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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