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The RADIANT | The Newsletter For Radiology, Medical Imaging & Intervention



     Jan / Feb- 2011

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RAD-Planning
(a division of JUNK Architects)

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Kansas City, MO 64105
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Radiology Codes

By: Tobias Gilk

“Paging Dr. Jones. Dr. Jones, ‘code 2011’.”

No, it’s not that kind of code…

As of January 1st, the Joint Commission (TJC) has updated its referenced building code from the 2001 edition of the Guidelines for Design and Construction of Health Care Facilities (which, by the way, required that you design photo darkrooms for your radiology suites), to the 2010 edition of Guidelines. What this means is that all new design and construction for Joint Commission accredited facilities, including radiology and nuclear medicine suites, will have to comply with the new standards, or your state’s standard, if they use something different. Just how big of a change this is depends on which modality you’re talking about…

First, let’s be clear… Guidelines is a design and construction standard. Technically, it’s not a building code, though it walks like a duck and quacks like a duck, so forgive me if I refer to it as a building code. For TJC accredited providers, the 2010 update is required only for new construction… projects for which design is begun January 1st or later (though you may live in a state that has also adopted the 2010 Guidelines as your state licensure standard, so you may be subject to preemptive, or alternative, state requirements). To be safe, however, our firm began using the 2010 standards as soon as they were published… except for those parts that are just plain-old wrong (more on this later).

Guidelines Architecture for Radiology Code

The largest change between the 2001 and 2010 editions is structural. The section numbers are wholly different, and there is a general attempt in the contemporary volume to group interventional imaging (which they define as cardiac catheter lab and electrophysiology lab).

However, there are sections which present some significant changes that clinical providers, facility planners and their radiology architects should be aware of:

2001 Guidelines
2010 Guielines
Radiation Protection 1’-6” (min.) from shielded view window to edge of shielded partition
Radiation Protection 3’-6” (min.) from shielded view window to edge of shielded partition
Computed Tomography (CT) CT Scan room shall be as required to accommodate the equipment
Computed Tomography (CT) The room shall be sized to allow a minim clear dimension of 3’ on three sides of the table




The door swing shall not encroach




A view window shall be provided to permit full view of the patient.




shall permit the control operator to see the patient’s head.
Diagnostic X-Ray Tomography and radiography/fluoroscopy Rooms. 
Diagnostic X-Ray Tomography and radiography/fluoroscopy Rooms. Separate toilets with hand-washing stations shall be provided with direct access from each dedicated gastrointestinal fluoroscopic room and to an adjacent passage so that a patient can leave the toilet without having to reenter the fluoroscopic room.
Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging (MRI) Space within the overall MRI suite… to meet the minimum technical siting requirements.




MRI suites as well as spaces around, above, and below (as applicable) shall be designed… to prevent unscreened individuals from entering the 5-gauss volume




MRI scanner room shall be large enough to accommodate equipment and to allow clearance in accordance with manufacturers’ recommendations.




Suites for MRI equipment shall be planned to conform to the four-zone screening and access control protocols identified in the American Collect of Radiology’s “Guidance Document for Safe MR Practices.”




The layout shall include…
  • Patient interview & clinical screening
  • Physical screening / changing
  • Ferromagnetic detection systems
  • Access control
  • Site-specific clinical and operational requirements




Anteroom visible from the control room shall be located




Any area in which the magnetic field is equal or greater than 5 gauss shall be physically restricted




Control room shall be provided with a full view of the patient within the MRI scanner.




Console shall be positioned so the operator has a full view of the approach and entrance to the MRI scanner room.




Hand-washing stations shall be provided convenient to the MRI scanner room




Patient prep / holding / recovery shall comply with interventional imaging services requirements




Power conditioning shall be provided as indicated by MRI manufacturer’s power requirements and facility conditions




Magnetic shielding shall be provided for those sites where magnetic hazards / interferences cannot be controlled through facility planning




For superconducting MRI, cryogen venting / exhaust / pressure relief systems shall be provided




Use of ferromagnetic materials… shall be avoided or minimized in MRI scanner rooms




Floor structure designed to support the weight of MRI scanner equipment…




Wall, floor, ceiling assemblies accommodate installation of radio frequency shielding




Magnetic shielding may be required




A knock-out panel is recommended




MRI rooms marked with lighted sign to indicate when the magnet is on




FF&E should be selected to minimize the need for maintenance / servicing




Recommended to use finishes or markings to identify critical values of the magnetic field (5-gauss or equipment tolerances)




Consider design consequences of interventional applications




Insulated quench pipe + room exhaust + pressure equalization shall be provided
Ultrasound Space shall be provided to accommodate functional program
Ultrasound Exam rooms shall have min clear floor area of 120 sf.




Minimum clearance of 3 feet provide on three sides of table.

Patient  toilet, accessible from the procedure room shall be provided

directly accessible from the procedure room…




Patient toilet shall be permitted to serve more than on procedure room.




Hand-washing station shall be provided within procedure room.
Cardiac Catheterization Lab Procedure room shall be a minimum of 400 square feet…
Interventional Imaging Services Equipment and space shall be provided for interventional imaging as necessary to accommodate the functional program.

Cardiac cath lab is normally a separate suite…

Required facilities shall be permitted to be in freestanding unit, in the imaging suite, or in the interventional platform that includes the operating rooms.



Electrophysiology Labs location of these labs shall be permitted within and integral to cath suite or in a separate functional area proximate to cardiac care unit.




Procedure rooms shall comply with all reqs for Cardiac Catheterization



Support Areas for Interventional Imaging Services Where patient cubicles are used, each shall have a minimum clear floor area of 80 square feet.




Each patient cubicle shall have a minimum clear dimension of 5 feet between patient beds and 4 feet between patient beds and adjacent walls.
Positron Emission Tomography (PET) Space shall be adequate to permit entry of stretchers, beds…
Positron Emission Tomography (PET) The scanner room shall be of a size recommended by the scan vendor.




Scanner room that accommodates both PET and CT scanning shall be permitted. No additional space requirements are necessary when PET is combined with CT. *




Where radiopharmaceuticals are prepared on site, a cyclotron shall be provided. 




If PET cyclotron is self-shielded, a separate lead vault is not necessary. However, a self-shielded unit shall be sited away from patient waiting areas or other areas of high occupancy by personnel not working with the cyclotron.




An unshielded cyclotron requires a concrete vault that is 6 feet thick.  *



Laboratory Facilities Hot lab shall be shielded according to the manufacturer’s specifications.  *

Holding area for patients on stretchers or beds shall be provided out of traffic and under control of staff and may be combined with dose administration…
Patient Holding and Recovery Area Dedicated patient holding and area shall be provided to accommodate at least two stretchers.



Patient Uptake Room A shielded room with a toilet to accommodate radioactive waste and a hand-washing station shall be provided.
Radiotherapy Suite Rooms and spaces shall be provided as necessary to accommodate the functional program…
Radiotherapy Suite Where a table is used, room shall be sized to provide a minimum clear dimension of 4 feet… on three sides of the table.



Secial Design Elements for the Radiotherapy Suite When entry into the radiation vault is via direct-shielded door, both a motor-driven automatic opening system and an emergency manual opening system shall be provided.




Height and width of doorways, elevators and mazes shall be adequate to allow delivery of equipment and replacement sources





The above ‘Cliff’s Notes’ version of the changes to Guidelines (excluding appendixes) are distillations and I strongly recommend that you read the source-text if you have questions or concerns about any of the above.
While some of the changes are minor, you can see that the MRI section was nearly entirely re-written. In the 2001 edition, the design requirements for MRI were comprised of four sentences, as opposed to the current edition’s (much more appropriate) 2-3 pages of guidance.

I point out the reworked MRI section because (in addition to being the biggest change that needs to be brought to your attention) I think that each modality’s guidance in the Imaging and Nuclear Medicine sections in future editions will ultimately wind up looking more like MRI does, now. Hopefully some will be updated in an interim publication, even before the anticipated 2014 edition, correcting significant errors.

Apart from the omission of stereotactic radiosurgery (presumably governed under radiotherapy) and proton beam facilities, altogether, from the 2010 edition, there are a couple of embarrassing errors or misstatements (which I flagged with asterisks in the table above) that I hope get fixed… quickly.
The 2010 edition of Guidelines includes hybrid PET / CT for the first time, though it erroneously states that a PET / CT takes no more physical space than a PET scanner, alone. Apart from the physical requirement for another doughnut-shaped ring of scanner, combined PET / CT scanners also require greater electronics in the equipment room, and more computing in the control room, incrementally increasing those areas, as well.

The 2010 edition also states that for sites that produce their own PET radiopharmaceuticals (a rarity given the post 9-11 NRC security restrictions) must have six feet of concrete vault around a cyclotron generator (despite the fact that it was referenced as a “lead” vault in the preceding paragraph). While this may sound appropriate, shielding requirements are nearly always performance-based, and not prescriptive. A six-foot-thick vault might be proper, but only if we know what the concrete density, admixtures, and overall shielding properties are, to say nothing of what the adjacencies are that require shielding protections. Without those critical characteristics defined, the thickness of the wall means very little. By contrast, the section on radiotherapy suites properly indicates that shielded enclosures should be planned by a certified physicist, with materials and thicknesses appropriate to the shielding requirements.

Despite these few errors, the 2010 edition of Guidelines is, on the whole, a substantial move forward for imaging services. The Facilities Guidelines Institute, the organization that publishes this code, has already begun to form an ‘Imaging Task Group’, which I have been asked to join. This group will be charged with a wholesale update for the 2014 edition of Guidelines to the sections currently designated ‘Diagnostic Imaging Services’, ‘Interventional Imaging Services’, and ‘Nuclear Medicine Services’.

In a future edition of The RADIANT, we will be delving into an MRI suite specific code conflict that arises between this 2010 edition of Guidelines and the 2010 edition of the Life Safety Code that is also a basis for new hospital design and construction.

If you have questions about the codes, standards, and best practices that govern radiology, nuclear medicine and radiation therapy, we invite you to contact us at TheRadiant@RAD-Planning.com.

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RAD-Planning (a division of JUNK Architects)
802 Broadway 5th Floor
Kansas City, MO 64105
USA

tel: 816-472-7722
www.RAD-Planning.com

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