virginia, began designing a new imaging center next to a daycare in 2005, safety was of the utmost importance.
Joseph P. Finizio, MD, president and chief executive officer of the practice, wanted to be certain that the center’s walls had enough lead shielding to prevent radiation transmission to the adjoining daycare. Finizio consulted with a medical physicist, as is standard practice, to calculate how much lead shielding would be necessary to protect the children and other occupants outside the procedure room from stray radiation exposure. “I wanted to be able to tell a mother who brings her child to the daycare that, without a doubt, her child will not be exposed to radiation,” Finizio explains.
The amount of lead shielding used in the walls is just one of the things radiology practices must consider when designing a new imaging center or renovating an existing facility. Other considerations include exam room and support space arrangement, hallway layout, imaging equipment procurement, and interior decor. “A radiology practice is one of the most complicated medical facilities to design because it’s a highly technical space that must also be welcoming to patients,” says Daniel D. King, president and principal architect of 2KM Architects, a Georgia–based architecture firm specializing in medical practice design. “Functionality, safety, maintenance, adaptability, budget, schedule, and aesthetics must all be taken into account.”
When it comes to making these design decisions, radiologists, technologists, medical physicists, office managers, patients, referring physicians, and other stakeholders should all be involved in the process. This stakeholder input is important to ensure a newly designed or renovated imaging center functions well for the people who work there and, perhaps more importantly, for the customers — patients and referring physicians — who patronize the practice. “Practices should get at least two representatives from each of these stakeholder groups to the table,” says Ehsan Samei, PhD, professor of radiology at Duke University. “Since all of these people will be using the facility, it’s terribly important to make sure the space is not only well designed for them but also meets the highest standards for quality and safety.”
Hiring a Design Team
As a radiology practice embarks on a design or renovation project, one of the first things it should do after determining its budget is hire an experienced architecture and engineering team to help design the project. Radiology practices often hire design teams they have worked with in the past or groups that other practices have recommended. “Practices should hire a registered architect who has designed a radiology practice before and who is familiar with their state and local building codes,” King notes. “The architect should be responsive and available throughout the design and construction process to ensure all of the client’s needs are met and the project comes together as envisioned.”
Even if the design team has experience building imaging centers, practices shouldn’t rely solely on the architect to develop the design. Instead, they should outline what they want in the design and clearly convey those details to the architect. Failing to do so could result in a design that lacks function, Samei says. “Without very explicit input, some architects have their own ideal concepts of what makes good design and what makes a good space without really considering the needs of the radiology practice,” he says. “It’s very important to make sure it’s not assumed that the architect is an expert who knows what needs to be done without explicit input from the project stakeholders.”
While stakeholder input is important, not every stakeholder needs to be involved in every design meeting. Instead, practices should appoint a liaison to facilitate communication between the stakeholders and the design team. Keith Strauss, MS, FACR, a clinical imaging physicist at Cincinnati Children’s Hospital, says medical physicists are well positioned for this role because they understand both the clinical needs of the practice and the technical aspects of building design. Technically minded radiology managers or directors can also serve in this capacity. “It’s helpful to have someone in the department who works directly with the architecture firm and who gathers the appropriate stakeholders as needed,” says Strauss, who has been involved in several design projects. “If you have everyone there all the time, you’ll be wasting a lot of people’s time, and they’ll get frustrated.”
Mapping a Layout
As they begin designing an imaging center, practices must decide which type of imaging the new space will provide and which brand of imaging equipment to purchase. Each equipment manufacturer has its own recommendations for the size and structural design of the spaces that house their equipment. “Manufacturers know when the weight of their equipment might be an issue for a particular site or building,” Strauss explains. Since the equipment brand can impact the building design, practices should select their equipment manufacturer early in the design process so that the vendor can work hand-in-hand with the architect, King says.
Regardless of which equipment manufacturer they choose, practices must ensure that the center’s corridors and doorways are wide enough to accommodate the equipment. Equally important is the exam room arrangement. Whenever possible, the exam rooms should be located next to storage areas and offices, spaces that can be easily adapted to enlarge the exam rooms as the practice’s needs change. “New types of equipment come along and needs change, so you absolutely must leave room for expansion,” Finizio says. Additionally, the column spacing in the exam rooms should be as wide as possible to accommodate expansion. “If you can space the columns about 20 to 22 feet apart, then it’s easier to go in there and sculpt out space for expansion,” King says.
Practices must also consider spaces for patient changing, prep, and recovery. For efficiency, practices must have an adequate number of dedicated rooms. This is particularly important in pediatric facilities, where some patients may need to be sedated for their imaging exams. “You want to minimize the amount of time that the patient is actually in the procedure room for things other than imaging because the amount of time the procedure room is tied up directly impacts the number of exams a practice can conduct,” Strauss says. He adds that one of the best examples of efficiency that he has seen was at a facility that had six prep rooms for its one CT scanner. “As a result, that hospital was able to scan two to three times more patients a day on their single CT scanner than most other institutions,” Strauss says.
Practices must also design their imaging centers for patient comfort. To that end, they should create spacious waiting rooms with multiple zones, such as a kids’ zone, a TV zone, and a quiet zone to give patients options as they wait. Hallways should also be carefully planned to ensure patients don’t have to pass the waiting room in their gowns. To further improve patient comfort, practices should consider housing the electronic components of their scanners outside of the examination rooms. “Some imaging equipment generates a lot of heat and needs significant cooling capacity. But if the temperature of the examination rooms is regulated for the equipment, the patient tends to get cold,” Strauss says. “If you separate the electronic components from the exam rooms, you can run the environments independently and address both needs.”
Beyond an imaging center’s structural design, practices can enhance patient comfort through decor. Practices should take diverse patient populations, including various ethnicities, socioeconomic backgrounds, and genders, into account when decorating their facilities. For instance, breast imaging centers should avoid washing their facilities in pink and instead use neutral colors to make their spaces more inviting to transgender patients. “The excessive use of pink or of female images on the wall of a breast imaging facility might invalidate a transgender man’s identity as male,” Charles Girard, a transgender man and activist, told the ACR Bulletin in September.
Practices can also leverage decor to make their facilities inviting to patients of different ages. The radiology department at UCSF Benioff Children’s Hospital took this approach when designing its facilities as part of a new $1.5 billion hospital in San Francisco. The department worked with the Global Design team from GE Healthcare to develop themes for its MRI, SPECT-CT, and CT rooms using landmarks and icons from the San Francisco Bay area.
For example, one room has a Golden Gate Bridge mural that can be animated with a specially designed video system to make it appear like whales are swimming in the bay or the sun is setting over the bridge. “Even though we’re a children’s hospital, 50 percent of our patients are adults, so we wanted something that would be relatable to patients from a wide age range,” says John D. MacKenzie, MD, associate professor in residence, chief of radiology at Mission Bay Medical Center and section chief of pediatric radiology at UCSF Benioff Children’s Hospital. “The themes reduce the stress and anxiety for patients and families.” In fact, MacKenzie says, the response from parents has been very positive and some children who previously required sedation for an MRI or CT are now able to cooperate, hold still, and complete the exam in the new space without anesthesia.
With so much to consider when designing or renovating an imaging center, it’s easy for practices to feel overwhelmed. But with an experienced design team, stakeholder input, and a detailed project plan, practices can develop imaging centers that meet both their technical and clinical needs. “The environment you create matters,” King says. “If you have an environment that your staff wants to work in and you create an experience that is pleasant for your patients, the return on investment will be significant.”
By Jenny Jones, Imaging 3.0™ content specialist