Unlike most of my posts, this one does not offer a position, much less a ‘call to action.’ Instead, I pose a question. You can read it as rhetorical, and allow me to stew in my own juices, or offer your thoughts. The essence of my question is what obligation do I have when I see horrible MRI suite design?
If you accept the notion that an expert is defined as a person who has survived in their industry despite having made nearly every mistake there is to be made, then I’m an MRI suite design expert. I don’t stand in an ivory-tower of self-aggrandizement, rather I offer what I’ve learned, more often than not, the hard way.
So I stumble across designs for an MRI suite that are to be built soon. The building has sprinklers, fire-exits, and presumably conforms to all requisite codes, but the MRI suite… well…
[segue] My bedroom is quite large. It’s big enough that there should be a half-dozen different ways to lay it out with the furniture that I have… except for reading lamps. Despite the size of the room (which suggests a great deal of flexibility), there is only one possible configuration (which doesn’t involve extension cords) that provides an outlet at the bedside table on each side of the bed. This seemingly simple design element constrains the function of this room. [/segue]
If my bedroom and this MRI facility are each compliant with the applicable codes, does that mean that they’re well designed? No, in both cases.
A poorly-designed MRI facility can handicap patient safety (e.g. failure to provide lines of sight to patients in the scanner or entrances to the scanner room), can degrade image quality (e.g. ferromagnetic content in construction, including magnetic shielding, approaching shim tolerances), can impair clinical utilization (e.g. inadequate space or ineffectual layout for anesthesia or biopsy patients), and, when combined, can accelerate the replacement need for equipment ($$$) or facility renovations ($$).
So last week I came across such a design. There were no apparent code violations, but the design ran counter to a very large number of design best practices for MRI. The project manager (working on behalf of the client) and the project architect, who I contacted, were largely dismissive of these concerns. After all, no mandatory codes were violated…
Should I have even stuck my nose in a project that was outwardly none of my business? Rebuffed though I was, should I have taken my concerns further up the food-chain? Or did I strike an appropriate balance of bringing concerns to their attention without evangelizing?
I think that these questions are ‘blog-worthy’ in part because situations like this occur fairly regularly. Sometimes I’m asked, and sometimes I just stumble into situations where I see MRI suite designs that would benefit from a major rework. My firm belief is that these design changes will benefit patients and building owners, but may come at the expense of someone else’s ‘rightness’ or authority. In each instance I find myself coming back to the same questions of how should I best handle the situation.
Tonight, as I’m nodding off to sleep, I’ll try and imagine what it would be like with the bed on the opposite wall, instead of imagining this MRI suite with an efficient and functional layout.Tobias Gilk, President & MRI Safety Director — Mednovus, Inc. Tobias.Gilk@Mednovus.com www.MEDNOVUS.com Sr. Vice President — RAD-Planning.com TGilk@RAD-Planning.com www.RAD-Planning.com