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.

Click here for Tobias’ Twitter Profile

For those of you who aren’t familiar with the Guidelines, they are the design requirements that are cited by the Joint Commission and, at last count, 42 of the 50 U.S. State Departments of Health. Technically, they aren’t a building code, but the function in almost the exact same way. For the first time, the Guidelines are going to have specific MRI suite design requirements for patient safety.

2010 Guidelines

The 2010 edition of the Guidelines are purported to codify the single most often cited MRI suite safety design criteria, the 5-gauss line (or three-dimensional bubble, more accurately). The design must necessarily control access to locations where the static magnetic field is present at strengths of 5-gauss or more.

the 2010 Guidelines will also define situational-awareness requirements for suite layouts. These will include a requirement that the patient can be seen inside the scanner from the operators’ console location, and that the operator has direct visual control of the entrance to the MR scanner room.

The unique challenges of infection control and handwashing in the MRI environment are also explicitly addressed, for the first time, in the new Guidelines.

And one of my favorite provisions is the new requirement that MRI suites be designed to follow the ACR 4-Zone model for screening and access controls, including ferromagnetic detection systems!

The Guidelines publication is undergoing a significant organizational overhaul along with the regular content update, so I don’t have specific section citations to where the new MRI safety design requirements will be (though MRI probably won’t have the same section numbers as the current, 2006, edition has). My understanding, however, is that the publication will be released on schedule in January, so it is only a very short time until we can verify the specific contents and section numbers.

It is particularly encouraging that these new requirements validate what the some of the best MRI providers have been doing for years. Clearly MRI site-safety, including ferromagnetic detection, can no longer be regarded as simply “a good idea.” With the 2010 edition of Guidelines, we will have one more codified example of how these elements are truly part of the contemporary standard of care.

If you would like more information about the Guidelines, including information on how to order a copy of the document, please click here.

Link

This new publication is intended to assist Architects, Engineers, Designers, Facility Planners, Radiology Administrators, Radiologists and Technologists, in planning the design of safe and effective MRI suites.

To obtain your copy, please click on the cover image, above.