Download Installation of Imaging Modalities

Installation of Imaging Modalities
Holland Basham Architects
Installation of Imaging Modalities
Patrick Leahy, AIA, EDAC
Senior Healthcare Planner & Designer
Susan Seidel, AIA, LEED AP
Partner, Senior Healthcare Planner & Designer
Jim Quinn
Operations Director / Facilities Operations, CHI Health
Holland Basham Architects
Imaging Modalities
Learning Objectives
By the end of this presentation, participants will be able to:
1. Define the imaging modalities and different medical uses of each
2. Shielding and Technical Requirements for installation for the
different modalities
3. Better understand schedule implications
Imaging Modalities
Imaging Modalities
Imaging: Examples
X-Ray
Imaging Modalities
Imaging: Examples
CT Scan
Imaging Modalities
Imaging: Examples
MRI
Imaging Modalities
Imaging: Examples
PET (without CT)
Imaging Modalities
Imaging: Examples
Angio
Imaging Modalities
Bonus Points:
1
3
5
2
What Are Each of These?
4
Imaging Modalities
How many right?
1. P.E.T.
3. TomoTherapy
5. Gamma Knife
2. M.R.I.
ANSWERS
4. C.T.
Imaging Modalities
Where do you find each modality?
• Radiology Department Hospital / Outpatient Imaging Centers
• Cardiac Cath, Angio Labs, CT, Nuclear Medicine, MRI,
Mammography
• Heart Center
• Cardiac Cath, Radiographic, Fluoroscopic, CT, MRI, Nuclear
Medicine
• Cancer Center
• Linear Accelerator, CT, Nuclear Medicine, Radiographic,
Fluoroscopic, MRI, Proton Therapy
• Women’s Health Center
• Mammography, Ultrasound, Bone Densitometry
Imaging Modalities
Imaging Equipment Common Themes
• Start with complete team:
• Facility Representative
• Architect
• MEP Engineer
• Equipment Installer
• General Contractor
Imaging Modalities
Imaging Equipment Common Themes
• Generic Planning Guidelines available
from most vendors
• Diagnostic and/or treatment room
size and configuration “suggestions”
Imaging Modalities
Imaging Equipment Common Themes
• Final Equipment Selection & Sign off purchase order by Owner
• Final installation / site specific drawings from the approved vendor for
a specific model
• Generated after owner signs a purchase agreement
• 1-4 weeks to generate drawings
• Required by Design team at least 4 weeks before construction
drawings can be completed
• Schedule Considerations
• Manufacturer lead time, Transport, Installation, Commissioning,
Training
Imaging Modalities
Imaging Equipment Common Themes
• Equipment Routing paths should be coordinated
• Corridor heights, widths, and door clearances along path
• Structural concerns
• Especially for MRI and Linear Accelerator
• Crane installation for larger equipment
• City and traffic coordination
• Roof Access if required
Imaging Modalities
Imaging Equipment Common Themes
• Radiation Shielding (excluding MRI)
• Determined by Physicist
• Location, height and thickness required
• Contracted by owner
• Larger health systems have on staff
• Typically done with lead lining
• Walls, doors, door frames, windows, window frames, door
hardware (pivots), electrical boxes
• 1/16” lead (common) behind drywall wall to 7’-0”
• Lead wrap on utilities incl. ductwork – Hanger concerns
Imaging Modalities
Imaging Equipment Common Themes
• Size of Service and Voltage
• Power Quality Concerns
• Analysis of existing conditions by MEP Engineer ($1,500)
• Power Conditioner installed to regularize the sign waves
• Raceways
• Exposed vs. concealed
• Tray vs. Conduit
Imaging Modalities
Imaging Equipment Common Themes
• UPS and/or Generator Back-up
• Large instantaneous draws
• How long will it carry after an outage?
• Cath Lab – 15-20 minutes for monitors and computers to re-engage
without UPS
Imaging Modalities
Imaging Equipment Common Themes
• Lighting
• Dimmable
• Indirect preferred
Imaging Modalities
Imaging Equipment Common Themes
• Fire Protection Coverage
• Water
• Wet Pipe
• Dry Pipe Coverage
• Single – 2 signals trigger Pre-Action
• Double – 3 signals trigger Pre-Action
• Dry Chemical - $$$
• FM Global requires 100% water coverage
• Fire Extinguisher type specific to modality
Imaging Modalities
Imaging Equipment Common Themes
• HVAC
• Verify humidity equipment requirements
• Patients sensitive to supply diffuser placement
• Hospital Radiology Waiting Rooms
• 100% Exhaust required if patients from ED routed through
for procedures
• Medical Gases
• Verify with FGI Guidelines and Facility requests
Imaging Modalities
Remodel Construction Common Themes
• PCRA & ICRA
• Separation (fire rating (NFPA 241), smoke, humidity, sprinkler,
dust, negative pressure)
• Adjacent continuous operations
• Patient safety
Imaging Modalities
Support Rooms
• Control room
• Adjacent to diagnostics or treatment
room
• Orient for staff to look down bore (CT,
MRI)
• # of staff considerations
• PACS / Reading Rooms
Imaging Modalities
Support Rooms (cont.)
• Patient Sub-waiting / Gowned Waiting
• Gender separation
• Dressing Rooms
• Consider ANSI / ADA requirements
• Apron Storage
Imaging Modalities
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• MRI is a non-invasive way to take pictures of the body. Unlike X-ray or
CT scans, MRI uses powerful magnets and radio waves instead of
radiation. Detailed MRI images allow better evaluation of anatomy and
certain diseases than X-ray or CT.
• Definitions
• Tesla (T): a unit of magnetic induction equal to one weber per
square meter (strength)
• Gauss: The unit of magnetic flux density in the centimeter-gramsecond system, equal to one maxwell per square centimeter, or
10-4 tesla (measurement)
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• 1.5T – $1-2m
• 3T – $2-3m
University of Iowa: MRI 1.5T
Imaging Modalities
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• Structure
• Weight considerations: 10,000 – 50,000 lbs.
• Isolated slab for vibration
• Equipment Placement
• Gauss 0.5mT – “Pacemaker” line
• Design to keep within diagnostic room walls
• Avoid major structural steel directly under unit
• Avoid placing near moving equipment (vehicles, elevators etc.)
• Avoid major electrical components (transformers etc.)
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• MRI Zones
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• Magnetic Shielding / Radio Frequency Cabin (Copper)
• Manufacturers / Installers
• Lindgren or PDC
• Cabin includes walls, ceiling and floor
• “Box in a box”
• Copper Lining to prevent outside RF from
entering room
• Floor systems typically 1 ¾ -2 ¼” thick so
require ramp into room or recessed slab/floor
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• Magnetic Shielding / Radio Frequency Cabin (cont.)
• MRI Doors
• Controls / manual vs. auto
• Automatic sealing
• Ferrous metal alert at door
• Exterior windows
• Cover with RF window as part of cabin
• Wave Guides through cabin
• Routing equipment into room
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• Eliminate or Limit use of ferrous metals within RF cabin
• Ceiling grid / hardware
• Specify non-ferrous metals within RF cabin
• Aluminum
• Brass
• Some stainless steel
Imaging Modalities
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• Steel Shielding
• Control .05mT gauss lines to keep within cabin walls
• Thickness determined by MRI mfr
• Acoustic Considerations
• Storage within room
• Wedges used for patient positioning
• Non-ferrous equipment
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• Dedicated Chiller for Process Cooling
• Different for each manufacturer
• Distance concerns (150’ round trip)
• Prefer unit to come from MRI manufacturer
• Connect to campus system possible, but rarely done
• Manage risk – install hose bibs
• Oxygen Depletion monitoring
• Dedicated exhaust
• Different requirements for each manufacturer
Imaging Modalities
Magnetic Resonance Imaging (MRI)
• Water
• “Clean” water for heat exchanger
• Quench Vent
• Emergency exhaust of helium used to keep MRI cool
• Location critical
• Protected area with signage for safety clearance area
Imaging Modalities
CHI Health – Northwest Imaging: MRI
Experience Design
Imaging Modalities
Boys Town National Research Hospital: Research and Diagnostic 3.0T MRI
Experience Design
Imaging Modalities
Boys Town National Research Hospital: Research and Diagnostic 3.0T MRI
Experience Design
Imaging Modalities
Boys Town National Research Hospital: Research and Diagnostic 3.0T MRI
Experience Design
Imaging Modalities
Boys Town National Research Hospital: Research and Diagnostic 3.0T MRI
Experience Design
Imaging Modalities
University of Iowa: MRI 3.0T
Imaging Modalities
Radiology Group: MRI
Imaging Modalities
Computed Tomography (CT or CAT Scan):
• An X-ray technique that produces images of internal organs that are
more detailed than those produced by conventional X-ray exams. An
X-ray tube and detector take images as the gantry revolves around the
patient and then these images are reconstructed in a computer.
Imaging Modalities
Imaging Modalities
Computed Tomography (CT or CAT Scan):
• Requires lead radiation shielding
• Manage heat from equipment
• GE – Ejects all heat, approx. 5 tons, into the diagnostic room
• Siemens – Ejects only a portion of the heat, ½ ton, into the
diagnostic room
Imaging Modalities
CHI Health – Northwest Imaging: CT
Experience Design
Imaging Modalities
University of Iowa: PET-CT
Imaging Modalities
Radiographic and Fluoroscopic:
• Radiographic – single frame image of a section of anatomy
• Fluoroscopic – live continuous image of internal movements
• Bowels and stomach, airway obstructions, and
can be combined with a radiographic image of the area of
interest
• C-Arm (Mobile Fluoroscopy)
• Approximately 1,800 lbs.
• Provide storage alcove
• CO2 gas to inflate abdomen
Imaging Modalities
Radiographic and Fluoroscopic:
• Requires lead radiation shielding
• Overhead or floor mounted equipment
• Unistrut systems for overhead mounted equipment
Imaging Modalities
Imaging Modalities
CHI Health – Northwest Imaging: RAD
Experience Design
Imaging Modalities
Methodist Gretna Clinic: RAD
Imaging Modalities
Miller Orthopedic Specialists: RAD
Imaging Modalities
Radiology Group: Fluoroscopy
Imaging Modalities
C-Arm (Mobile Fluoroscopy)
Imaging Modalities
Molecular Imaging / Nuclear Medicine / Gamma Camera
• A patient ingests or is injected with a small amount of radioactive
material. The radioactive material gives off gamma rays that can be
detected by a special camera that produces computerized images
Imaging Modalities
Molecular Imaging / Nuclear Medicine / Gamma Camera
• Requires lead radiation shielding
• Hot Lab
• Radioactive material storage
Imaging Modalities
Nuclear Medicine
Imaging Modalities
Radiology Group: Nuc Med
Imaging Modalities
Mammography:
• Mammography uses low-dose X-rays to examine the breast and
surrounding tissues. To obtain an image the breast is compressed
while an image is taken.
• Low energy
• May require lead radiation shielding
• Control area within diagnostic room
• Often just a mobile screen
Imaging Modalities
Mammography
Imaging Modalities
Ultrasound:
• A non-invasive system for imaging internal anatomy
Imaging Modalities
Imaging Modalities
Ultrasound
• In OB, typically adjacent to a toilet room
• Enlarge room for additional family members
Imaging Modalities
Imaging Modalities
Bone Densitometer:
• Used to measure the calcium content of bone to reflect bone density
and therefore bone fracture risk
Imaging Modalities
Bone Densitometer
Imaging Modalities
Bone Densitometer
Imaging Modalities
Imaging Modalities
Cath and Angio Labs:
• X-ray image that visualizes the inner opening of blood filled structures
including arteries, veins and heart chambers
• Radio-opaque contrast agent is introduced into blood stream and
imaged as it moves through vascular system
• Cardiac – Heart
• Angio – everywhere else blood flows
Imaging Modalities
Cath and Angio Labs:
• Requires lead radiation shielding
• Ceiling Layout
• Gantry for Imaging equipment,
• Med. Gas booms,
• Monitor booms,
• light booms,
• conflicts with HVAC diffusers
• Scrub Sink location
Imaging Modalities
Cath & Angiography Lab
Imaging Modalities
Cath & Angiography Lab
Imaging Modalities
Mobile Diagnostics
• Patient Access considerations
• Inclement weather
• Ramps
Imaging Modalities
Linear Accelerator:
• a device imparting high velocity and energy to atomic and subatomic
particles used for radiation therapy of cancer patients
Imaging Modalities
Imaging Modalities
Linear Accelerator:
• Radiation Shielding
• Cast-in-place concrete or concrete/lead blocks
• Structural Considerations
• Maze at entrance to treatment room
• For staff & patients as well as utilities
• 2-4 feet concrete thickness
• Block in utility routes
• Treatment Room (bunker)
• 3-8 feet concrete thickness
• Primary beam wall, floor and ceiling impacts
Imaging Modalities
Linear Accelerator:
• Radiation Shielding (cont.)
• Neutron door
• 8” thick
• Automatic controls
• Plumbing and Conduit lines angled away
from unit & beam line
Imaging Modalities
Linear Accelerator:
• Remote Control Room
• No direct window
• Patient positioning lasers
• 2 on walls and one on ceiling
• Cameras
• 2-3 throughout room for control
viewing
Imaging Modalities
Linear Accelerator:
• Support
• Patient Zone vs. Staff Zones
• Experience Design
• Lighting considerations
• Speakers
• Equipment Room for modulator cabinet (noise)
• Adjacent toilet facilities
Imaging Modalities
Linear Accelerator:
• Support (cont.)
• Therapy Storage
• Wedges for patient positioning,
electron cones, Bolus, &
Aqua Plas
Imaging Modalities
Linear Accelerator:
• Support (cont.)
• Physics Storage
• Also provide hose bib in treatment
room
• Used for phantom’s during calibration
Imaging Modalities
CHI Health Bergan: Linear Accelerator
Experience Design
Imaging Modalities
Methodist Jennie Edmundson: Linear Accelerator 2015 Rendering
Imaging Modalities
Proton Therapy:
• Proton therapy, also called proton beam therapy, is a type of radiation
treatment that uses protons rather than x-rays to treat cancer.
Proton Therapy: Gantry, Magnet, Nozzell, and Treatment Chamber
Proton Therapy: Cyclotron, Electromagnets and Gantry
Proton Therapy Building
Imaging Modalities
Imaging:
Migrating To Surgery
Imaging Modalities
C-arm
Image Collection In Surgery
Imaging Modalities
Multi-Modal Surgical Suite
Image Collection In Surgery
Imaging Modalities
Combination Surgical / Standard Imaging Suites
Questions?
Holland Basham Architects
Thank
You
Holland Basham Architects