The Architecture of Medical Imaging

Transcription

1 University of Kansas Architecture 731 Systems and Components of Healthcare Facilities F. Zilm The Architecture of Medical Imaging Designing Healthcare Facilities for Advanced Radiologic Diagnostic and Therapeutic Techniques Learning Objectives 1. Learn about key trends in medical imaging 2. Understand key drivers of imaging facility design 3. Review various design concepts for imaging g facilities, departments and rooms 4. Recognize safety issues related to imaging facility design Bill Rostenberg, FAIA, FACHA, NCARB Principal and Director of Research Anshen + Allen Webinar Presentation Wednesday March 4, 2009 Presentation Outline 1. Overview 2. Imaging Techniques 3. Design and Planning Considerations 4. Convergence of Surgery and Imaging 5. Design and Experience 1 Overview Early X-Ray Circa 1900: The first x-ray department at Boston Children s Hospital was limited in its function because it was not equipped with electricity. eect cty It was obliged to obtain its power from the Opera House nearby. Photo: Stevens, E. F. The American Hospital of the Twentieth Century; Architectural Record Publishing Company; 1918 Milestones in Medical Imaging ACR MRI Safety- 2002,2004,2007 Nobel Prize CR, 1984 for MRI 2003 Direct EBT 1982 Radiography PACS, 1982 Multidetector CT 1996 Clinical Fluoroscopy PET/CT 1996 PET, 1953 DSA 1979 MRI, st Filmless hosp. X-Ray MRI Discovery Cardiac 1885 Catheterization, Automatic Film CT 1972 I-MRI, Processor,1942 US 1966 DICOM, 1993 SPECT PACS Development s A wire was run from the Opera House to the Hospital, but when there was no music there was no current Molecular Medicine No opera, no X-rays! * * Eisenberg, R. L. Radiology: An Illustrated History. Mosby-Year Book, 1992 Early Medical Imaging Information and Communications Advanced Medical Imaging Page: 1

2 Resource Shortage Drivers Communications Drivers The Staffing Crisis will continue at many levels: radiology nurse radiology technologist radiologists PACS specialists New types of personnel are evolving in the procedural environment: Image-guidance radiologists Surgical Imaging Technologists Surgical IT Managers Non-surgical Interventionalists Digital image acquisition and transmission Digital pathology, pharmacy, lab, etc. Digital supply management / billing Artificial intelligence / CAD Images & Information acquired digitally... The PACS Concept...transferred electronically......stored digitally......made available to a variety of review stations... Productivity Drivers Collaboration Drivers Advanced technology. Image courtesy of Brigham and Women s Hospital. can accelerate or disrupt collaboration. Radiography Conventional x-rays Analogous to casting shadows, but with much stronger light Radiographs are essentially shadowgrams 2 Imaging Techniques Staff Core idor Patient Corr Bones, soft tissues, and air attenuate the x-ray beam differently this is the basis for radiographs Digital radiography Replaces film with a digital detector Separates the image capture, display, and storage functions Page: 2

3 Fluoroscopy Mammography Early fluoroscopy Used a fluorescent/ phosphorescent screen in place of film Allowed viewing of moving structures Very high radiation exposure Modern fluoroscopy Uses an image intensifier or digital detector Much lower radiation exposure Conventional Film Basically radiography but with very high-resolution film/screen system Proven to reduce breast cancer deaths Digital Similar to digital radiography, but uses a high-resolution digital detector High resolution is needed because important findings are often very small Computed Tomography Staff Core Patient Corridor Abdominal CT A major revolution in radiology Allowed for the first cross-sectional imaging of the body in living humans (and animals) CT is an x-ray technique and depends on the different attenuation of tissues In cross-sectional imaging, the great advantage for the physician is that the overlap of structures on radiographs is eliminated The newest CT machines can generate many slices (up to 256) per rotation, as a result, scan times have fallen by an order of magnitude Interventional Radiology and Cardiology Largely use fluoroscopic techniques Viewing and recording motion are critical To achieve the views that the radiologists and cardiologists need, the equipment has to be able to move in many directions and angles Cardiologists usually need higher frame rates (more images per second) because of the rapid motion of the heart and cardiac valves Ultrasound Magnetic Resonance Imaging Relies on sound, not x-rays Sound is reflected differently from different tissues Typically done in real-time mode so moving structures are easily imaged Limitations it ti are bone and gas through which ultrasound does not pass The lack of radiation means the technique can be used on children and fetuses The newest systems allow for 3- and 4-dimensional imaging (4D = 3D + time) Taking your protons out for a spin Uses the magnetic properties of the nuclei of some atoms The atoms are lined up with a strong magnetic field The atoms are hit with a radio pulse As the atoms return to their starting state, they give off a radio signal that signal varies with the atom and the environment of the atom The signal is detected and results in the MR image Page: 3

4 Nuclear Medicine Hybrid Imaging Typically a functional imaging technique Combination imaging methods Radioactive isotopes are attached to molecules of interest The molecules can be targeted to particular cellular or organ functions; for example, radioactive iodine which is avidly taken up by the thyroid gland The radiation emitted by the molecules is detected Isotopes that give off positrons can be used to generate cross-sectional images PET-CT: combines nuclear medicine positron imaging (a cross-sectional technique that is good at functional imaging) with CT (good at anatomic imaging) The machine has a single patient table with PET and CT gantries around it PET-MRI The newest hybrid imaging: combines PET and MRI Images courtesy of: Image Management - PACS, IMACS Digital image management systems: Replace film and paper-based management Acquire images digitally Display images on computer-based workstations Store images in servers Manage images, patient information, reports, scheduling, and billing information Manage workflow get information where needed when needed Trends Plain film procedures (R&F) being replaced by advanced cross-sectional imaging (CT,MR) Increasing demand today for intensive air, power, data, and structural capacities Need to provide additional infrastructure capacities for future equipment and procedures Hybrid modalities (PET/CT, PET/MR, PET/OR/MR) require more space and infrastructure Greater horizontal & vertical space required Questions?? Design and Planning 3 Considerations Page: 4

5 Workflow Workflow Analysis Radiologist Technologist Flow Type Location RECEPTION WAIT / HOLD BUSINESS OFF. INTERVIEW DRESS / TOILET ACQUIRE IMAGE PROCESS IMAGE QA IMAGE READ IMAGE MD CONSULT STORE IMAGE INPATIENT Patient OUTPATIENT PATIENT RECORD Information MEDICAL IMAGE TECHNOLOGIST Equipment / Supplies RADIOLOGIST = IMPACT OF DIGITAL IMAGE MANAGEMENT Traditional Film-based Department ED Lab Radiology CT Dark MRI Angio- graphy R/F R/F R/F The Digital Department ICU HC Enterprise OR IMAGING ED M/S Tech Dock Images to/from ED, OR & ICU Images to/from Med/Surge Floors Images to/from Technology Dock Images to/from Entire Enterprise Intradepartmental Relationships Special Interventional* * Commonly located near surgery Outpatient Circulation IP Hold Routine Outpatient Work Core Routine Inpatient Inpatient Circulation Elevators/ Emergency Entry OP Wait Recep Departmental Zoning Diagram Routine/ Short Duration CT Chest Mammography General Radiography Outpatient MRI Nuclear Medicine Special Fluoroscopy Interventional Radiology Complex/ Long Duration Inpatient FRONT BACK Page: 5

6 Planning Typologies Department ple (on-stage / off-stage) / Supt / Supt Supt Staff Work Core Single Corridor Double Corridor Modality Pod Expansion Department ple (imaging modality clusters) Department ple (diagnostic vs. interventional) Department ple (growth strategies) Imaging Environments that Improve Outcomes and Safety Radiation Safety MRI Safety Handed vs. Mirrored s Environments that Improve Diagnostic Interpretation Page: 6

7 Radiation Safety Radiation Barrier Basics Architect Radiation Health Physicist Equipment Planning Consultant Equipment Vendors Health Safety Compliance Officer Image, courtesy of: Scott Jenkins, EDI Design Radiation Barrier Basics Radiation Barrier Basics Barrier should protect staff & door opening Solid end of barrier should be min. 18 wide Barrier should protect staff & door opening Solid end of barrier should be min. 18 wide Shielded window should provide unobstructed view of patient and room Equipment Orientation Equipment Orientation CT orthogonal with scan room CT diagonal, away from door CT diagonal, toward door Direct radiation through doorway. Marginal visibility into scanner Minimal direct radiation through doorway. Poor visibility into scanner Direct radiation through doorway. Good visibility into scanner Page: 7

8 Location of Openings MRI Safety Window Staff Pat ient Patient Window Staff Window Staff ent Patie In the future, much of pediatric imaging will transition from ionizing radiation techniques (general x-ray, CT, etc) to MRI due to concerns about potential hazards of radiation exposure. MRI hazards are among the top 10 healthcare concerns leading to errors and adverse events 1 Good visibility into scanner. Good radiation protection Good access from control into scanner room Good patient access onto scanner 1 The Quality Letter for Healthcare Leaders, April 2003, Lippincott Williams and Wilkins MRI Design Variables Influencing Safety Landmark Accident (2001) RF Interactions Tissue Heating Magnetic Interactions Translational Attraction (projectile) Torque Emergency Egress Restricted Access Cryogen Safety Incident: July 27, 2001, Westchester (NY) Medical Center Source: The Journal News June 1, 2002 Image, courtesy of: Scott Jenkins, EDI Design ACR MRI Safety Guidelines- 2002, 2004, 2007 ZONE 1: Unrestricted [outside MR suite] MRI Safety Planning Implications MRI suite with 3 scanners ZONE 2: Restricted to supervision by MR personnel [reception, waiting, toilets, dressing] ZONE 3: Highly restricted area where serious injury can occur [control room, computer room] Source: The Journal News June 1, 2002 ZONE 4: Most highly restricted where all non-mr personnel must be in direct visual supervision of Level 2 MR staff at ALL times [MR scanner room] Imaging Department Future 4 th ner Page: 8