The patient care center in the imaging department of Advocate Christ Medical Center, Oak Lawn, Ill, was designed to increase throughput by acting as a receiving center and holding area for inpatients and a preparation area for outpatients who require contrast administration or other special preparation.

Dramatic changes are occurring in the design of radiology centers as a result of the latest digital radiological procedures. Digital storage, electronically transferred images, and decentralized reading rooms are streamlining the entire procedural process and treatment flow for physicians, patients, and staff. More rapid patient throughput, in turn, translates into healthier economic yields for a health care facility.

Currently, the changeover from film to filmless in digital radiology imaging continues to be very much in transition. X-ray films once required a tremendous amount of space for storageseveral hundred square feet or more. Today's digitized films are stored electronically in a small closet that contains the controls for the files, or the picture archiving and communications  system (PACS). PACS are now situated in the department, completely eliminating the separate storage area.

DESIGN FACILITATES THROUGHPUT

Besides space, design is a key factor in creating maximum patient throughput. In the past, design tended to encompass very large, multi-user reading rooms. Today, design in general radiology is moving from centralized to decentralized reading rooms. Open reading rooms are replaced by single rooms, grouped together, which continue to provide a common area for colleagues to share ideas or to house a library or resource center.

Single radiology reading rooms provide many benefits. First, the PACS workstations can be large: they can have up to four monitors, with a screen size of up to 14 in. x 17 in. Light emitted from each workstation has the potential for substantial glare if other PACS monitors are situated nearby. Also, current voice-activated dictation systems popular for reporting often do not function optimally due to background noise. Single rooms mean more efficient dictation, which means faster reporting and, hence, faster patient information transfer.

With specialized radiology modalities that include CT, fluoroscopy, or interventional radiology, reading rooms also are becoming decentralized and organized into pods. In a large department that is distributed over a wide area, this layout requires less movement for radiologists. Each modality can be self-contained, allowing staff within the unit to operate more efficiently.

Floor plan of the imaging department in Advocate Christ Medical Center, Oak Lawn, Ill.

Digital imaging technology inherently increases work flow. Because the film-development process is eliminated, results are instantaneous. This permits images to be transferred electronically to a radiologist in the reading room, and he or she can immediately ascertain if the study is accurate. The radiologist can save or order a new study without the traditional lag time between patient testing and reading.

For further efficiency, PACS workstations can be distributed in patient areas throughout a large facility, such as surgery, ICU, and nursing units. As physicians make their rounds, they can go to an alcove on a patient floor and access radiology studies without having to travel to the radiology department, possibly in another wing of a sprawling facility.

CHANGE ORDERS VS CUTTING EDGE

When undertaking a department design or redesign, it is important to balance the schedules of technology selection and commencement of construction. Failing to do this can result in costly architectural change orders. Due to rapid changes in technology, it is natural for facility administrators to want to select the most current equipment at the latest possible point in the design process. However, this delay can result in technology that has a larger footprint than specified in original drawings.

Due to rapid technological obsolescence, it is understandable that health care specifiers need to wait for the latest point possible before purchasing a piece of diagnostic equipment that requires a significant financial investment. Therefore, determining the proper balance in specifying equipment vs start of construction becomes one of the biggest demands in designing a radiology centerespecially a larger facility.

As a rule of thumb, vendors will not provide a site-specific architectural drawing until receiving a purchase order from the owner. This includes important data regarding the exact placement of mounting plates, ducts, and electrical outlets that architects incorporate into their construction drawings. While typical drawings provide minimum dimensional requirements, they do not take into account odd-shaped rooms or special facility considerations.

Despite not having specific plans, an owner may move forward with generic drawings to speed up the process. Obviously, a drawback is the further along with non-site-specific drawings you progress, the higher the exposure to change orders. Real economic problems begin to occur if an equipment vendor has not been chosen, and architectural plans based on these generic drawings are issued to the contractor for construction.

Owners can paint themselves into a corner if the process continues too far without vendor specifications. Because minimum room sizes vary among vendors, if one of them is changed midstream, the new vendor's minimum space may come up short. This can prove catastrophic to a construction budget.

Placement of equipment is pinpointed to the finest detail by vendors. Computer hardware, cabinets, ducts, and mounting structures need to be configured precisely if minimum room size is to be met. If the space allotted, however, is even a foot short, frames and studseven whole wallsmay need to be removed and reconfigured. While it is not as much of a problem in the case of a single radiology room, if the design is across a multi-room facility, the problems can grow exponentially. The cost impact on the project budget and schedule is again problematic.

In the end, only the owner can decide how much risk the institution can tolerate. If multiple vendors are being considered, it is best to allow for the minimum space of the vendor with the largest requirement.

A CASE STUDY

The Imaging Center at Advocate Christ Medical Center, Oak Lawn, Ill, can be approached by inpatients through the hospital and by outpatients through a separate street entrance.

The Advocate Christ Medical Center, Oak Lawn, Ill, offers a good example of a very large radiology department that was  well planned in advance. With 50,000 square feet for diagnostic imaging, the center has 22 rooms of varying sizes, including six radiology reading rooms. It completes 240,000 examinations annually.

The center achieved success by separating the design into two construction packages. Working with the architect, the contractor released the first set of drawings for the ancillary spaces in the department, such as the lounges, gowning areas, waiting room, reading rooms, and classrooms. Construction commenced, giving the owner additional time for equipment selection. By the time the second set of drawings was needed, the owner had chosen the equipment. This two-phase solution gave them the best of both worlds; they were able to wait until the last possible moment in the construction process to choose the equipment. Consequently, the schedule was maintained, the owner avoided change-orders, and the budget was maintained.

Getting the contractor on board at the same time as the architect is another cost-savings strategy. This allows the owner to receive constant updates on pricing throughout the process.

The owner is made aware of costs from the programming stage, which is the tabulation of space, to schematic design, which outlines operational

flow, through the design-development stage, where details are specified. Consequently, by the time construction begins, the contractor is very familiar with the plans and may have even hired subcontractors. The constant checks and balances throughout the process help a project operate more smoothly, raising red flags earlier and keeping the project on budget.

It also is vital that the owner or user group is involved in the schematic design and design development process. Radiologists, nurses, and technicians, who have extensive knowledge of system workings, can be invaluable in planning how to best get patients through a center in the most effective manner possible.

FUTURE CHALLENGES

Increasingly less-invasive procedures in radiology, which are being used more frequently by teaching hospitals, will rapidly find their way into standard radiology treatment centers. As these real-time procedures are adopted in general radiology or CT radiology roomsand the proliferation of interventional MRI procedures proceedsit will impact the cost of design and construction.

At present, the greatest concern in the design of the radiology environment is the comfort of the patient and, perhaps, regulating equipment temperatures. Conditions do not reflect the sterile requirements that are essential in an operating room. As interventional procedures proliferate, design that once was reserved for surgical rooms soon will be occurring in these cutting-edge facilities.

Radiology centers will need to be designed more like operatories, and thus incorporate code requirements for, among others, number of air changes per hour, filtration, lighting, and special ceiling and flooring materials. Budgets will need to reflect the changes, not only in design, but also in soft costs.

Regardless of the future, these contemporary radiology centers are incorporating streamlined designs. They allow more efficient reading, reporting, and work flows, thus freeing up the rooms faster, maximizing throughput, and increasing patient satisfaction.

David Redemske, project designer with HDR in Chicago, can be reached at (773) 380-7900 or dredemsk@hdrinc.com.