Planning and Design of

Radiology & Imaging Sciences

Introduction
Medicine is a science, but the practice of medicine is an art. This is
especially true in the branch of medicine called medical imaging.

- The art of applying medical imaging requires high-technology

equipment, tremendous care and patience, and a unique sensitivity.

- Imaging equipment may cost considerably more. It is vital that design

professionals do not focus on technical requirements so closely that they
forget the needs of the people who will use that technology.

- As such it is important to understand both the processes and the

equipment used for medical imaging and for the medical team to
understand how the design process will be orchestrated.
Special Features

It must accommodate :
- Special needs of imaging patients and their families;
- Needs of the imaging staff including radiologists,
technologists, other health care providers,
administrators, clerical personnel and housekeeping;
and
- Needs of the equipment in terms of its function,
installation, maintenance, modification and
replacement.
Special features of an imaging facility?
The Needs of Patients
 Patients have many needs,
- some of which are for information, stress reduction, comfort, dignity, and privacy.
Most patients come to an imaging department to “solve a medical mystery.
- ” Ultrasound, magnetic resonance, computed tomography, or any one of a
number of other imaging modalities offer special abilities to “see within” and
visualize what would otherwise be invisible. This information needs to be precise. In
terms of facility design, the equipment needs to installed properly so that it yields
reliable and accurate results. It also means that user capacity must be considered
to ensure that patients have access to the equipment they need in a timely
manner.
In addition to this, patients have a great need for stress reduction. The diverse
array of machinery is foreign and even frightening to most patients. The odd
postures patients must assume, the duration for which they must hold still and the
overall sense that their health and well being may be determined in part by an
electronically rendered illustration of their inner anatomy and physiology can be,
at best, impersonal and intimidating. At worst, it can be terrifying. Patients are very
apprehensive about what the machines will say about them.
 Patients need to be as comfortable as possible while waiting. Patients often feel a
sense of alienation, and waiting areas should be large enough to permit family
members to wait with them.
 Patients need to maintain a sense of dignity. They need privacy to remove their
clothing, and they appreciate it when private offices and public spaces are
Staffing
 X-ray installations shall have a radiologist/related
medical practitioner/ X-ray technologist with
adequate knowledge of radiation protection to
operate the Xray equipment.

 All installations having X-ray equipment with

fluoroscopy facility, computed tomography and all
establishments performing special procedures, shall
have the services of a qualified radiologist or
related medical practitioner, with adequate
knowledge of radiation protection for interpretation
and reporting.
Staffing
Radiologist

 MBBS
 MD 3 year MCI approved programme
 Residency programs
3 years Radiology training
 Fellowships
 Fellowship programs allow for sub-specialization
 E.g., Interventional/CT/Mammo/MR
Needs of Staff

 Imaging is an “information hub”. Staff members need precise,

timely medical information. For example, imaging facilities must
provide staff members with ready access to medical records,
test results, scheduling and billing information, and so on.
Additionally, staff need adequate storage space.
 Factors that enable imaging staff to perform their duties
efficiently are:
 Task lighting should be appropriate and adequate
 Size and configuration of treatment rooms should facilitate their
function
 Needs of housekeeping and maintenance personnel must be
addressed
 Imaging staff have stressful work, and need break rooms and
private areas and appreciate pleasant conditions as much as
patients do.
Needs of Equipment

 As imaging equipment becomes more computer based, the need

for “clean” and uniform power and efficient air-conditioning
systems is magnified. Infrastructure systems designed by engineers
must be carefully coordinated with architectural design.
 Because medical technology is changing at an increasingly rapid
rate, the need for flexibility in every aspect of design becomes
more crucial. Alternatives for future growth and modifications
should be part of the initial design, not an afterthought.
 Finally, although imaging equipment itself is shrinking in size, the
capabilities of any single piece of equipment are expanding. As a
result, multiple ancillary instruments may be used in the exam room.
Therefore, the need for both examination space and support
space may increase.
General Layout
Regulatory Requirement
X-ray equipment are covered :
• Radiography (Fixed, Mobile, Portable)
• Interventional Radiology CATH,
• C-Arm
• Computed Tomography
• MRI
• Mammography
• Dental radiography [ Dental (intra-oral), OPG, Dental CBCT]
• Bone Mineral Densitometer
 Procurement of X-ray Equipment: The employer of X-ray facility
shall procure NOC validated/ Type Approved X-ray equipment
from authorized supplier(s) and after obtaining procurement
permission from the Competent Authority.

 Operation of X-ray Equipment: No diagnostic X-ray equipment

shall be operated for patient diagnosis unless Licence for
operation is obtained from the Comp

 The room housing an X-ray equipment shall have an appropriate

area to facilitate easy movement of staff and proper patient
positioning.

 Appropriate structural shielding shall be provided for walls, doors,

ceiling and floor of the room housing
 The X-ray equipment so that radiation exposures received
by workers and the members of the public are kept to the
minimum and shall not exceed their respective dose limits.

 The control console of computed tomography equipment

shall be installed in a separate room located outside but
adjoining to computed tomography room and provided
with appropriate shielding, direct viewing and oral
communication facilities between the operator and the
patient.

 Interventional Radiology equipment room shall have an

adjoining control room with appropriate facilities for
shielding, direct viewing and oral communication facilities
between the operator and the patient
Location & Configuration

 The numerous activities surrounding an imaging examination

intertwine to form a complex, almost choreographed sequence
of events. For hospital based imaging departments, the
department location and configuration must be coordinated with
the hospital-wide flow of patients, staff, supplies and material.

 Where the imaging department should be located

within the hospital depends on two factors:

 Who will be using the departments services

 What the facilities overall organizational philosophy is
with regard to the provision of imaging services
 Imaging departments are located on the ground floor
of the hospital. Major parts of the department may not
have access to natural daylight. The weight of imaging
equipment and film files and desired adjacencies to
other departments frequently located on the lower
levels (such as the emergency department and the
outpatient department) are some of the reasons that
make this ground floor location necessary.

 This grade-level location is preferred for this

department. It can accommodate the need for future
expansion. This ability to expand the department or to
allow for future conversion of areas within the
department should be a primary consideration in
determining location and configuration.
Users of Imaging Services
Imaging services often comprise of at least two components:
- Basic imaging
- Special imaging and nuclear imaging

Basic imaging includes routine procedures (for example, basic radiology

and fluoroscopy) that are of short duration and frequent demand.

Special imaging includes procedures (for example, magnetic resonance

imaging (MRI), computed tomography (CT) and interventional imaging) that
are of longer duration and often require specialized equipment.

Sometimes they are organized to form a central imaging department.

Sometimes basic imaging is decentralized whereas special imaging and
nuclear medicine are centralized; and sometimes nuclear medicine is
organized as a separate department. Additionally, in some cases, special
zones within the department are dedicated to certain patient groups- for
example, a women’s screening area with ultrasound, mammography and
bone densitometry.
 Centralized imaging department include:
- Outpatient registration and clinic areas
- The emergency department
- The surgical suite
- Nursing units
Interdepartmental Functional
Relationships
Access from Outpatient Areas
- ambulatory patients make up an increasing majority of imaging
procedures.
- outpatients will be required to have chest X ray, prior to other form of
outpatient treatment. Basic x-ray services, as part of an outpatient
imaging facility or the main imaging department should be near the
OPD.
- Imaging services should also be easily accessible to specialty clinics, such
as orthopedic clinics (which frequently use general radiography, MRI and
CT), obstetric/gynecological clinics (which use ultrasound) and oncology
clinics (which use many imaging modalities such as MRI, CT, radiography,
fluoroscopy, mammography, ultrasound, and nuclear medicine).
Access from the Emergency Department
- Emergency patients often need immediate access to many imaging
services, especially basic radiography, CT and MRI.
- Most large ER’s have some imaging capabilities within the department.
Despite this, close proximity to the imaging department is desirable to
improve access to specialty imaging services that are integral to ER care.
- Additionally, if some imaging services are not staffed at night, ER may be
the only area that is fully staffed. Thus, if the ER is located on the ground
floor, ideally imaging services should also be located there.
Access from Surgery
 Imaging is becoming an increasingly important component of surgery, and
surgical procedures are becoming an increasingly larger component of
imaging. Presurgical planning, which utilizes three-dimensional CT and MRI, is
useful in the preparation for complex surgical procedures. Various forms of
imaging such as ultrasound, fluoroscopy, and even CT also are significant
tools used within the operating suite to track surgical progress and location.
Imaging itself is becoming more interventional. Surgical procedures such as
stereotactic neurosurgery or biopsies may be performed within CT or even
MRI suites.
 Many imaging procedures now involve invasive treatment, and thus some
imaging procedure rooms may require a high level of sterility and additional
support spaces for additional personnel and patient observation and holding.
 Imaging integral role in surgery requires that:
(1) radiologists and technologists need access to surgical suites and
(2) surgeons will be performing more procedures in conjunction with imaging
personnel. Thus both proximity and advanced communication systems
between the two departments is desirable.
 Imaging’s interventional nature suggests that some patients may need
surgical backup in the event of a medical emergency. In addition,
observation of imaging patients prior to and after their procedures can
sometimes be effectively combined with the end-stage observation of
surgical outpatients.
Access from Nursing Units

 The patient population in the hospital is generally more critically ill

and imaging plays a pivotal role in the management of
inpatients.
 In the intensive care unit (ICU), in particular, rapid turnaround of
images and image interpretation is essential to the effective care
of patients because their medical condition is likely to change
quickly. In addition, it is important to minimize transport of these
patients.
 One approach is to process, interpret and hold ICU patient’s
images within the ICU for the duration of the patients stay in the
unit. Another alternative to help accomplish these goals would be
a picture archiving and communication system (PACS),
connecting the ICU to a centralized imaging department.
 The imaging department should have direct access to and from
elevators used for inpatient transport.
Centralized versus Decentralized Imaging Services

 For centralized departments, where both basic and specialized

imaging services are located within one zone, vertical and horizontal
connections to the various users of imaging services will be necessary.

Proponents of centralized
imaging claim that in a
centralized department, quality
control is monitored better,
radiology personnel are utilized
more effectively, and equipment
is not duplicated unnecessarily.
Organization based on decentralized programs is often found in
large teaching hospitals where patients, staff, interns, and medical
students would otherwise have to frequently travel long distances
between related areas.
Decentralized imaging is also part of
the patient-focused health care
delivery strategy to reduce the amount
of inpatient transport, to simplify the
radiography work flow process, and to
reduce overall labor costs. Another
form of decentralized imaging occurs
when outpatient imaging is separated
from inpatient imaging.

Advocates of decentralized imaging cite reduced patient transport,

decreased waiting time, reduced overall labor costs, a streamlined
imaging workflow process, and flexibility as beneficial outcomes of
decentralizing these functions.
The Functional Design

1. Patient zone, where waiting and

patient preparation occur
2. Examination zone, where the primary
activity of imaging examination
occurs
3. Central image-processing zone,
where the three functions of image
handling occur
4. Personnel zone, where staff offices
and support spaces are located
5. Long-term file zone, where inactive
files are stored
Patient Zone
The patient zone includes space for patients prior to and after their imaging
procedure(s). Patients have their first contact with the imaging department and staff
in this area. First impressions should be positive ones.
If both inpatients and outpatients are seen in the department, the patient zone can
be separated into two distinct areas, each adjacent to the examination zone.
Functions found in the patient zone include:
 Patient and visitor waiting areas
 Dressing rooms
 Toilet rooms
 Lockers
 Education space
 Reception and registration areas
 Patient corridors
 Patient preparation and holding areas
Reception and registration should be provided such that clerical staff can easily
supervise waiting areas and have easy access to patient records and administration
areas. A room or alcove screened from the waiting area should be provided for
confidential or financial conversations and/or as an education space.
Sometimes, dressing rooms are clustered together, with each cluster serving a series of
procedure rooms, rather than locating a dressing room near each procedure room.
Examination Zone
 The examination zone consists of two primary elements: examination or
procedure rooms and control areas. Both patients and staff enter the
examination zone. Patients are limited to the procedure room and the
patient side of the registration area; they are not permitted in the control
area.
 The control area is where technologists’ consoles and other equipment
used to “control” the imaging procedure are located. In the functional
zone concept, all control functions were removed from the procedure
room and placed in a control corridor, running parallel to a series of
procedure rooms.
 In many facilities, however, the preferred location for control alcoves is
within the procedure room. This occurs more often in basic procedure
rooms than it does in special procedure rooms. Special procedure rooms
often have a large control room directly adjacent to the procedure
room, rather than within a control corridor. There are advantage and
disadvantages to both.
 The imaging department should be arranged such that those procedures
that are of short duration and high frequency are located near the
waiting area and the department entrance. This configuration will thus
reduce the amount of traffic congestion in the patient corridor.
Image Processing Zone
 Imaging departments that have been planned using the functional zone
concept often have a staff work core in the center. If the control corridor
approach is used, the work core abuts the control corridor. If the control
corridor approach is not used, the work core abuts procedure rooms that
have internal control alcoves and control rooms adjacent to the procedure
rooms.
 The image-processing zone provides space for three functions:
 Image processing, quality control and preliminary viewing, where the image is
processed and reviewed for quality prior to being sent to the radiologist
 Reporting and consulting, where the radiologist reviews and interprets the
image for diagnosis and/or consults with the referring physician or others
 Film sorting and short-term film storage, where active images are sorted and
stored for archiving (active status may last for months or even years)
 In some practices, reporting and consulting are performed in the personnel
zone instead of the image-processing zone.
Personnel Zone
 The personnel zone includes office space and staff support areas such as
lockers, toilet rooms, lounges and conference spaces. If staff lounges and
conference are to be shared by other departments, these spaces should
be located along the perimeter of the department to keep non-
departmental traffic away from busy work areas.
 Many radiologists review and interpret images in their offices; others
review and interpret them in multi-viewing rooms complete with film
alternators, film illuminators and multimedia computer workstations that
integrate PACS, IMACS and RIS (radiology information system), and HIS
(hospital information system) capabilities.
Filing Zone
 Various regulatory bodies have rules regarding
the length of time inactive films must be retained,
as well as individual practice philosophies. It is not
uncommon for films to be archived for seven
years or longer. Inactive film storage often can
be located in an area remote from the main
department, providing that some means of
retrieving old films is practical.
Plan Typologies

 Single-corridor
 Double-loaded corridor
 Core plan
 Cluster plan
Double corridor

Core plan
Cluster plans
Space Determinant Methodology

 Functional programming
 Space programming

- Functional programming evaluates historic and present workload

data in order to calculate future projections.
- Space programming begins with a series of interviews among
planners and the administrative and medical users of the facility

Space for:
- Activity
- Support
- Administration
Activity Clusters
 Certain types of spaces are grouped together in what can be called an activity
cluster.
- In the case of film processing, a darkroom (or daylight processing area), an image
quality viewing area and a film sorting area form an activity cluster. Separate tasks
are performed within each space, and yet if one of the spaces is not provided, the
entire film-processing activity cannot be accomplished. Thus, a film processing
room is usually supported by a viewing area to verify image quality.
 A film-processing activity cluster can be centralized, decentralized or. When film
processing occurs in the procedure room, image quality can be checked without
a separate viewing area. With some image acquisition techniques such as MRI
and CT, image quality is reviewed on computer monitors.
 Fluoroscopy room/toilet room (so that patients can eliminate immediately
following the exam in the event barium enemas are used)
 Ultrasound room/toilet room (so that patients undergoing abdominal ultrasound
can eliminate large quantities of water consumed prior to the exam)
 Radiography room/control room/dressing area
 CT scanning room/patient prep and holding/ control
 Nuclear medicine scanning room/toilet/dressing/holding dose room
 Positron emission tomography (PET) scanning room, cyclotron/dose room
Activity Clusters
Variables Affecting Facility Size

 The number of annual operating hours.

 Renovation projects
 Location - If radiographic facilities exist in the emergency
department,.
 Equipment Specific
 Imaging workload
 Outpatient imaging centers, as compared to hospital
imaging departments
 Specialisation - nuclear medicine as a part of radiology,.
 central imaging department; others decentralize
 Archival film area
 Filmless imaging departments
Room Design

General Considerations for Procedure Rooms

- Complexity and characteristics of many procedure rooms are
evolving Size, sophistication, type and quantity of equipment to
be found in many rooms are changing equally rapidly
- The dimensions, physical characteristics and infrastructure
requirements of some rooms are not necessarily fixed
- Special procedure rooms, such as angiography and
catheterization labs, than is does to most basic procedure rooms,
such as general radiography/fluoroscopy (R/F) rooms
- Some procedure rooms require higher levels of infection control,
greater emergency and uninterruptible power supply, emergency
equipment, medical gas outlets, and more space than was
previously required.
Details of fixtures and accessory equipment :

- A hand-washing fixture should be provided in the room.

- Some special procedure rooms need to have scrub sinks located
nearby.
- Some rooms, such as cardiac catheterization labs, need an
additional sink located nearby for cleaning catheters.
- Many procedure rooms that emit radiation require that that patients
and personnel wear lead-lined aprons or other forms of protective
clothing. Therefore apron racks are required in or near those
rooms. Additionally, radiation protection is integrated into the room
construction itself.
- If conventional film processing is used, a lighttight through-the-wall
cassette pass-box should be installed, ideally directly between the
control portion of the procedure room and the darkroom.
- Film illuminators of the proper orientation and configuration should
be placed where they are accessible for easy viewing.