Square Pegs in Round Holes: Imaging Suite Solution

Integrating advanced medical technologies like MRI and PET/CT machines into existing healthcare facilities presents unique challenges that require careful planning, strategic collaboration and adaptive execution. These projects must balance technical demands with logistical constraints to ensure that new equipment not only fits within the physical space but also enhances the overall functionality and efficiency of the healthcare environment. At the University of Iowa Hospitals and Clinics (UIHC), thoughtful design and execution transformed constrained spaces into cutting-edge medical facilities, improving patient care and operational effectiveness.

Medical imaging is vital to modern healthcare, offering critical insights for diagnosis, treatment planning and monitoring. However, incorporating these advanced technologies into existing clinical environments involves overcoming challenges such as space constraints, infrastructure upgrades and the need to maintain seamless operation. In this article, we explore the complexities of replacing equipment and look at two case studies at UIHC that illustrate how strategic design and execution can help healthcare environments remain at the forefront of medical advancements.

The Complexities of Replacing MRI and PET/CT Equipment

Space constraints are one of the primary challenges of replacing MRI and PET/CT machines in existing healthcare facilities. These machines are large and require significant space not only for the equipment but also for the associated control rooms and patient preparation areas. Reconfiguring existing spaces to accommodate new machines often involves structural modifications and careful space planning to ensure everything fits seamlessly without disrupting the overall flow of the facility.

Another critical factor is the need for infrastructure upgrades. Advanced imaging technologies like MRI and PET/CT have specific infrastructure requirements, including robust electrical systems, adequate cooling and specialized shielding to prevent interference and ensure safety. Upgrading systems within an operational hospital can be challenging, requiring meticulous planning to minimize or avoid disruptions to ongoing medical services. Ensuring patient and staff safety during the replacement process is also paramount. This includes managing magnetic fields in the case of MRI and radiation safety for PET/CT. Proper shielding and adherence to safety protocols are essential to prevent exposure risks.

Minimizing downtime is another significant challenge. Hospitals must continue to provide uninterrupted care during the equipment replacement process. This necessitates phased construction schedules, temporary relocation of services and efficient coordination to minimize downtime and ensure continuity of care. Finally, regulatory compliance is crucial. The installation of new imaging equipment must comply with stringent regulatory standards and guidelines, including adhering to building codes, health and safety regulations and obtaining necessary approvals from relevant authorities. These complexities underscore the importance of meticulous planning, strategic collaboration and adaptive execution in successfully integrating advanced imaging technologies into existing healthcare facilities.

The Role of Design in Transforming Healthcare Spaces

Design plays an important role in shaping the functionality and efficiency of healthcare facilities. Notably, the ability of design to turn constrained spaces into state-of-the-art environments can vitally enhance patient care and operational effectiveness. This transformation begins with a deep understanding of the unique challenges and opportunities that each space presents. Older facilities, for example, often come with limitations in infrastructure, requiring innovative solutions to integrate modern technologies without disrupting ongoing medical services.

Effective design in healthcare facilities involves creating environments that support the clinical workflow, improve patient outcomes and ensure safety and comfort. For instance, the replacement of advanced imaging technologies like MRI and PET/CT machines in established hospitals necessitates careful planning to manage space constraints, airflow and the heavy demands on electrical and mechanical systems. By reimagining these spaces, designers can optimize the layout to facilitate better patient flow, reduce wait times and enhance the overall experience for both patients and staff.

The design of healthcare spaces can have significant impacts on the psychological and emotional well-being of patients and healthcare providers. Thoughtfully designed spaces can reduce stress and anxiety, improve patient satisfaction and even contribute to faster recovery times. Elements such as natural lighting, calming colors and ergonomic furniture are essential to a healing environment. In imaging suites, where patients may experience anxiety about procedures, design elements that promote a sense of calm and reassurance can make a significant difference.

As medical technologies continue to advance, the flexibility and adaptability of the design become paramount. Spaces that can easily accommodate new equipment and evolving healthcare practices ensure that facilities remain at the cutting edge of medical care without requiring frequent and costly renovations. This forward-thinking approach is integral to maintaining high standards of patient care and operational effectiveness over time.

The Challenge in Action

The University of Iowa Hospitals & Clinics (UIHC) is a public teaching hospital and Level 1 trauma center. In addition to its clinical work, the hospital also serves as a major educational hub, training future medical professionals, and is also one of the largest healthcare providers in the state of Iowa. RDG has been a key partner in UIHC’s ongoing efforts to enhance its facilities, with collaborations that span various projects, including the recent replacement of MRI and PET/CT machines within the Pomerantz Family Pavilion. These projects are part of a broader initiative to integrate cutting-edge medical technologies into UIHC’s existing infrastructure, ensuring that the hospital remains at the forefront of medical care. These projects required managing accelerated construction schedules, addressing existing conditions and ensuring uninterrupted hospital operations. Let’s look at each more closely.

Case Study 1: MRI Replacement

Feasibility

The MRI replacement project was situated on the lower level of the Pomerantz Family Pavilion within the Radiation Oncology department. The initial step involved assessing the infrastructure needs, where it was determined that the MRI machine required support from the campus's chilled water system and a dedicated backup. Additionally, a Variable Air Volume (VAV) system was necessary for the scanner room to accommodate current and future equipment, as humidity requirements have become increasingly stringent with advancements in imaging technology. The project also included updates to finishes, lighting and telecom systems to align with current UIHC standards.

A significant challenge was rerouting the quench vent from the lower level to the roof, covering a 120-foot distance through multiple active departments. Working closely with equipment providers and engineers, our design team devised a cost-effective solution by placing the vent inside the healing garden one floor above. This unconventional approach saved over $75,000 in labor and materials, avoided disruptions to active departments and ensured the hospital could maintain secure and safe access for future maintenance.

Planning the Plan

With the feasibility study complete, we transitioned to the design phase, prioritizing the accelerated construction schedule driven by the urgency of ongoing research and clinical operations. Removing the old MRI, infrastructure updates and installation of the new machine needed to be completed within approximately 100 days. The design team proactively engaged with trade partners to understand lead times, especially given the uncertainties of the COVID-19 pandemic impacting supply chains. We crafted a detailed construction schedule and included language in the bidding documents requiring contractors to have all necessary materials on hand before starting on-site work. Additionally, we collaborated with the owner to implement incentives for contractors to reduce the construction timeline by offering higher payouts for each week saved.

Execution

During execution, our team efficiently decommissioned the old MRI machine and addressed existing conditions. We maintained focus on responsiveness, providing solutions to contractor inquiries within days to keep the project on track.

By adhering to a well-structured plan and remaining adaptive, we completed the MRI replacement project within the anticipated schedule, minimizing disruptions and enhancing the facility’s capabilities.

Case Study 2: PET/CT Replacement

Feasibility

The PET/CT replacement project, also located on the lower level of the Pomerantz Family Pavilion, involved upgrading the Radiation Oncology department by replacing an older CT machine with a PET/CT machine. During the feasibility phase, we identified that updates to the HVAC systems, casework, finishes and lighting were necessary. Proper shielding and equipment placement were crucial to ensure the new machine’s optimal functionality while maintaining operational efficiency and patient safety.

Planning the Plan

In the planning phase, we confirmed all design elements and equipment specifications, paying particular attention to the project schedule to align with equipment delivery timelines. It was discovered that the existing floor was uneven and compromised by previous imaging machine installations, necessitating the addition of a new floor pad and structural reinforcements. Although this was a challenging decision, it was necessary due to the proximity of support functions for the PET/CT operations. The owner agreed to replace portions of the floor and with careful planning, the team minimized the impact on affected departments. We took advantage of this opportunity to modify the floor, extending an in-floor raceway to serve future machines, thus preventing the need for similar interventions later. Strategic collaboration with the UIHC team was essential throughout this phase.

Execution

The execution phase focused on managing existing conditions and coordinating the installation of the new equipment. Our team ensured all updates met UIHC standards and adhered to safety requirements. By completing the project on schedule, we minimized disruptions and enhanced the department with an upgraded imaging suite, demonstrating that meticulous planning, strategic collaboration and adaptive execution are essential to successfully integrating advanced imaging technologies.

For both case studies, the existing structure presented significant challenges in meeting the current manufacturers' requirements for the new imaging machines. The success of these imaging suite projects was largely attributed to the specialized products and processes that demanded meticulous attention to installation. A critical aspect of our approach was understanding the requirements of advanced technologies and the level of precise control needed over the environments in which these technologies are installed. Challenges related to structural capacity and floor levelness often arise in older buildings, which were not originally constructed with the stringent requirements of modern imaging equipment in mind. Having the breadth of knowledge and experience allowed us to anticipate and address these challenges from the outset, enabling us to deploy effective solutions quickly.

The Path to Future-Ready Healthcare Spaces

Integrating advanced imaging technologies, such as MRI and PET/CT, into existing healthcare facilities is a complex yet essential process that requires careful planning, strategic collaboration, and adaptive execution. These projects demonstrate how innovative design solutions and deliberate, detailed execution can transform constrained spaces into state-of-the-art medical environments. By addressing space constraints, infrastructure upgrades, safety considerations and regulatory compliance, our approach helped enhance the operational capabilities and patient care standards at UIHC.

As we progress, medical technology and healthcare evolve and demand continuous adaptation and innovation. Looking ahead, healthcare facilities must continue to embrace flexibility and forward-thinking design to stay at the forefront of medical advancements. The insights gained from these case studies provide valuable lessons for future projects, reminding us that with the right approach, even the most complex challenges can be transformed into opportunities for growth and improvement. By fostering a culture of innovation and collaboration, healthcare institutions can ensure they remain equipped to meet the needs of patients and staff, now and in the future.