Architects react to changing imaging paradigm

Ample documentation catalogs the challenges of integrating new imaging technologies into large healthcare institutions. But few built facilities actually address the new imaging paradigm.

"The single most important challenge when designing a new imaging facility today is rethinking the workflow and its impact, not just on the imaging department but on the entire facility," said Carlos Amato, senior medical planner for RBB Architects in Los Angeles.

The fact that images are now available anytime, anywhere has not only changed the traditional role of the radiologist but has also started to blur department lines, creating turf issues, according to Amato.

"The provider of the future is cross-trained to perform tasks previously performed only by imaging technologists," he said.

Imaging decentralization presents new challenges that require planning integration with other areas, as well as a seamless way to transfer information inside and outside the facility. The traditional centralized design based on core supporting images and equipment is giving way to a more free-flowing virtual environment, Amato said.

The new hospital the University of California, Los Angeles is building offers an example.

"Imaging and information systems in the new hospital will be filmless, paperless, and fully electronic," said Dr. Osman Ratib, vice chair of information systems in the UCLA radiology department. "Communications networks will revolve around the patient, not PACS."

The shift to patient-focused care and the desire to improve the patient's medical experience have a profound effect on the functional plan design, which must create an imaging department user-friendly to staff and patients and focusing on the patient, not the technology.

"As architects, we should study workflow from a patient's perspective and envision what the ideal patient visit to the imaging department would be like, and then plan with that concept in mind," Amato said.

Newer, faster imaging modalities, for example, generate more patient volume and increase throughput, which in turn affects the amount of space required for patient waiting, dressing areas, and other support spaces.

"In mammography examination areas, we have recently observed that patients prefer to wait in private spaces rather than sit in a common area with a television hanging from the wall," Amato said.

With the emergence of digital mammography and its five to seven-minute procedure time, patients now spend more time changing clothes they do receiving the actual mammogram.

"The accelerated workflow has to translate into effective planning that can deal with the new paradigm," Amato said.