Radiology Architects Forecast the Facility of the Future

The ever-evolving world of healthcare virtually guarantees the radiology facility of tomorrow will look very different from the structures of today, according to noted radiology architects.

Bill Rostenberg, A.I.A. Anshen + Allen

Steven C. Horii, M.D. University of Pennsylvania Medical Center

William N. Bernstein, A.I.A. Architecture for Radiology

"I like to call this the chess board approach to design," said Bill Rostenberg, A.I.A., a principal and director of research at San Francisco-based Anshen + Allen who designs radiology spaces in hospitals and freestanding medical buildings. "You always need to be looking five, six or seven steps ahead."

Rostenberg will moderate the multisession course, "Architecture That Makes a Difference: Design Guidelines for Tomorrow's Imaging Environment," on Monday, Nov. 30, at RSNA 2009.

Changes in practice, technology, referrals and revenue streams have driven the evolution of radiology architecture, said Rostenberg, who has a long history of working with radiologists as the liaison between the American Institute of Architects (AIA) and RSNA's Associated Sciences Consortium.

"There is a convergence of surgical and medical imaging with less invasive procedures that rely more on image guidance," he said. "The physical environment must anticipate this and future collaboration."

Although the integrated interventional platform may stimulate competition among surgeons, cardiologists and radiologists, Rostenberg said he feels there is value to greater collaboration.

For example, some catheterization labs and angiography suites are now located adjacent to or within surgical suites. In fact, Rostenberg foresees that the operating room of the future will look a lot like a cardiac catheterization lab.

"We're already seeing greater need for control rooms and additional electronic equipment rooms in surgical suites," he said. "Currently electronics equipment racks are often placed within operating rooms where they should not be located. We need to change tradition and build new surgical rooms with adjacent control rooms and electronics rooms, or at least provide the space to build them in the future."

Changes in Technology, Work Patterns, Demand Reading Room Changes

Intraoperative MR Imaging Perhaps the most complex example of surgical and imaging convergence, intraoperative MR imaging (I-MRI) provides image guidance during surgery. I-MRI facility design requires a unique understanding of MR imaging safety criteria as well as surgical protocol for clinical workflow. In this example, the magnet is mounted on a track that allows the I-MRI to move from the diagnostic area into the operating room and then back into the diagnostic suite for surgery to continue. Image courtesy of ANSHEN+ALLEN

Steven C. Horii, M.D., one of the presenters for the multisession course at RSNA 2009, agrees there must be a hand-in-hand relationship between radiology and architects. "It is extremely important to work with a radiology architect and facilities management personnel when redesigning or building new spaces," said Dr. Horii.

Dr. Horii, a professor of radiology at the University of Pennsylvania Medical Center in Philadelphia, said his facility recently underwent a reading room renovation and that he and his colleagues are still working to create configurations that accommodate as many users as possible.

All radiologists are affected by the design of the reading room and its impact on diagnostic speed, accuracy and overall work performance, Rostenberg said.

Changing technology requires that radiology architects work to enhance reading room ergonomics, said Dr. Horii. In the past, radiologists handling film distributed work over large groups. They also took breaks in the day as they searched for films. With PACS, images are read as they come in and there is little opportunity for breaks.

Radiologists must work with architects and vendors to improve lighting and workflow and reduce noise, said Dr. Horii, who will discuss the topic in depth at RSNA 2009. He and Rostenberg will also discuss regulatory issues impacting radiology architecture.

Design Shifts from Radiology-Centric Areas

Overall facility design is another area ripe for optimization, said Dr. Horii. "We need to get away from radiology-centric areas," he said. "When a doctor has to wander around the hospital for 10 minutes searching for a consulting radiologist, that's too time-consuming."

Location makes a difference when it comes to patients as well. Despite all the advancements that have come with PACS, patients must still go to the equipment, which can be time-consuming. If a CT scanner is 300 feet from an elevator, it takes longer for the patient to get to and from the scanner and on and off the table than it does to take an image.

Such considerations are particularly key in this age of healthcare reform, Dr. Horii said, as the utilization of equipment must increase dramatically. "Hospital administrators and the government seeking a 90 percent utilization rate on a million-dollar piece of imaging equipment should know that it is going to be very difficult with inefficient room turnover," he said.

That is one reason architects strive to bring equipment design in sync with the design process, said William N. Bernstein, A.I.A., a principal with the New York-based firm Architecture for Radiology, whose members regularly attend RSNA annual meetings.

"Clients often delay the final equipment selection until the very end of the process in order to keep options open and, in some cases, reduce costs," said Bernstein. "That creates an issue on the design end when final equipment specs are needed sooner. One way of dealing with this is designing 'universal rooms' that allow physicians greater flexibility and more time to make their final equipment selection."

Bernstein said radiology architects ensure that the infrastructure supports the equipment and that architects who are trained to understand the needs of radiology learn to ask, "When the equipment needs to be replaced in the future, what is the exit path?"

Dr. Horii said that exit path is sometimes forgotten until it's too late. "When an MR is built in the center of a facility, how are you going to get the giant magnets out when it's time to upgrade?" he asked.

He cited one hospital that initially broke into the side of a building to bring the magnet inside. Years later, another building went up next door. When it was time to upgrade the MR, the magnet had to be broken apart in order to remove it, which was very costly.

Value of Radiology Architecture Not Fully Understood

"Many radiology professionals don't have a good sense of what architects do," said Bernstein. "There is a huge value in what a properly trained radiology architect can do in terms of framework design, construction, getting equipment in place, the aesthetics of the project and ultimately, the success of the business."

"We put a great deal of emphasis on what the space feels like for the patient, staff and faculty," said Rostenberg. "That is extremely important."