Balancing patient populations with changes in procedures and equipment
Radiology room requirements are a paradox. Imaging rooms require solid construction to support 1,000 pound overhead tube cranes as well as lead linings to contain x-ray scatter. Yet they must be somewhat fluid to accommodate advances in imaging technology and new procedures that have a host of associated equipment.
Winthrop University Hospital is a 591-bed university-affiliated medical center that offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. Located in Mineola, NY, we offer a full complement of inpatient and outpatient services.
To meet our population’s imaging needs, we have two fluoroscopy rooms, a general imaging room, and two imaging rooms for our emergency department. In addition, we have a CT, MRI, and ultrasound system.
Imaging for the inpatient side of operations is especially complicated. Rooms need to be large enough to handle the critical care patients who come down for special exams. These patients might need anesthesia and special gases. They might be tethered to ventilators and multiple pumps. Doctors and other attending care professionals need easy access to kits, implants and other devices, and patient monitoring pumps.
Next, you need to factor in the number of staff members which can include MDs, physician assistants, and residents if you are a teaching facility like ours. A neuro procedure, for example, could require 10 people in the room. So ample size, room to maneuver, and strategic placement of devices is paramount for inpatient medical imaging.
OR, IR, and ED have special rad room requirements, too
Post-op patients coming directly from the OR have their own special protocols. For example, bariatric patients require equipment to check for leaks and blockages. Their advanced weight and limitation of movement – even prior to surgery – also have an impact on rad rooms and equipment.
Some manufacturers have x-ray tables that can accommodate patients up to 705 lbs without losing important functionality such as table top movement. For our CT scanner, we swap out our existing table for a wider and heavier one to accommodate larger patients, but of course this impacts space and movement in the room.
Interventional procedures are on the rise and they also have their own set of radiology room requirements. Not a day goes by when we are not doing draining or performing a biopsy. These procedures require numerous line placements and ideally a room with a CT in it so patients don’t have to be moved from one room to the next. Rotating tables make the move within the room easier, too.
Of course, we also have to consider room lighting and temperature. And we try to accommodate the preferences of our doctors, such as which side of the table they like to work from, when possible.
Imaging for the ED has its own challenges. Like other hospitals, it needs to support a lot of traffic 24/7. It requires counters and tables that can take a lot of abuse without showing it. We also make sure the room can be easily and quickly cleaned. For ED and trauma, you want as large a room as possible to accommodate stretchers and beds. And a critical patient will require multiple doctors, nurses, respiratory and other staff.
Imaging equipment drives room requirements
Some room changes are driven by aging imaging equipment. Your equipment might be functioning but it’s too old to accommodate the newest technologies that can help reduce dose. Or you’re having trouble finding replacement parts.
With analog equipment, it was possible to retain the same equipment for a longer period of time. But the lifespan of digital systems are limited by the computer software and components that can be obsolete in just a few years.
Also, digital flat panel detectors have evolved rapidly impacting equipment design over the past 10 years. For example, older fixed detectors were large and required significant space within the X-ray table. Today’s modern cassette-sized detectors fit within existing bucky trays and pave the way for upgrading from analog to DR.
I expect that advancements will be made soon in the ways we capture and store dose information for patients and technologists. How this will be accomplished is still a question, but I expect that it will be driven in part by new regulations.
While we’re on the topic of equipment, I have recommendations for mobile equipment, too. Make sure your portables are easy to use and move. They need to be agile enough to navigate halls, patient rooms, and ICUs with their array of patient support devices and pumps in use.
Of course, the hardest and most expensive upgrade is one that involves room construction, which we try to avoid if at all possible. Instead we ask questions like, “what can we do if we don’t move the table?” and, “is there a way to replace tables and control panels?” – anything to minimize construction.
Right now we are working with Carestream to replace the imaging rooms in our emergency department. It’s a tough challenge. We’ve got columns in the way, and techs can only enter from the rooms, not from the corridor.Construction of imaging rooms can be a challenge since many times we interrupt services below due to work on structural support, plumbing, and electricity.
Radiology room requirements: starting point
I’ve learned quite a lot about radiology room requirements during my 30-plus years as a radiology administrator. Here are the questions I always start with before designing or modifying an imaging room:
- Who are our customers? Will they be adults, pediatrics, bariatrics, others? Then we design the room to meet their particular needs.
- Can we design a room that can accommodate the universal population and multiple operations? This is the ideal approach for designing for the long term – and also the most difficult.
- What type of interventional procedures will we need to do in the room? Will there be a need for anesthesia? Will we need oxygen and suction placement? What about transfers to and from tables?
- What other special requirements, like long-length imaging, do we need to support?
My last piece of advice is to involve your imaging equipment vendor. They have a lot of experience designing radiology rooms. They understand cabling paths, control booth requirements, and other factors you might overlook. Or they might have an option that doesn’t require a total equipment swap.
Of course, the imaging equipment itself has its own set of requirements. Read the blog on 9 questions to answer before you make any purchasing decisions on radiology equipment.
What are your suggestions for room design? I’d like to hear them.
Rick Perez, has served as the Administrative Director of Winthrop University Hospital’s Department of Radiology since 2003. He oversees 253 full-time employees and 31 radiologists while managing a $27 million budget. The hospital and its affiliated sites conduct 265,000 procedures a year. Mr. Perez is a member of Carestream’s advisory board. #radiology