VA 2020 Imaging Services Design Guide.pdf

Imaging Services Design Guide

September 1, 2020 rev. 08/01/2023

Cover images used with permission from RAD-Planning

PG 18-12 – IMAGING SERVICES DESIGN GUIDE August 1, 2022

CHAPTER 295

TABLE OF CONTENTS i

1.0 GENERAL ....................................................................................................................................... 1-1

1.1 Foreword .............................................................................................................................. 1-1

1.2 Acknowledgement ............................................................................................................... 1-3

1.3 Introduction ......................................................................................................................... 1-5

1.4 Codes and Standards ............................................................................................................ 1-6

1.4.1 VA Technical Information Library ......................................................................................... 1-6

1.4.2 VHA Directives, Handbooks and Manuals ............................................................................ 1-6

1.4.3 National Industry Codes/ Standards .................................................................................... 1-6

1.5 Definitions ............................................................................................................................ 1-7

1.6 Abbreviations ..................................................................................................................... 1-11

2.0 NARRATIVE .................................................................................................................................... 2-1

2.1 General ................................................................................................................................. 2-1

2.1.1 About Imaging Services ........................................................................................................ 2-1

2.1.2 Conjoining Separate Design Guides. .................................................................................... 2-1

2.1.3 Radiology, MRI, and Nuclear Medicine within Imaging ....................................................... 2-1

2.1.4 Intraoperative / Interventional Imaging Guidance .............................................................. 2-2

2.2 Imaging Services Operations ................................................................................................ 2-2

2.2.1 Public vs. Staff Core Organization ........................................................................................ 2-2

2.2.2 Merged / Separated Areas ................................................................................................... 2-2

2.2.3 Central vs. Distributed Imaging Services .............................................................................. 2-3

2.2.4 Diagnostic Imaging Processes .............................................................................................. 2-3

2.2.5 Interventional Imaging Processes ........................................................................................ 2-3

2.2.6 Imaging Patient Care Support .............................................................................................. 2-5

2.3 Imaging and Patient Acuities & Interventions ..................................................................... 2-6

2.3.1 Use of Acuity / Intervention Classes .................................................................................... 2-6

2.3.2 Reference To Facility Guideline Institute (FGI) Guidelines .................................................. 2-7

2.3.3 Criticality & Support Infrastructure ...................................................................................... 2-7

2.4 Changing Facility Needs for Imaging Services ...................................................................... 2-7

2.4.1 Current Trends ..................................................................................................................... 2-7

2.4.2 Future Trends ....................................................................................................................... 2-7

2.4.3 Strategic Planning ................................................................................................................. 2-8

2.4.4 Changes in Technology / Clinical Utilization ........................................................................ 2-8

2.4.5 Operational Costs ................................................................................................................. 2-9

2.5 Planning Imaging Services Facilities ..................................................................................... 2-9

2.5.1 Imaging Services Space Allocation ....................................................................................... 2-9

2.5.2 Where within the building ................................................................................................... 2-9

2.5.3 Service Design Considerations ........................................................................................... 2-10

2.5.4 Internal Adjacencies ........................................................................................................... 2-11

2.5.5 Imaging Services Common Rooms / Spaces ....................................................................... 2-11

2.5.6 External Departmental Adjacencies ................................................................................... 2-17

2.5.7 Imaging Equipment Types / Internal Adjacencies .............................................................. 2-19

2.6 Building Technical Considerations ..................................................................................... 2-19

2.6.1 Structural Design ................................................................................................................ 2-20

2.6.2 Mechanical Design ............................................................................................................. 2-21

2.6.3 Plumbing / Piping Design ................................................................................................... 2-23

2.6.4 Lighting And Power Systems .............................................................................................. 2-24

2.6.6 Information Management Systems.................................................................................... 2-26

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TABLE OF CONTENTS ii

2.6.7 Architectural Design .......................................................................................................... 2-26

2.6.8 Infection Control ............................................................................................................... 2-30

2.6.9 Security / Life Safety ......................................................................................................... 2-30

2.6.10 Sustainable Design ............................................................................................................ 2-31

2.6.11 Safe Patient Handling ........................................................................................................ 2-31

2.7 Imaging Modality Considerations ..................................................................................... 2-32

2.7.1 Equipment ......................................................................................................................... 2-32

2.7.2 Shielding ............................................................................................................................ 2-32

2.7.3 MRI Room / Suite Design Considerations ......................................................................... 2-37

2.7.4 PET/CT and PET/MRI Design Considerations .................................................................... 2-49

2.7.5 Hot Lab Design Considerations ......................................................................................... 2-51

2.7.6 Cyclotron Design Considerations ...................................................................................... 2-52

3.0 FUNCTIONAL DIAGRAMS .............................................................................................................. 3-1

3.1 General ................................................................................................................................ 3-1

3.2 Suites ................................................................................................................................... 3-3

3.2.1 General Radiology Suite ...................................................................................................... 3-3

3.2.2 Radiography / Fluoroscopy Suite ........................................................................................ 3-5

3.2.3 Breast Imaging Suite ........................................................................................................... 3-7

3.2.4 Ultrasound Suite.................................................................................................................. 3-9

3.2.5 CT Suite ............................................................................................................................. 3-12

3.2.6 MRI Suite ........................................................................................................................... 3-14

3.2.7 Nuclear Medicine Suite ..................................................................................................... 3-20

3.2.8 PET Suites .......................................................................................................................... 3-21

3.3 Functional Relationships ................................................................................................... 3-24

4.0 ROOM TEMPLATES ........................................................................................................................ 4-1

4.1 General ................................................................................................................................ 4-1

4.2 Room Templates ................................................................................................................. 4-1

4.2.1 Class 1 Radiology Imaging Room, Imgng Svcs (CI011) ........................................................ 4-3

4.2.2 Class 2 Radiology Imaging Room, Imgng Svcs (CI016) ...................................................... 4-18

4.2.3 Chest Imaging Room, Imgng Svcs (CI021) ......................................................................... 4-34

4.2.4 Class 1 R/F Imaging Room, Imgng Svcs (CI031) ................................................................. 4-49

4.2.5 Class 2 R/F Imaging Room, Imgng Svcs (CI036) ................................................................. 4-62

4.2.6 Class 2 Multipurpose R/F Imaging Room, Imgng Svcs (CI041) .......................................... 4-81

4.2.7 Class 2 Prone Breast Imaging Room, Imgng Svcs (CI053) ............................................... 4-100

4.2.8 Class 2 Standing Breast Imaging Room, Imgng Svcs (CI056) ........................................... 4-115

4.2.9 Class 1 Ultrasound Scanning Room, Imgng Svcs (CI063) ................................................. 4-130

4.2.10 Class 2 Ultrasound Scanning Room, Imgng Svcs (CI065) ................................................. 4-143

4.2.11 ABUS Scanning Room, Imgng Svcs (CI067) ...................................................................... 4-156

4.2.12 Bone Densitometry Scanning Room, Imgng Svcs (CI076) ............................................... 4-171

4.2.13 Class 1 CT Scanning Room, Imgng Svcs (CI081) ............................................................... 4-182

4.2.14 Class 2 CT Scanning Room, Imgng Svcs (CI086) ............................................................... 4-200

4.2.15 Class 1 MRI Scanning Room, Imgng Svcs (CI111) ............................................................ 4-220

4.2.16 Class 2 MRI Scanning Room, Imgng Svcs (CI121) ............................................................ 4-237

4.2.17 Class 1 NM Scanning Room, Imgng Svcs (CI211) ............................................................. 4-254

4.2.18 Class 1 SPECT/CT Scanning Room, Imgng Svcs (CI214) ................................................... 4-266

4.2.19 Class 2 SPECT/CT Scanning Room, Imgng Svcs (CI221) ................................................... 4-285

4.2.20 NM Radiopharmacy/Hot Lab, Imgng Svcs (CI227) .......................................................... 4-305

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4.2.21 Class 1 PET/CT Scanning Room, Imgng Svcs (CI242) ....................................................... 4-321

4.2.22 Class 2 PET/CT Scanning Room, Imgng Svcs (CI251) ....................................................... 4-340

4.2.23 Class 1 PET/MRI Scanning Room, Imgng Svcs (CI271) ..................................................... 4-360

4.2.24 Class 2 PET/MRI Scanning Room, Imgng Svcs (CI281) ..................................................... 4-377

4.2.25 Imaging Physician Reading Room, Imgng Svcs (CI401) ................................................... 4-394

4.2.26 Teaching Reading/Consultation Room, Imgng Svcs (CI411) ........................................... 4-406

4.2.27 [Modality] Patient Holding Bay, Clncl Sprt (SC291) ........................................................ 4-418

4.2.28 [Location] Uptake Room, Imgng Svcs (CI256, CI291) ...................................................... 4-431

4.2.29 [Location] IV Start Room, Imgng Svcs (CI074, CI104, CI204, CI236, CI265) .................... 4-446

4.2.30 [Modality] Medication Preparation Room, Clncl Sprt (SC083) ....................................... 4-461

5.0 SITE VISIT REPORT .......................................................................................... (Separate Document)

PG 18-12 – IMAGING SERVICES DESIGN GUIDE September 1, 2020

GENERAL 1-1

1.0 GENERAL

1.1 Foreword

VA Program Offices, project teams, designers and constructors, are obligated to our Nation's Veterans and taxpayers to make the most effective and efficient use of resources, by providing a continuum of safe, secure, high quality, high performance, and high value environments of care and service for Veterans. The VA Office of Construction & Facilities Management (CFM) supports the Department's mission through development and application of standards as a basis for disciplined planning, design, and construction of VA facilities.VA Standards are the culmination of a partnership among the Department of Veterans Affairs (VA), the Veterans Health Administration, Program Officials, Clinicians, Industry, Academic and Research Organizations, Consultants, and the Office of Construction and Facilities Management. Design Guides are developed through integration of VA-specific requirements, Federal law and regulation, benchmarking of industry best practice, evidence-based research and design, and value-based analysis of leading-edge innovation. The result is the establishment of best value standards for optimum functionality, safety, operability, performance, and quality throughout the VA environment of care and service.

Design Guides (PG-18-12) are a critical component of the VA Technical Information Library (TIL) (www.cfm.va.gov/TIL) which provides standards for all VA planning, design, and construction projects. Design Guides focus on selected healthcare departments and services and include an overview narrative of VA-specific planning and design principles and concepts, room templates, equipment lists, and basic technical/engineering requirements. They communicate the basis of design and are required to be utilized by project teams working on new construction and renovations of existing facilities. Design Guides will maximize the effectiveness and efficiency of the planning and design process and ensure a high level of design, while controlling construction, operating, and maintenance costs.

The material contained in Design Guides constitutes a Standard for VA Planning, Design and Construction. For all VA projects, it is required that project teams comply with the following in all phases of project development:

1) All applicable VA Standards published in the VA Technical Information Library (TIL) shall be applied as a basis, foundation, and framework in planning, design, and construction. Any substantial variance from Standards shall be considered only as required to accommodate specific site, functional, and operational conditions. Upon consideration of variance CFM shall be consulted, and each Administration will function as Authority Having Jurisdiction for decision. Each substantial variance shall have a basis rationale and be documented in the project record.

GENERAL 1-2

2) Clinicians, providers, primary users, and other stakeholders shall be involved in all phases of project development to best adapt Standards for specific functional, operational, and site conditions, and to provide optimum service environments for Veterans. This also includes installations and modifications of systems or technology involving safety, security, functionality, or environmental quality. Stakeholder involvement shall be documented in the project record.

Design Guides are not project-specific. It is impossible to foresee all rapidly evolving requirements of healthcare facilities and each site or project will have unique requirements or conditions. Site-specific issues must be addressed within the context of these standards and applied to each individual project. Use of this Guide does not preclude the need for, nor absolve planners, designers, and constructors of their responsibility to provide complete, functional, safe, and secure designs suited to the unique requirements of each project, within budget, and on schedule.

Materials, equipment and systems are shown in an illustrative, performance-based format and are not intended to depict, suggest, or otherwise constitute endorsement of any specific product or manufacturer. Manufacturers should be consulted for actual dimensions, configurations, and utility requirements.

All participants in the project development process must embrace VA Planning, Design and Construction Standards as fundamental in providing optimum environments for Veterans’ care and services, in fulfilling VA's mission.

Donald L. Myers, AIA, NCARB Director, Facilities Standards Service US Department of Veterans Affairs Office of Construction & Facilities Management

GENERAL 1-3

1.2 Acknowledgement

Credit is due to the following individuals whose leadership, knowledge, skills, and ability made this document possible:

Department of Veterans Affairs

National Radiology and Nuclear Medicine Program Office and Subject Matter Experts

Robert Sherrier, MD Chief Consultant, Diagnostic Services

William Arndt, MD Director, National Radiology Program

David Bushnell, MD Director, National Nuclear Medicine Program

Jeffrey Chenoweth, MD Associate Director, National Radiology Program

Lisa C. Wall, MBA, CNMT, R.T.(N)(ARRT) Assistant Director, National Radiology Program

Debra L. Blansett, MA, BSN Administrative Officer, National Nuclear Medicine Program

Stacy O'Neall, CNMT, R.T.(N), NMT Formerly, Mammography Program Director, National Radiology Program

Keith Thibault, R.T.(R)(CT)(ARRT) VISN 1, Radiology Program Manager

Derek S. Lee, B.S. CNMT Supervisory Nuclear Medicine Technologist

Office of Construction & Facilities Management (003C) Dr. Michael Brennan Executive Director, Office of Construction &

Facilities Management

John Bulick Acting Executive Director, Office of Facilities Planning

Donald L. Myers Director, Facilities Standards Service, Office of Construction & Facilities Management

Gary Fischer Senior Healthcare Architect, Office of Construction & Facilities Management

Mark Goeller Project Manager / COR, Office of Construction & Facilities Management

Orest Burdiak Principal Interior Designer, Office of Construction & Facilities Management

GENERAL 1-4

Dave Tashakkori Senior Mechanical Engineer, Office of Construction & Facilities Management

Lam Vu Senior Electrical Engineer, Office of Construction & Facilities Management

Linda Chan Healthcare Planner / Architect, Facilities Planning Development Service

Jacob Brown Senior Medical Equipment Specialist, Office of Construction & Facilities Management

Consultants RADIOLOGY-Planning (RAD-Planning) Robert Junk, AIA Principal Tobias Gilk, M.Arch, MRSO, MRSE Senior Project Manager Amelia DeVolder Project Designer

Sub-Consultants (Space Planning / Equipment Planning) The Innova Group Chris Phillips Principal / Project Manager Lee Pettit, AIA Senior Healthcare Planner Bill Ahern, PMP Senior Medical Equipment Planner

Henderson Engineers Carson Moser, PE, LEED AP Principal / Project Manager

VA Space Criteria Integration / SEPS Consultant

HDR

Ronald Villasante, M.Arch, RA, CAP, MRCP Director of Federal Healthcare Planning

GENERAL 1-5

1.3 Introduction

This document merges three prior documents, Radiology Design Guide, Nuclear Medicine Design Guide, and Magnetic Resonance Imaging (MRI) Design Guide, under a common Imaging Services Design Guide to better reflect contemporary realities of the technologies, clinical applications, and enterprise-wide usage of Imaging Services.

The Imaging Services Design Guide is a tool to assist Contracting Officers, Medical Center Staff, and Architects and Planners with the design and construction of Imaging facilities. This publication is intended to provide an overview with respect to the design and construction of medical imaging facilities. Guidance herein may be applied to the siting of individual pieces of imaging equipment, or to departmental level planning and design.

Imaging Services is an area within healthcare that is experiencing extraordinarily rapid technological advancement. While the needs of a specific project are typically defined by contemporary and historical usage data, it is very strongly encouraged that the users of this document and planners of any VA facilities anticipate future equipment upgrades / replacements, expansions of clinical usage beyond the immediate conditions, and continued acceleration of examination times and the throughput implications that result. Planning and design decisions made exclusively based on historical data, without consideration of these continuous changes to the practice environment, may create long-term cost, staffing, and operational burdens for the VA facilities.

Room templates for various imaging rooms and associated spaces are included in this chapter to illustrate typical VA furniture, equipment, and personnel space needs. They are not project specific as it is not possible to foresee future requirements. The project specific space program is the basis of design for an individual project. It is important to note that the room templates are intended as a generic graphic representation only.

In addition to the general guidance included herein, equipment manufacturers should be consulted for specific minimum dimensions, utilities, shielding, power, structural requirements, and other requirements as they relate to specified equipment. Use of this design guide does not supersede the project architects’ and engineers’ responsibilities to develop a complete and accurate design that meets the user’s needs, appropriately integrates complex medical equipment, and complies with appropriate code requirements and governing accreditation standards.

GENERAL 1-6

1.4 Codes and Standards

Refer to the current versions of national, regional, and local codes and standards in addition to the VA specific standards and directives when designing facilities for Imaging Services.

Additional codes and standards, not listed below, may also apply.

1.4.1 VA Technical Information Library

1. Master Construction Specifications PG 18-1

2. Design and Construction Procedures PG 18-3 (refer to Topic 1 for the list of Codes, Standards, and Executive Orders)

3. Standard Details PG 18-4

4. Equipment Guide List PG 18-5

5. Seismic Design Handbook H 18-8

7. Various Design Manuals PG 18-10 and technical criteria pertaining to

Architectural, Heating, Ventilation, and Air Conditioning (HVAC), Plumbing, and Electrical

8. Barrier-Free Design Standard PG 18-13

9. Room Finishes, Door, and Hardware Schedule PG 18-14

1.4.2 VHA Directives, Handbooks and Manuals

1. VA Directive 7512, Seismic Safety of VA Buildings

2. VA Directive 7531, Acquisition of Artwork, Decorative Furnishings, and

Decorative Items

3. VA Directive 0055, VA Energy and Water Management Program

4. VHA Directive 1611, Safe Patient Handling and Mobility Program

5. VHA Directive 1105.03, Mammography Programs and Procedures

7. VHA Directive 1105.04, Fluoroscopy Safety

6. VHA Directive 1105.05, Magnetic Resonance (MR) Safety

1.4.3 National Industry Codes/ Standards

1. National Council on Radiation Protection & Measurement (NCRP) Report No. 147

2. American Association of Physicists in Medicine (AAPM) Task Group 108 Report

3. American College of Radiology (ACR) Manual on MR Safety

4. Facility Guidelines Institute (FGI) Guidelines for Design and Construction of

Hospital Facilities

GENERAL 1-7

1.5 Definitions

4-Zone: A safety and screening paradigm promoted by the American College of Radiology (ACR) for MRI suite layout and operation.

Active Shielding: An electromagnetic system, integrated in MRI scanners, by which the magnetic field is condensed into a smaller volume.

Automated Breast Ultrasound (ABUS): Specialized imaging system utilizing three-dimensional ultrasound technology to supplement screening mammography.

Automated Supply Dispensing Unit (ASDU): Automated material or medication dispensing and inventory control systems.

Bone Densitometry: Imaging technique utilizing low-dose ionizing radiation to measure bone loss, commonly used to diagnose osteoporosis. Also known as dual-energy x-ray absorptiometry (DEXA).

Bore: Open cylindrical center portion of ‘doughnut’ shaped MRI magnets.

Bore Format MRI: A type of MRI system most commonly used in current MRI procedures. The patient is fully surrounded by the bore during the scanning process.

Class: Designation of an imaging room based on the level of intervention / acuity it is intended to support, with Class 1 being low-acuity diagnostic, Class 2 being higher-acuity diagnostic or interventional, and Class 3 being intraoperative.

Computed Tomography (CT): A CT scan, or computed tomography scan is a medical imaging procedure that uses computer-processed combinations of many X-ray measurements taken from different angles to produce cross-sectional (tomographic) images (virtual "slices") of specific areas of a scanned object, allowing the user to see inside the object.

Cryogen: Ultra-low temperature liquid refrigerant with a boiling point of -238 Degrees Fahrenheit (-150 Degrees Celsius) or lower. For imaging, cryogens are typically required for MRI scanners, and the cryogenic liquid most often required is liquid helium.

Cryogen Quench Vent Pipe: A pipe which provides a pathway for gaseous cryogen escape from a superconducting MRI to an exterior discharge point.

Departmental Net-to-Gross (DNTG) Factor: A parameter, determined by the VA for each space planning criteria chapter, used to convert the programmed Net Square Foot (NSF) area to the Department Gross Square Foot (DGSF) area.

Digital Radiography: A form of radiography that uses x-ray–sensitive plates to directly capture data during the patient examination, immediately transferring it to a computer system without the use of an intermediate cassette.

Exclusion Zone: An area or volume to which access should be restricted and in which there are specific hazards.

Ferromagnetic: The property of a material or device which is attracted to magnetic fields.

Ferromagnetic Detection Systems (FMD / FMDS): Devices which detect ferromagnetic materials but do not alarm on non-ferromagnetic metals.

Fluoroscopy: The technique using X-rays to produce realtime images. Imaging procedures utilizing this modality include upper and lower gastrointestinal series, cystography, myelography, angiography, and esophageal mobility studies.

GENERAL 1-8

Fringe Field: Magnetic field that extends from an MRI scanner and may penetrate walls, floors, and ceilings, into adjacent spaces. Typical expressions of Fringe Field are in units of Tesla (T), milliTesla (mT), or Gauss (G).

Full-Time Equivalent (FTE): A staffing parameter equal to the amount of time assigned to one full time employee. It may be composed of several part-time employees whose combined time commitment equals that of one full-time employee (i.e., 40 hours per week).

Functional Area (FA): The grouping of rooms and spaces based on their function within a clinical service or department.

Gamma Imaging: Nuclear medicine imaging technologies, such as SPECT, that use gamma radiation.

Gauss: Measure of magnetic field strength. Equal to .0001 Tesla. Also see Tesla.

Gauss Line (Isogauss Line): Lines depicted on plans and sections which indicate the boundaries of the magnetic field at a given field strength.

General Purpose Radiology Room: A room in which general radiography is performed.

General Radiology: Medical imaging which uses X-rays to produce a planar image of the inside of the body.

High-Field: A description typically used to describe MRI equipment equal to or greater than 1

Tesla in magnetic field strength.

“Hot”: A colloquial term used to describe the presence of measurable radioactivity.

“Hot Lab” / Radiopharmacy: Area for storage, preparation and dispensing of radiopharmaceuticals. Hot labs must be secured and provided with adequate shielding.

Imaging / Radiology: The medical specialty that utilizes imaging examinations with or without ionizing radiation to affect diagnosis or guide treatment. Techniques include radiography, fluoroscopy, ultrasonography, mammography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine or molecular imaging.

Imaging Room: Designated room containing diagnostic equipment performing patient procedures such as radiography, radiography / fluoroscopy (R/F), breast imaging, ultrasound, interventional radiology (IR), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine or molecular imaging.

Input Data Statements: A set of questions designed to elicit information about the healthcare project in order to create a Program for Design (PFD) based on the parameters set forth in this set of documents. This information is processed through mathematical and logical operations in the VA Space and Equipment Planning system (SEPS).

Interventional Radiology (IR): Interventional radiology is a medical subspecialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices.

Ionizing Radiation: A type of energy exemplified by X-rays and inherent to radiopharmaceutical agents, that may lead to the development of chromosomal damage at sufficient levels of exposure.

Isocenter: The center of the imaging volume within a device. In MRI this is typically the location of system’s rated field strength.

GENERAL 1-9

Low-Field: A description typically used to describe MRI equipment less than 1 Tesla in magnetic field strength.

Magnetic Spatial Gradient: The rate at which magnetic field strength changes by distance.

Typical expressions of Spatial Gradient are in units of Tesla per meter (T/m) or Gauss per centimeter (G/cm)

Mammography: Mammography is the process of using low-energy X-rays to examine the breast for diagnosis and screening.

MR / MRI: Imaging technique utilizing magnetic and radio frequency fields to produce computer calculated images of human anatomy and monitor body chemistry. Other terms include magnetic resonance, magnetic resonance imaging and nuclear magnetic resonance.

All refer to the same process or modality.

MR Conditional: An ASTM International / FDA designation which indicates that an object is safe under specifically defined MR environmental conditions.

MR Safe: An ASTM International / FDA designation which indicates that an object is safe under all MR environmental conditions.

MR Unsafe: An ASTM International / FDA designation which indicates that an object is unsafe under all MR environmental conditions.

Net Square Feet / Net Square Meters (NSF/NSM): The area of a room or space derived from that within the interior surface of the bounding walls or boundaries.

Non-Ferromagnetic: The property of a material or device which is not attracted to magnetic fields.

Non-Ionizing Radiation: A type of energy exemplified by radiofrequency (RF) transmissions, ultrasound, and magnetism, that is not believed to contribute to the development of chromosomal damage at any current clinical levels of exposure.

Nuclear Medicine / Molecular Imaging: Method of producing images using devices that detect radiation from different parts of a patient’s body after administration of a radioactive tracer material. Modalities include Single Photon Emission Computed Tomography (SPECT) imaging, and Positron Emission Tomography (PET).

Passive Magnetic Shielding: Plates of magnetic material that may be provided to constrain the volume of the magnetic field from an MRI scanner.

Penetration Panel: An access point through the RF shield between the MRI Scanner Room and the MRI System Component Room, provided by the MRI equipment vendor.

Permanent Magnet: A material that retains magnetic properties indefinitely.

PET/CT: An imaging modality that combines the functions of both positron emission tomography (PET) and computed tomography (CT).

PET/MRI: An imaging modality that combines the functions of both positron emission tomography (PET) and magnetic resonance imaging (MRI).

Picture Archiving and Communication System (PACS): A system designed for the digital capture, transfer, storage and evaluation of medical images.

Positron Emission Tomography (PET): An imaging modality that generates the signal used for constructing the physiologic image from the energy emissions of a radioisotope that has been injected, ingested, or inhaled, which either binds to or absorbed by targeted cells within the body. Typically provided in hybrid form with another modality (i.e. PET/CT).

GENERAL 1-10

Program for Design (PFD): A project specific itemized listing of the spaces, rooms, and areas required for the proper operation of a specific service / department, and the corresponding area for each.

Quench: An event in which the liquid cryogen within an MRI system rapidly boils, escaping to atmosphere. This may be deliberately or spontaneously triggered.

Radiofrequency (RF) Shield: A special enclosure required around all clinical MRI scanner equipment, typically integrated in room construction, which keeps incidental RF energies from interfering with MRI scans.

Radiography: A still image of the density of tissues created through the use of ionizing X-ray radiation.

Radiographic / Fluoroscopic Room: A room containing a radiographic / fluoroscopic system that produces either still photographic records or real-time cinematic images of internal body structures.

Radiology Room - Chest: A specific or specialized radiographic room used for routine chest X-rays and those radiographic procedures which can or should be performed in an upright position.

Rotational / Torque Effect: The force exerted on ferromagnetic objects that attempts to align those objects with the polar orientation of magnetic fields.

SEPS: Acronym for Space and Equipment Planning System which produces equipment lists and Program For Design for a healthcare project based on specific information entered in response to Input Data Questions.

Shim Tolerance: The limits for an MRI scanner of the mass of ferromagnetic material that can be placed in proximity to the scanner.

Single Photon Emission Computed Tomography (SPECT): An imaging technique using signal from photons generated by the decay of a radioisotope injected or ingested by a patient.

May be stand-alone or provided in hybrid form with another modality (i.e. SPECT/CT).

Stereotactic Mammography: Specialized technique for performing image guided breast biopsies utilizing low-dose x-ray images taken in two planes, allowing the radiologist to precisely locate the tissue to be examined or biopsied.

Superconducting: A property of some electrical conductors where no current is lost to resistance during transmission. The majority of contemporary MRI scanners utilize low-temperature superconducting materials, which must be bathed in cryogenic liquids, to facilitate the generation of high-strength electromagnetic fields.

Tesla: Measure of magnetic field strength. One Tesla (T) is equal to 10,000 Gauss (G).

Ultrasound: Diagnostic ultrasound, also called sonography or diagnostic medical sonography, is an imaging method that uses high-frequency sound waves to produce images of structures within your body.

Wave Guide: A component of an RF shield for MRI and PET/MRI rooms which is used to create an opening in the shielded enclosure that still prevents RF energies from entering the MRI Scanner Room. Needed for all penetrations into the room, including ductwork, piping or openings for medical equipment.

GENERAL 1-11

1.6 Abbreviations

SYM DESCRIPTION

A Amperes

ABA Architectural Barriers Act

ADA Americans with Disabilities Act

AFF Above Finished Floor

AR As Required

ASTMI ASTM International

AT Acoustical Ceiling Tile

AT (SP) Acoustical Ceiling Tile (with Sprayed Plastic Finish)

BC Base Cabinet

C Degree Celsius

CB Circuit Breaker

CBOC Community Based Outpatient Clinic

CC Contractor Furnished, Contractor Installed

CFM Cubic Feet per Minute

CLG Ceiling

CP Carpet (without cushion broadloom)

CPT Carpet Tile

CRS Corrosion Resisting Steel (SS)

CT Ceramic Tile

DG Design Guide

DS Door Switch

ESS Essential Electrical System

F Degrees Fahrenheit

FC Foot-candle

FD Floor Drain

FDA US Food & Drug Administration

FIXT Fixture

SYM DESCRIPTION

FLUOR Fluorescent

FMS Facilities Management Service

GFI Ground Fault Circuit Interrupter

GWB Gypsum Wallboard

HAC Housekeeping Aides Closet

HVAC Heating, Ventilating and Air Conditioning

HP Horsepower

HR Hour kW Kilowatt

LB Pound/Pounds

LLTS Lockers, Lounges, Toilets & Showers

MA Medical Air

MATV Master Antenna Television

MCS Master Construction Specifications

MID Motion Intrusion Detection

MTD Mounted

MV Medical Vacuum

NFPA National Fire Protection Association

NSF Net Square Feet

NSM Net Square Meters

OCFM Office of Construction & Facilities Management

OIT Office of Information & Technology

OPC Outpatient Clinic

PACS Picture Archiving and Communication System

PH Phase

GENERAL 1-12

SYM DESCRIPTION

PL Plaster

PFD Program for Design

RB Resilient Base

RPS Radio Paging System

RSF Resilient Sheet Flooring

SD Standard Detail

SF Square Feet, Square Foot

SSTV Security Surveillance Television

STC Sound Transmission Class

TBB Telecommunications Bonding Backbone

TGB Telecommunications Ground Bar

UPS Uninterruptible Power Supply

SYM DESCRIPTION

V Volts

VA Department of Veterans Affairs

VACO Veterans Affairs Central Office

VAMC Veterans Affairs Medical Center

VC VA Furnished, Contractor Installed

VCT Vinyl Composition Tile

VHA Veterans Health Administration

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2.0 NARRATIVE

About This Design Guide.

This Design Guide provides both general planning guidance for imaging departments, and guidance to the level of individual imaging resources / modalities. The design criteria in this document have been developed with the intention of balancing the minimum effective standards and industry best practices. Comparing the standards and guidance herein with prior VA Design Guides, the reader will find some rooms very similar to prior releases, and some rooms substantially different. Every implemented change is a direct result of carefully considered changes in technology, patient mix, operational models, and the level of intervention / acuity that each modality supports (and is expected to support over the useful life of this document).

2.1 General

2.1.1 About Imaging Services

Imaging Services have traditionally been those used for diagnostic purposes. Increasingly, these services are being used for anatomical guidance for different forms of intervention or therapy. Modalities within Imaging Services include X-ray emitting devices, such as radiography (conventional X-ray), fluoroscopy, and CT, and non-ionizing devices, such as ultrasound and MRI, and devices frequently identified as belonging to nuclear medicine / molecular medicine.

2.1.2 Conjoining Separate Design Guides.

In earlier versions of the VA Design Guides, separate Imaging Services (Magnetic Resonance Imaging (MRI), Nuclear Medicine, Radiology Services) were described in different guides.

The separations were due, at the time, to distinct uses and planning criteria between and among the different groupings, including patient flows.

Technological innovations have changed both diagnostic / therapeutic capabilities and the very nature of imaging modalities, themselves. Imaging Services are now integral elements threaded throughout the healthcare enterprise, and not simply pieces of hardware collected in a centralized department.

This document unifies previously separate design guidance, though it is not the intent that this unification is to be seen as prescriptive instruction that all of the imaging resources described herein should be gathered in a single contiguous department.

This unification also follows other industry standards which seek to treat previously disparately-managed Imaging Services under a unified structure.

2.1.3 Radiology, MRI, and Nuclear Medicine within Imaging

MRI and Nuclear Medicine, which had been previously been described in separate Design Guides, are shown integrated within this document. Sites may choose to integrate or, if

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facility needs dictate, may pull these sub-departments out to be developed independent of the bulk of Imaging Services.

2.1.4 Intraoperative / Interventional Imaging Guidance

This document speaks to planning and design criteria for diagnostic clinical applications, and some interventional clinical applications for Imaging Services. This document covers the usage of conventional diagnostic imaging platforms, such as CT or MRI, as platforms for interventional procedures. For planning and design criteria for interventional clinical applications which use fixed installations of C-arm fluoroscopic devices (single-plane or bi-plane where the C-arm system is either mounted to an articulated arm on the floor, or suspended from a ceiling track), such as for cardiac catheterization, and for planning and design criteria for surgical uses of imaging systems (i.e. Hybrid OR), please refer to the Surgical and Endovascular Services Design Guide.

2.2 Imaging Services Operations

The planning of Imaging Services requires more than placing pieces of equipment into a floor plan. Issues related to the strategic approaches to the delivery of Imaging Services, and the clinical care that Imaging Services will support, create the expectation that the facility planner will develop the facility layout in collaboration with clinical and operational input from the site.

2.2.1 Public vs. Staff Core Organization

The Imaging Services documents have been developed based on the operational model of a ‘front of house’ patient accessible portion of the department, and a ‘back of house’ staff-only work core. Many of the individual imaging rooms illustrated herein are based on the concept of direct patient access to the imaging room from a patient corridor, and direct staff access to the control room / alcove from the staff work core. This concept is expanded upon in Section 3.0, FUNCTIONAL DIAGRAMS.

2.2.2 Merged / Separated Areas

Individual imaging rooms were designed with minimum required dimensions and areas to serve the particular technical, operational, and clinical needs represented by the equipment and the clinical service. These rooms should not be casually modified from the provided room templates.

Support areas, on the other hand, may be understood to have a greater degree of flexibility in how their spaces are assigned, allocated, and configured. As an example, if several Radiology and Radiography & Fluoroscopy rooms were all accessed from a shared staff core, then the support spaces allocated for each room (e.g., Automated Supply Dispensing Unit (ASDU) alcoves) could be conjoined into a larger combined / shared area and would not need to be multiple independent spaces.

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2.2.3 Central vs. Distributed Imaging Services

Imaging Services may be organized as one central department serving emergency, outpatients, and inpatients, or as separate facilities distributed throughout the enterprise as needed to serve specific patient populations.

These distributed services may be positioned to serve patient origins (e.g., inpatient vs.

outpatient), different acuity levels (e.g., imaging surgical patients), separate clinical care pathways (e.g., cardiology vs. oncology), or even to gather services around a patient sub-group with shared needs (e.g., women’s health). This distribution may also include imaging resources placed with the intention that they serve uses wholly separate from the general diagnostic role of a traditional radiology department, including interventional imaging, intraoperative imaging, or specialty-dedicated Imaging Services. For example, it is expected that all VA healthcare facilities with an emergency department would have a CT provided.

2.2.4 Diagnostic Imaging Processes

One of the principal changes from previous editions of the VA’s guidance for these clinical areas is the distinction between diagnostic and interventional procedures. This change is in keeping with the changes in clinical practice and other design standards.

Diagnostic processes are those performed for all patient types, inpatient and outpatient, on a scheduled, as available, or STAT basis, depending on the facility and patient needs. These studies are performed to identify injury or disease process / progression for the purpose of informing subsequent decisions about the individual patient’s care.

Diagnostic examinations may also have greater needs for patient care and support depending on the acuity of the patient. For example, if an ambulatory outpatient and a critical ICU patient each need a CT scan of the head, patient care needs above and beyond the specific siting requirements of the CT device should be a major consideration during planning.

2.2.5 Interventional Imaging Processes

Imaging modalities that previously only served diagnostic roles are becoming platforms to inform interventional examinations or procedures. Where diagnostic imaging processes gather information for later decision-making, interventional imaging processes gather information for concurrent decision-making related to an intervention. Fluoroscopic, ultrasound, and CT-guided procedures and MRI-guided biopsies are examples of interventional procedures that are becoming increasingly common in VA medical centers.

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Similar to the considerations about patient acuity levels that may present themselves for diagnostic imaging processes, the degree of intervention and the concerns that interventions may bring (e.g. working space for clinicians and equipment, infection control, medical gases and emergency power) should also inform the planning and design of imaging facilities. (See Section 2.3.1, Use of Acuity / Intervention Classes, for further information on patient acuity classifications and the division of authority for design standards between this document and standards for Surgery and Endovascular Services.)

Imaging facilities shall be planned based on their highest anticipated level of regular patient usage (acuity and intervention); facilities planned for higher levels of acuity and intervention may support lower level patient care. The reverse is not true: facilities shall be planned for higher acuity level if it is reasonably anticipated that the patient care needs will require care of higher acuity level patients.

Figure 2.2.5: Example of Class 2 Radiographic / Fluoroscopic (RF) Multipurpose Room that may support higher acuity and/or patient intervention.

Photo: New Orleans VA Medical Center.

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2.2.6 Imaging Patient Care Support

Providing convenient access to healthcare in a warm and inviting environment is an objective of Imaging Services. Patient education and family consultation can further reduce the stress sometimes associated with imaging exams or procedures for patients who are not familiar with the process and imaging equipment. (See 2.6.7.1, Interior Finishes)

Figure 2.2.6: Example of finishes and artwork used to make more inviting environments within Imaging Services (Image used with permission from RAD-Planning)

It is anticipated that, as imaging utilization continues to increase, patient support spaces such as Dressing Room, Patient Waiting, and the IV Start Room, will be increasingly important in the future if maximum operational efficiency is to be maintained. Projects being planned today should ask ‘what if’ questions related to significant increases in patient volume capacity per scanner of 10% - 20% over the life of the piece of imaging equipment, or potentially as much as 50% greater throughput with the next replacement.

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2.3 Imaging and Patient Acuities & Interventions

Just as design criteria in other areas of hospital standards vary between examination rooms, procedure rooms, and surgical rooms in response to the level of patient care, Imaging Services have evolved from only being examination / diagnostic resources, and now serve as platforms for intervention and image-guided surgery.