Engineering Considerations in the Design of Imaging Suites

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Dan Koenigshofer, PE MS Public Health and

Ted Bartelt, PEAugust 13, 2008

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Purpose

Discuss the design of mechanical, electrical, plumbing and structural systems for new and replacement

imaging systems

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The 10 Great Lies1. It is just an equipment replacement2. The manufacturers will do the design3. DHSR won’t care4. The contractor will design it for free5. The check is in the mail6. NC Regulations are just like any other state7. We will use the manufacturer’s BTUH8. The number of procedures does not matter9. I’ll remember that I told you to cut corners10. Cost is more important than performance11. They will never do that in this room

Steps in the Design

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1. Understand the modality2. Know codes and guidelines3. Obtain general information4. Fieldwork5. Specific Information6. Design7. Construction and Commissioning

Section 1 – Understand the Modality

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Department NamesOB GYN – UltrasoundED – X-Ray, CTVascular - Fluoroscopy, UltrasoundSurgery – Fluoroscopy, MRIOncology – Linear Accelerator, Cyber Knife, PETRadiology – Fluoroscopy, MRI, CT, Ultrasound, R&F, X-RayNuclear Med – Nuclear Camera, PETCardiology – Fluoroscopy, UltrasoundUrology – Fluoroscopy, Ultrasound

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• Cardiac Catheterization Lab• Angiography, Specials• Vascular and Interventional• CT (Computed Tomography)• MRI (Magnetic Resonance Imaging)• PET Scan (Positron Emission Tomography)• Lin Acc (Linear Accelerator)• X-ray• R & F (Radiography and Fluoroscopy)• Endo (Endoscopy)• Cysto (Cystography)

Room Names

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Fluoroscopic Unit Diagram

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X-Ray Generator

X-Ray

ED, MOB – DiagnosticSingle snapshotOften small, mobile unitsSelf-contained – all load in roomNot procedure room6 ACH or meet load

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P h i l i p s X -Ray System

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FluoroscopyTreatment - Vascular, Angio, Cardiac Cath, EP, Ortho, EndoscopyContinuous X-ray – diagnostic and procedure with injection, live imageMultiple componentsMay have separate equipment roomLead shielding May have remote air cooled chiller (EWC)May require 6 or 15 ACH

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Catherization, EP Lab, AngiographySimilar room, clinical use variesEquipment in various sub-rooms (scan, equipment, control)Separate thermostatic zones for scan, control rooms, equipmentRugged support structure for equipment in ceilingComputer room type A/C unit for equipment room/spaceConsider occupant count in control room

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Angiography

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Angio/Vascular

Siemens Fluoroscopy (Angiography)

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Philips Fluoroscopy (Cath Lab)

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Radiographic & Fluoroscopic (R & F)

Treatment - Ortho, Endo, NeuroCombination of X-ray “snapshot” and continuous with injection and real time monitoringMultiple componentsMay have separate equipment roomMay be procedure room6 or 15 ACH

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CTDiagnostic – Cardiology, Ortho, Internal, Spleen, Brain/NeuroMay have remote cooling w/ CHWMay be self-contained or have an equip roomInjection assembly mounted on ceilingMulti-slice, 360º X-ray (photons)6 ACH or meet load

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Interventional MRI

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OR with CT

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Philips 64-Slice CT

MRIDiagnostic – Ortho, neuro, internal, cardio , breastRemote water cooling, exteriorNon-magnetic room materialsLarge equipmentContinuous cooling loadLiquid helium-cooled superconductor – Quench Vent w/ dielectric isolatorWave guides in ductworkFM-200Gauss lines affect area layout6 ACH or meet loadLong procedureHVAC ZoningEmergency Power

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MRI

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MRI

Gamma Knife(Radiation Therapy / Oncology)

Targeted radiation treatmentShielded space (typically lead) Equipment in the various sub-rooms (procedure, equipment, control)Separate thermostatic zones for scan, equipment, control rooms

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Radiation Therapy –Gamma Knife

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Gamma Knife

PET Scan

Diagnostic – Oncology, Neurology, CardioRadioactive injection – position emission/annihilationGamma ray detectionReal-time studies, early diagnosis6 ACH or meet loadHot lab adjacent

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PET Scan

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PET Scan

Linear AcceleratorOncology, Radiation TherapyEmits radioactive particlesMaze floor planLow load in roomLarge equipmentAdjacent simulator room with CT6 ACH or meet loadHeavily shielded space (lead or thick concrete) limits duct, piping routings within treatment spaceEquipment in the various sub-rooms (procedure, equipment, control)Separate thermostatic zones for scan, equipment, control rooms Cooling of equipment via chiller or chilled water system – continuous and reliable

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Linear Accelerator

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Linear Accelerator

Siemens Linear Accelerator

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Section 2 – Know codes and guidelines

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• ASHRAE HVAC Design Manual for Hospitals• NFPA 101 Life Safety• NFPA 110 Emergency Power Systems• NFPA 99 Healthcare• ASHRAE Applications Chapter 7• ASHRAE 170P Proposed Ventilation Guidelines, Draft 3/08• NEC• IBC Mechanical Volume• IBC Volume 1 General• AIA Guide for Design of Healthcare 2006• CDC Guides for Infection Control• The Joint Commission 2007 Accreditation Manual• This Class

List of References

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Classification of SurgeriesClass A: Minor procedures under topical, local or regional anesthesia w/o preoperative sedation. Excluding intravenous, spinal & epidural procedures.

Class B: Minor or major procedures with oral, parenteral or intravenous sedation or analgesic or disassociative drugs.

Class C: Major procedures with general or regional block anesthesia & support of vital bodily functions.

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Section 3 – Obtain General information

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Getting Started

Preliminary Floor PlanManufacturer’s generic drawingsSite Information (if existing)Names of rooms

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Anesthesia

Not required; sometimes desiredIn Cath, Angio, EPIf Anesthesia, then WAGDTriggers many additional NFPA requirements

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Film Based Dark RoomScope CleaningHot LabSimulator

Auxiliary Rooms/Areas

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Section 4 - Fieldwork

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Existing BuildingsAir Change Rates (ACH)Verify HVAC Controls, ZoningDoes room meet current MEP codes???FiltrationPower available, V, A, locationVoltage, A required, normal/emergencyLighting (if to remain)Med Gas availabilityNeighbors

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Section 5 - Specific Information

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Meet with Owner, Users and Manufacturers

Exact procedures to be done - Minor/MajorInvasive, diagnosticDiscuss details with manufacture representativePossible changes of useRoom name

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Administrative Information

Any owner purchased equipment?Clarify the role of imaging system installer points of demarcationCON Budgetary Issues - $2 million maximumBid Package: CM, CMGC, Bidding MEP Subs?Total BudgetBuilding Ownership and Maintenance

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Is This Really An OR?

Use of AnesthesiaT&H desired by Doctor

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Typical Manufacturer’s Layout

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Imaging Suite Details• All equipment in the procedure room?• Separate equipment room?• Water-cooled equipment – inside air cooled, House

CHW?• Dedicated chiller – air cooled outside, e.g., MRI?• Med gas, data, light, power in ceiling boom?• Hard ceiling?• Lead lining, wave guides• Shielded control room?• Quench vent (MRI only)• Structure conflicts• Emergency power• Gauss Lines

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Careful Review of Engineering Systems Desired

Med GasAnesthesiaEmergency PowerIsolated PowerLighting and ControlsBoomsTemperature and HumidityHand Wash

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Section 6 – DesignMechanical StructuralElectrical Plumbing

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Mechanical Considerations

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• Interface to FA• Smoke purge• Process cooling (inside/outside)• MRI requirements• Ceiling conflicts• Load in each room• Occupant load and preferences

Requirements for Class A Procedure Rooms• 15 ACH SA• 3 ACH OA• Positive pressure• High supplies• Low returns on opposite sides of the room• Reg is 70-75º dB, 30-60% RH • Most doctors want 62-70º dB, 30-60% RH• Cath Lab (Class B and C OR is 20/4 ACH)• MERV 14

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Function Pressure OA ACH

SA ACH

FF RH% Temp E.

Class B & C OR + 4 20 14/17 30-60 68-75

Class A Procedure + 3 15 14 30-60 70-75X-Ray Diagnostic & Treatment

N/R 2 6 14 Max 60 72-78

X-Ray (Surg, Critical Care, Cath)

+ 3 15 14 Max 60 70-75

Endo + 2 15 14 30-60 68-73Surg Cysto + 4 20 14 30-60 68-75

ASHRAE S-170 Ventilation Requirements

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Typical Imaging Suite

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Equipment Layout

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Equipment Heat Load

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System ManufacturerMax. 60

min. TWA (BTUH)

Calc. Baseline (BTUH)

Design Value (BTUH)

MRI Vision Siemens 83,331 75,873 N/AMRI Sonata Siemens 80,475 65,323 N/A

X-Ray Philips 4,258 3,692 4,604Fluoroscopy Philips 41,384 31,322 24,946Fluoroscopy Siemens 17,100 15,105 20,123

CT Philips 24,085 22,437 65,450PET/CT Siemens 43,008 33,438 N/A

Nuclear Camera Siemens 3,790 3,620 N/ALinear Accelerator Siemens 111,238 67,807 31,249*

Ultra Sound Acuson / Siemens 2,927 1,692 N/A

*Load to air, unit is water cooled with house CHW

Manufacturer Suggested Total Heat Gain and Measured Heat Gain

Process Cooling

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Structural ConsiderationsEquipment Loads (CT/PET 3-6K, MRI 10-35K)Structural Floor SystemsStructural CapacityServiceability (deflection and rotation)Seismic ConsiderationsLocation of Equipment in Relation to Structural componentsAccess to the Up-fit LocationMounting of Equipment

Equipment Loads

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Imaging System Manufacturer Ceiling Load

Floor Load

3 TESLA Magnet (MRI) Philips 13,85364 CT Slicer Philips 4,280 Gemini PET Scanner Philips 2,925Precedence Spect Scanner

Philips 5,700

Clea – Ceiling/Floor Philips 2,387 2,513Omni Diagnost Eleva Philips 3,068

Steel Floor SystemsMetal Deck with Bar Joist (Roof system)Conc Deck with Steel Beam (Composite/Non-Comp)◦ Higher Probability of over-stressing existing structure.◦ Higher deflection and vibration.◦ Existing Plans are Critical!

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Concrete Floor SystemsConcrete Beam with One Way/Two Way Concrete Slab◦ Existing Plans are Critical to analysis◦ Lower Probability of over-stressing existing structure.◦ Lower deflection and vibration

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Concrete Floor SystemsConcrete Multispan Joist Slab/Waffle Slab◦ Existing Plans are Critical to analysis◦ Equipment must be coordinated with joist/waffle system◦ Lower Probability of over-stressing existing structure.◦ Lower deflection and vibration

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Structural CapacityStructural Analysis to Determine StressesNeed to Know if Spans are Simple or Continuous◦ Existing Plans are Critical!

Evaluate Bending Stress◦ Highest stress at mid-span

or possibly at supportEvaluate Shear Stress◦ Highest at support◦ Usually not a problem

Best placement of Unit is usually near a column.

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Bending StressRegion

Loading

Span

Loading

Span

Shear StressRegion

Shear StressRegion

ServiceabilityDeflection and VibrationCan be more difficult to resolve deflection problemsSteel structures are most flexibleConcrete structures are least flexibleIBC requires live load deflection to be > L/360Equipment deflection requirements can be 1/16” or > L/3840 for a 20ft span

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Loading

Span

Maximum Deflection

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Unistrut Systems for Ceiling

Coordinate with Structure, Utilities, and Ceiling GridTypical Attachments to Structure◦ Through Bolts or Wedge Anchors - avoid rebar in floor slab.◦ Bolting or Clamping to steelNeed Lateral Bracing for Movement of Equipment

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Access to Upfit Location

How large is the Equipment?Will it fit through doorways, hallways, ramps, elevated walkways.May require temporary shoring.

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Mounting of Equipment

Need to Coordinate with Structure and Utilities (both floor and ceiling)◦ Coring for electrical conduit or other utilities must be

field verified prior to final location of equipment.Base Plate Mounting◦ Must avoid steel and concrete beams (Main Reinf.)◦ Through Bolts or Wedge Anchors must be located to

avoid main rebar in floor slab.◦ Embedment in Concrete can be an issue with ribbed

deck pans. (Deck thickness < 4”)

Electrical

Typically a single 100-200 amp 3-phase 480 power to a disconnect provided by contractorDownstream usually by manufacturer’s installerEngineer to verify coordinationVoltage RequiredPower qualityEPSIsolated Power

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Electrical Testing by IES

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Electrical Testing by IES

Electrical Testing by IES

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Measured CT Load

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MRI Test Graph

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RacewaysData and low voltage; cabling by manufacturer, empty raceway by ECEquipment Power – usually the same; empty raceway by EC, power by manufacturer’s installer downstream of single point disconnectCable lengths available and bid

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Raceway Floor Plan

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Raceway Sections

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Raceway Sections

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Raceway Sections

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Raceway Sections

Emergency Power

Verify owner’s desires; if objective is to maintain equipment charge, for example MRI, then power equipment only. If full normal operation – then cooling lighting, controls and equipment on EPSIf EPS, then normal is required also (2 sources)UPS duration

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Observed Electrical Peaks vs. Disconnect Recommended

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System Manufacturer Measured Peak Current (A)

Manufacturer Specified

Disconnect (A)Volts (V)

MRI Vision Siemens 48 125 480

MRI Sonata Siemens 89 125 480

X-Ray Philips 87 100 480

Fluoroscopy Philips 122 125 480

Fluoroscopy Siemens 53 150 480

CT Philips 59 100 480

PET/CT Siemens 116 125 480

Nuclear Camera Siemens 8 30 208Linear

Accelerator Siemens 67 70 480

Ultra Sound Acuson / Siemens 8 20 120

Isolated Power

Required in NC where procedures involve direct electrical path to the heart muscle, example, EP and Cath LabsIf EPS is available, then isolated normal and isolated emergency is requiredCaution: Vascular room used for cardiology

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• Reduce shock hazard (from phase-to-ground contact with equipment/devices)

• Minimal arcing effects (first phase-to-ground fault conditions)

• Mandated by NEC in the following:

Patient care areas classified as “wet” locations and flammable anesthetizing rooms

Why Isolated Power?

• An ungrounded electrical distribution system

• Typically consisting of the following:

A shielded isolation transformer (with the secondary windings not referenced to ground)

Line-isolation monitor (LIM): Continuously monitor leakage current to ground in a mA threshold range of not greater than 5mA

2-Pole primary circuit breaker and several 2-pole secondary circuit breakers (per NFPA 99 and NEC Article 517)

Isolated Power

Isolated Power Details

Separate racewayX HHNLength limitationsNumber of receptaclesOne panel per room on EPSSeveral rooms may share NormalLIM (local and remote)

Square D Isolation Panel

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Electrical

Electrical

Plumbing

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BoomMed gasesSprinklerFM 200 especially in MRIClarify responsibilitiesInterlock to FA / exhaust hand wash

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Boom Detail

Floor Pedestal

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Medical Gas Outlets

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Med Gas Pipeline Components

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Med Gas Locations

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WallFloor (avoid table)Boom

Medical Gas Alarms

Local Panel must be manned at all times when imaging room is in useIndividual zone valve box required for Cath roomZVB must open on corridor

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Other GasesCarbon dioxide used for inflationNitrogen often used for instruments requires pressure regulator in procedure roomBe sure no physical conflicts with VAC bottles

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Section 7 – Construction and Commissioning

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Construction and Commissioning• Shop Drawings• Smoke Purge Test• Fire Alarm Interface Test• Medical Gas Certification• HVAC Test in all Modes, T&B• FM 200 Exhaust• Electrical Tests: equipotential (mV & ohms),

grounding, isolated power• Certificate of Occupancy

Closeout

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O & M ManualsTraining with EngineeringRecord drawings11 month retestUser debrief

Summary

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• Hire an Engineer/Architect• Verify existing conditions• Obtain manufacturer’s final drawings• Understand user’s need• Installation responsibilities• Budget, Ownership• Iso & EPS requirements• Understand Modality• Know CODES!!!• Three Zones with Good T & H Control• Test all systems; All scenarios