January / February 2016
by John Doumitt, President, Greenfield Solutions
Tobias Gilk, Principal, RAD-Planning

Savile Row is an area in central London that is world-renowned for its tailors who will custom fit you for a suit designed to your exact specifications. Today, when less-expensive off-the-rack options abound, the idea of having a bespoke suit made seems somehow from a time past. If fashion changes, or one puts on 10 kilos, they could always buy another ‘disposable’ suit, right? But what if today’s choice locks you in to the one suit you will wear for the next 20 years, irrespective of how stiff, or ill-fitting, or scratchy, or poorly cut it is? With a longer perspective in mind there’s a whole new appreciation for the value of a bespoke suit.

The field of Nuclear Medicine is often accompanied by vendor-driven facility designs. While these solutions may accommodate the immediate needs for proposed equipment, are they really advocating for the client’s best interests? Are they taking into account the ‘long perspective’ for their clients, or are the equipment planning and design services there to secure the equipment sale? Before committing to a single-solution design, learn how to afford your project flexibility, efficiency, and accommodations for the future generation of nuclear medicine equipment.

Many hospitals and clinics around the world, and certainly those within the Gulf Cooperation Countries (GCC), have traditionally invested in the best medical technology available. This is especially true in larger cities and at larger medical centers. Nuclear Medicine, and related Molecular Imaging, is a growing medical specialty worldwide. In the GCC, the rate of growth of Molecular Imaging scans has been particularly strong as specialized centers for PET and SPECT imaging open or add new scanners at a rapid pace.

Of course, this growth has not been without typical challenges such as capital investment, regulatory compliance, and safety factors related to production, distribution, patient administration, and disposal of radiopharmaceuticals used in Molecular Imaging procedures. Operating these facilities requires highly trained specialists and implementation of best practices to achieve economical results. This means it is imperative to get all elements of the project defined up front and ensure they are diligently and consistently managed throughout the entire process – from preliminary design, through engineering, construction, equipment installation, and start-up.

Additionally, it is critically important to consider the interdependencies of supply (radiopharmaceutical production) with demand (imaging) in the practice of Nuclear Medicine. This is especially true when planning for a completely new Molecular Imaging Center…Where will the supply of radiopharmaceuticals come from? In Europe and the United States of America, where ample commercial radiopharmaceutical supply exists, this is not a big concern. However, this is absolutely a concern at many new centers in the GCC. For this reason, we increasingly see vertically-integrated production/imaging centers in this region.

While vertical integration of radiopharmaceutical production and molecular imaging has long been the rule at large medical centers, we are now seeing demand emerge for stand-alone radiopharmaceutical production / imaging centers. Because they are self-contained and usually have a tightly-focused mission, these specialized outpatient imaging centers have some key advantages. Primarily, it is easier to plan for a balanced supply and demand for product and services, especially as patient volume grows. The timing of the project can be optimized so that capital is deployed efficiently. And, most importantly, management and accountability of the whole project can be more easily achieved. These advantages frequently allow projects to be completed more quickly and at lower cost than at existing medical centers.

Even the most efficiently built stand-alone radiopharmaceutical/imaging center can be costly to run if best practices have not been built into the facility from the initial design, to the equipment / vendor selection, to workflow planning. More alarmingly, these facilities can be hazardous to patients, staff, and the community, if effective radiation safety precautions are not engineered up front to make sure exposures are kept as low as reasonably achievable. For these reasons, the only practical approach to developing a Nuclear Medicine facility (of any size) is to simultaneously plan the equipment, operations, and layout. The best way to achieve your goals in this regard is to retain a qualified vendor-neutral advisor to oversee and manage the full design-to-delivery process. This is referred to as turnkey project delivery.

Such an advisor should help clients identify the clinical studies that they want to perform, determine the best radiopharmaceutical agents for those studies, forecast the volume needed for direct use or sale, help identify likely shifts / growth in production volumes, identify appropriate products / vendors for the generation and production of the identified agents, plan the equipment and production workflow to adhere to international standards and best practices, develop a facility design that eases anticipated growth, and provides the appropriate radiation protections for workers, patients, and the public. The role of this advisor is far more than just a facilitator of an equipment tender / purchase, but is really – to use our analogy – the master tailor who is developing a bespoke solution to a truly individual need.

It goes without saying that your turnkey radiopharmacy advisor should remain vendor-neutral to help you identify the specific products, systems, and workflows that match your needs, and not catalogue numbers from one vendor’s list. It should be noted that the absence of a vendor-affiliation isn’t sufficient if your consulting advisors don’t also bring with them expertise with different manufacturers, vendors, systems, and workflow. When marrying radiopharmaceutical production with molecular imaging clinical services, this means having a consultant group who can mix and match products and systems from IBA and Siemens, Tema and Philips, Comecer and GE, to provide ‘best of breed’ options for both production and clinical services.

And when we say that the ‘consultant group’ should have this expertise, what we really mean is that the individuals consultants to the project have this expertise. Large, multi-national healthcare design or consulting groups may have an impressive portfolio of work performed under the firm’s name, but unless the individuals working on your team bring the decades of experience and proven projects, prior reputation is meaningless. Make sure that your project team gives you the commitment of principal involvement in your project.

Particularly on the radiopharmacy production side, with the safety, licensure / regulatory, and time-critical operational requirements, it isn’t even enough to have helped build dozens of facilities before. The operational requirements are so specific that a photogenic building, one that looks impressive, may be profoundly difficult to run well. Your equipment planners, facility designers, and consultants should have the intimate knowledge of what running the facility will entail, from direct operational experience. Even if you don’t need training, management or operational services, the way that these experiences inform equipment planning and design can’t be overstated.

Can you find less expensive, off-the-rack solutions to radiopharmacy and molecular imaging facility planning? You bet you can. Remember, however, that the solution you choose will be built to last, and your decisions will literally be cast in concrete. The strong decisions will be foundations that will protect the operation and lifetime flexibility of your operations. The poor decisions will be discovered to be roadblocks that will prove to impede safe practices, responsiveness, and may have disproportionate downstream costs.

For something that needs to remain safe, efficient, and effective over a measurement of decades, perhaps you’d be better off with a bespoke solution…

John Doumitt, PE, President of Greenfield Solutions, Inc., will be joining RADIOLOGY Planning staff in the RAD-Planning booth (1H01) during Arab Health to help address questions about radiopharmaceutical production equipment and processes.


THE RADIANT: Arab Health Edition Homepage
January / February

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