Untapped potential: Expanding healthcare space, capabilities within a limited footprint
July 21, 2021
Using creative design can unlock more room for treatment space and greater possibilities for care
Health systems face unique challenges in balancing aging buildings with the desire to install the most advanced treatment technology. The impact of the pandemic on capital budgets also makes new construction less likely. Despite this, providing advanced care in modern settings remains a priority.
In balancing these realities, our team has found creative ways for providers to expand facilities and enhance care¡ªall while remaining in the same footprint. By maximizing underused space, we¡¯ve found success meeting the needs of patients and a health system¡¯s budget.
Jefferson Health¡¯s Sidney Kimmel Cancer Center in Philadelphia, Pennsylvania, recently added a ViewRay MRIdian? to assist cancer patients. The Â鶹´«Ã½ design team worked to find room in the existing facility for the new technology.
Jefferson Health¡¯s Sidney Kimmel Cancer Center in Philadelphia, Pennsylvania, is one such example. The Center is one of 71 National Cancer Institute-designated cancer centers in the country. As such, they are a leader for cutting-edge cancer treatment in the region. The Center wanted to be the first in the region to provide MRI-guided radiation therapy by adding ViewRay¡¯s MRIdian?.
This technology is notable for enabling the radiation beam to target the tumor and save adjacent healthy soft tissue. With improved targeting precision, it delivers higher and potentially more effective radiation doses. There are 17 MRIdian machines in the US and 38 worldwide.?
By maximizing underused space, we¡¯ve found success meeting the needs of patients and a health system¡¯s budget.
While this advanced tool helps solve clinical challenges, it introduces unique design requirements. Adding the MRI modality creates the need for:
- Magnetic shielding in addition to radiation shielding for vault walls and doors.
- RFI filters in addition to wave guides.
- MRI-compatible lighting, monitors, PCs, and electronic devices.
- Establishment of the American College of Radiology Safety Zones.
- Setting up a cryogen system and quench venting/emergency exhaust into an already crowded ceiling cavity.
- Supplementary cooling from the HVAC system and increased chilled water to cool the magnet and LinAc. It also requires more ceiling cavity space and tighter coordination of MEP infrastructure.
Jefferson Health chose our team for project design services because of our experience in this arena. Our team also brings a long history delivering successful solutions for difficult designs.
Creating space to add a new vault to the suite
The Center is in the basement of the Bodine Building. This level was originally constructed as a parking garage after the building was occupied. It has a low floor-to-floor height and a significant foundation that posed a challenge for the new MRIdian pit. We had to remove a large portion of the floor slab to provide new foundations for the vault and machine. We also had to consider a high water table.
Before the installation of the MRIdian vault, the space was used as a machine shop.
The initial approach was to locate the new vault in an unused operating room close to the street-facing side of the basement. But this was abandoned during design development due to caissons that interfered with the new grade beams needed for the vault. A concrete beam supporting the first floor also prohibited routing of cable trays for the MRIdian cabling, HVAC ducts, and cryogen vent. The only other option was to locate the new vault at the farthest point from the street by relocating support functions.
With such difficult access to the new treatment room, the team decided to use Veritas Dry-Stacked Shielding Modules for the vault and their sliding radiation shielding door to eliminate a maze. This system removed the need for design and documentation of a traditional concrete vault by a structural engineer. It also reduced the thickness of the walls since the modules improved radiation shielding performance.
The MRIdian pit and treatment room slab being formed and poured.
The existing floor slab was 18 inches thick, poured over a mud slab with membrane waterproofing. Unfortunately, the new pit for the MRIdian and the new grade beams for the vault penetrated the mud slab. Fortunately, weather conditions were unusually dry before construction, so the water table did not complicate matters.
Focusing on the patient experience
Located in the building¡¯s bowels, the treatment room and control room were given upgraded finishes to enhance the patient experience and ease anxiety. Interior design details included cherry wood wall panels, wood plank vinyl flooring, and a Sky Factory Luminous SkyCeiling.
Upgraded finishes enhance the patient experience and provide a more inviting environment.
Working during the COVID-19 pandemic
Philadelphia¡¯s COVID stay-at-home order was issued on March 23, 2020, just as construction was ramping up. Although hospital projects were considered essential, COVID-19 construction site requirements limited the number of tradespeople on site to four. This meant 24/7 construction with trades working in shifts. Having multiple prime contracts for construction facilitated the process but increased the oversight required by Jefferson Health and Â鶹´«Ã½. Weekly owner/architect/contractor (OAC) construction meetings were moved online and focused on coordination between trades.
Adding an MRI to a radiation oncology suite introduces new safeguards and protocols for the staff. The extended OAC meetings were also the venue to finalize MRI protocols.
Although technology like MRIdian requires more complex facility design and infrastructure, there is a great opportunity for healthcare systems to utilize existing space to upgrade treatment. Through collaborative design practices and the use of the right tools, there are opportunities to unlock the potential of existing square footage.