Why the push to plan ahead? Because subsequent replacements or expansions may be vastly simplified, projects may be accelerated by months, and hundreds of thousands of dollars may be shaved from project budgets, if you follow these recommendations.
Take, as an example, a facility that has just installed a new MRI system. Replacing that new $1.5 million device should be the furthest thing from its mind, right? Wrong. However unpleasant to contemplate, new magnets can be irrevocably damaged as a result of quenches, requiring replacement. We all count on a magnet lasting five years or more, but there is the chance that circumstances may conspire to force you to act sooner than that. In that difficult situation, wouldn't you want to have the capacity to replace the system as quickly as possible?
And what if the magnet does last as long as 10 years? We recently visited a facility that was decommissioning its MRI system with a cutting torch, manually slicing it into sections because the building had been so modified around the MRI suite that removing the magnet whole without disrupting other critical functions was impossible. This hospital decided it was better to carve the magnet into bits, which took weeks to complete, and suffer a major disruption only once during the load-in of the new MRI system.
For facilities without redundant capacity, this sort of decision can result in weeks, if not months, of impaired patient services. This may mean extended waiting times for patients, or losing patients and physicians to competing providers. To combat this, facilities will often lease interim MRI service from a magnet in a custom semitrailer. These services begin at around $50,000 per month.
If a magnet room must be partially or completely disassembled to enable a replacement project, it may be out of commission for 90 days or more, depending on the scope of work. This can add at least $150,000 in interim trailer lease costs to the price of replacing a magnet. It doesn't take long before the cost of an interim trailer lease begins to rival the total construction budget for a new suite. At this point, it is wise to consider an alternate location.
Major considerations for new MRI suite locations are staffing and patient flow. Often MRI suites are sited in a radiology department where staffing can be shared among the different modalities. MRI patients, however, may be almost exclusively outpatients, navigating their way through half the hospital to reach the bowels of the radiology department. Work flow would indicate that it might be better to put the MRI in a more accessible and public location.
Another argument against siting the new MRI magnet in the old radiology department is that other imaging and nuclear medicine modalities can be extremely sensitive to magnetic disturbances. Just a few of the devices that are contraindicated for MRI are CT, PET, rotational angiography, and gamma cameras. While today's magnet may not present problems, upgrading to a 3.0-tesla or a high-field open system in the same space may cause tremendous complications for the neighboring modalities.
Irrespective of whether your preference is to put the MRI system in the radiology department or a location with greater autonomy, locations should be carefully considered for potential vibration. Any location within a quarter mile of a rail line or subway, or adjacent to areas with pumps, motors, fans, or chillers, should be carefully scrutinized for vibration. Many vibrational issues can be overcome, but alternate locations may not present the same technical and financial hurdles.
Because of the concerns about magnet disruption and the cost of interim MRI leasing, many facilities wisely build unoccupied shell space, warehousing it until it is needed for additional MRI equipment. Prebuilding this space also minimizes the risks of construction machinery and activity disrupting in-place MRI scans.
Your next MRI project may seem to be well over the horizon, many years distant, but that doesn't mean that the planning for it should be, too. It is wise to evaluate existing MRI facilities for future upgrades or replacement, and preserve the design and construction options that have the smallest negative impact on patient care and operations. This planning may only take a few hours, but may reward you with hundreds of thousands of dollars in future project savings. With an understanding of healthcare construction and the technical nature of MRI equipment, it pays to have a master plan.
By Tobias Gilk
AuntMinnie.com contributing writer
July 12, 2006
Reprinted from www.mri-planning.com by permission of the authors. If you would like more information on any aspect of MR facility design or safety, please contact Robert Junk or Tobias Gilk at Jünk Architects.
Radiology is dead -- long live imaging! June 23, 2006
Keeping Zone III secure: Access controls for MRI suites, June 7, 2006
Magnet room doors and quench entrapment, May 22, 2006
When MRI throughput means more than revenue, April 11, 2006
ECRI's report on MRI safety, March 28, 2006
Copyright © 2006 Jünk Architects, PC