The push for new imaging modalities calls for the planning and construction of new facilities. The trick: to anticipate future demands from current trends.

By Tobias Gilk

Twenty years ago, personal computers were a luxury. Ten years ago, they were a convenience. Today, passengers in any major airport jockey for seats near outlets to charge laptops and compose e-mails on their PDAs—in short, we're profoundly dependent on digital technology. Medical imaging has followed a similar path, with health care providers dependent on information and revenue derived from contemporary imaging modalities.

The upshot: Virtually every major health care facility plans to up the ante. They're window-shopping for a new 128-slice computed tomography (CT) or 3 Tesla magnetic resonance imaging (MRI) unit, equipment that may even be one or two generations dated by the time it scans its first patient. This imaging arms race demands faster capital purchases and more rapid buildouts to support installation of these new modalities. This need for speed is coupled with the pressure to plan effectively or risk losing tens of thousands of dollars—or more—on a failed project.

Design and construction mistakes have the unpleasant tendency to become—literally and figuratively—cast in concrete. And when sensitive imaging modalities depend on tight tolerances, these mistakes can delay projects, impair imaging and hemorrhage money. Facilities can avoid $1 million memorials to poor planning by closely examining current needs and anticipating future demands and technologies.

Site and vision

One of the best-kept secrets in planning an imaging facility is that CTs and MRIs aren't toasters. Sales representatives profess the ease with which their equipment can be sited, requiring only a few hundred square feet and a plug to power it up like an oversized appliance. They may minimize—or even forget to mention—the lead shielding, extra electrical and HVAC equipment demands, or special room construction. They'll almost surely forget to tell you that most major imaging modalities interact, sometimes negatively, with other imaging equipment. That fact slips their minds more frequently if the other equipment is provided by another vendor.

Take positron emission tomography (PET) and CT scanners, which can be highly sensitive to interference from magnetic sources such as MRI. Or consider that gamma camera images can be distorted by a nearby PET scanner that has only enough lead shielding to meet minimum attenuation requirements for human exposure. Or that a new MRI may significantly throw off the shim of an existing MRI if sited with the wrong orientation.

One facility installed a new PET/CT scanner in a room formerly occupied by an MRI. After nearly a year of degraded images and troubleshooting every conceivable hardware and software issue with the new equipment, the facility's manager learned that the room's residual permanent magnetization had been contributing to the image problems. The passive steel shielding, magnetized from years of exposure to high-strength magnetic fields, was deemed too costly to remove along with the former MRI.

Even if you're replacing only one device, you should evaluate all potential interactions between the new modality and nearby equipment before signing a purchase agreement. This due diligence will put you miles ahead in your planning efforts and arm you with information to test the preliminary siting suggestions.

Plans and details

Often, imaging projects are a response to equipment damage or acute needs, and planning is seen as an obstacle to critically needed capabilities. But planning's end product need not be a 12-phase strategic facility plan that takes a year to complete. Installation or replacement planning can be quick, beginning with elementary questions such as, "How does the equipment get from the loading dock into the suite?"

While many imaging modalities can have a clinically useful life of five to 10 years, most hospitals count on serving patients long after a particular MRI has reached obsolescence. How will the equipment be removed and replaced?

Given the trend toward higher-strength magnets, coupled with the growth of image-guided procedures, what key capabilities should an MRI suite have to support these new clinical applications and revenue opportunities? If you feel that procedure lighting, medical gasses, hand sinks or other features missing from the vendor's typical suite layouts may not have justifiable demand today, anticipate the cost of and difficulty in adding these capacities later. Running plumbing lines for a hand sink through the lead-shielded wall of a CT scanner is inconvenient, but to do the same in an MRI may necessitate shutting down the magnet and modifying the radio frequency shield, resulting in tens of thousands of dollars in incidental costs.

Even facilities whose long-range plan is limited to the next fiscal quarter can enhance the planning of multimodality suites without knowing all of the pieces likely to be in place in 10 years.

What about tomorrow?

One thing to consider is the impact of future changes on equipment being sited today. For example, many contemporary MR scanners are extremely sensitive to vibration. Siting an MRI next to a space slated to undergo major construction may incapacitate your MRI for days, weeks or months of construction. Changes in ferrous mass from construction machinery or structural steel near the MRI also can disrupt the magnet's shim, requiring service to restore image quality and enable more sensitive scans.

And while we're not certain whether the greatest growth will occur in volumes for CT, ultrasound, conventional X-ray, MRI or PET, U.S. population demographics indicate that imaging will grow in the years ahead. While knowing that a PET/CT will be the ideal piece of equipment to purchase in five years would be helpful, you can make many planning decisions now, secure in the knowledge that patient volumes will increase. This can impact patient waiting and support spaces, and help facilities gain greater certainty in planning for future expansions.

Facilities should develop five-, 10- and 20-year plans relative to their patient care needs, population demographics and long-term goals. Unfortunately, few undertake such an exercise and fewer still use those plans as guidance. The cost of contemporary imaging equipment and the degree to which we depend on the clinical care they empower are powerful arguments to plan, within whatever constraints a project presents, to maximize patient care and revenue.

Tobias Gilk is an associate architect for Junk Architects in Kansas City, Mo., which specializes in MRI and radiology planning consulting. He is also an editor of the MRI Newsletter (www.mri-planning.com) and a member of the American College of Radiology's MR Safety Committee.