Technology, staff and patients have seeming divergent needs in a modern medical imaging facility. Whether in a hospital or an outpatient facility, advances in digital imaging have made the challenge the movement of people as well as the images. Blending “high tech” with “high touch” and being able to expand and change in the future becomes the opportunity. Understanding what has changed—and what has not—in both architecture and technology is essential to medical imaging departments that are safe, productive and comfortable. 

The design of the modern medical imaging department must meet several seemingly divergent needs: 

New developments in medicine and architecture influence the design of medical imaging facilities. An understanding of what has changed – and what has not – is essential to developing safe, productive and comfortable imaging departments and outpatient centers.

Technology
Change in imaging technology accelerates, fueled by the development of digital information technologies. Imaging technology is developing in four ways: new technology, advances in specific modalities, convergence and functional imaging.

The variety of imaging modalities and equipment available make flexibility a key design factor. The suite’s space and infrastructure must support the latest technology, allowing for multiple upgrades.

Future upgrades may involve more than simply replacing old equipment. For example, some hospitals now have two or more CT scanners, not all located in the imaging department.

Imaging technologies have increased in number, speed and power. A patient’s full body can be scanned in less time that it takes to move the patient in and out, creating design implications for patient staging areas, dressing and staff work areas.

Radiologists use the digital information base to improve patient outcomes. The image of radiologist in a dark room is transformed to an integral information provider. As developments in digital technology continue, imaging becomes accessible and cost-effective. Scans are drastically increasing in volume and number, with shorter scan sessions and larger patient information sets.

Evidence-based medicine and, evidence-based design has spurred important research into the measurable impact of design on patient outcomes, staff performance and overall efficiency. Based on research, design includes increased natural light, appropriate materials and measurable design impacts on work performance are being incorporated into new hospitals and outpatient imaging centers. Natural light in imaging rooms of all types – MRI, CT, even R/F – will have the most significant impact on patient comfort and anxiety.

Patient changing and staging areas should be designed for privacy and dignity, avoiding the bullpen-style large waiting spaces that are unfriendly and unwelcoming. At the same time, individual dressing rooms that really allow the patient to change clothes and prepare, before and after the imaging exam, will go a long way.  Think about department store dressing rooms, and what works and what does not.  Family spaces can be designed for personal details and comfort, reasonably close to the exam spaces and facilitating a connection to daily activities. 

Staff work areas are designed to facilitate tasks and ergonomics to avoid repetitive drudgery, staff comfort and ease of access to patients, work products, radiologists and often the family, are all appropriate examples utilized in projects today.

Re-arranging the puzzle
The great benefit of digital imaging is that it allows the movement of information and images – not people. The design of any imaging department is based on workflow and patient satisfaction, not the physical movement of film. This fundamental change allows the imaging department to be patient focused, improve staff work habits and provide a supportive family model.

A full understanding of technology design and implementation is crucial, but it is only one piece of the imaging puzzle. As technology becomes more transparent, the organization of all functions becomes a major determinant. With the development of digital image systems, radiologists are often centralized for collaborative, specialized imaging interpretation.

The other piece is patients: the number of procedures and time required for each visit and requirements and average number of procedures is changing. More recent designs provide individual dressing rooms adjacent to the procedure room, where patients can change and wait with greater privacy and dignity. Modern imaging departments require patient prep and recovery spaces for interventional procedures.

Rules for planning and design
Although much of today’s imaging equipment and healthcare construction is new, many of the rules for planning and design remain the same. The environment stresses the transparency of medical imaging technology and installation. Unfortunately, that thinking allows a lack of attention to details, fundamental requirements and even safety concerns. A good rule of thumb for basic imaging planning: Architecture (and architects) may be forgiving, but technology never is. For instance, while MRI installation has been accomplished in smaller rooms, the basic understanding of magnetic field placement or restrictions has not changed. Current-generation CT or R/F equipment still requires adequate radiation shielding and clean power, if not more so.

Current Determinants
Imaging technology is focused toward MRI, CT and PET, more often being combined with CT in PET/CT. It is timely to consider current design determinants:

Safety standards and guidelines
Patient safety in radiology is a growing concern. Safety standards and guidelines are significant for architects and owners. Carelessness in planning and design is often the result of taking basic criteria for granted. Adopted safety guidelines should be referenced in planning standards or regulations.

For ionizing radiation, shielding characteristics are based on the National Council on Radiation Protection and Measurements (NCRP) Report 147: Structural Shielding Design for Medical X-Ray Imaging Facilities. The information has been updated, including new modalities not previously discussed.

Expect more safety standards and planning questions for radiology.

Healing environments for imaging
While imaging equipment and technology planning concerns are important, these considerations should not override those of employees and patients. Patients and staff are in a stressful situation, no matter the quality of technology. The requirements of the technology should be dealt with transparently, so that individuals can focus on the environment.

Patients are concerned about privacy and the unknown. Imaging can be a sterile, restricted environment. Thus it makes good sense to utilize design to stress communication flow, involvement and empowerment whenever and wherever possible. Let’s face it; imaging for the patients involves waiting and abandonment, two difficult factors to overcome without some help in the design.

Staff are concerned about technical performance and patient accommodation, while performing highly repetitive tasks. The design of staff spaces that focus on work flow and improved job performance will result in patient and staff satisfaction, less errors, and likely improved work.

In both cases, the result will be a tangible step to deal with increased work demand and ever faster technology. Shorter imaging exams due to less patient anxiety and improved staff performance can be expected. Another side benefit of happier patients and staff is the long-term relationship, another step to confront the anonymity of the medical care process.

An evidence-based consensus emerges that the design of care environments helps patients feel safe, comfortable and facilitates the healing process, the trend toward healthy design and its compelling benefits is too powerful to ignore for imaging spaces.  Evidence suggests design can improve patient, family, and staff satisfaction, provide a positive return on investment and even directly impact image quality.

Trends
A survey in the October 2006 issue of Health Imaging and IT magazine revealed that the top three trends in imaging are:

Improvement of the environment was not explicitly mentioned in any of the top 20 responses, yet all of these goals can be accomplished through a design process.

No matter what the technology, it has a fundamental relationship with planning and design. While technology density and patient volume might be of the greatest concern, the environment may have the biggest impact on improving the imaging experience.

Teamwork

Due to the complexities of designing for modern medical imaging, design teamwork is ever more important. Everyone involved in the design—architects, radiologists, equipment vendors, patients and their families—all contribute to the design that successfully meet the needs of advanced imaging technology while supporting the people who use it.