Health care facilities used to just worry about beds. Now, as health care has become more high-tech, they need to worry not only about beds, but also about linear accelerators, radiation and giant magnets.
Certainly, adding new technology means increased demands on infrastructure. That includes electricity; HVAC; internet connectivity and simple space requirements.
A CT machine at Saltzer Health. Photo courtesy of Saltzer Health
“With the recent rise of digital health initiatives, most health care organizations have experienced a rapid increase in the number and type of end-user devices that require network connectivity, either wired or wireless,” said Mark Wennstrom, regional chief information officer for the Trinity Health West Region — which owns Saint Alphonsus. “At Saint Alphonsus Health System, we anticipate this growth and incorporate tactical implementation plans to ensure our core, edge and wide-area network infrastructure, as well as our power, cooling and space capacity, stay ahead of this demand.”
But some hospital technology is a little more demanding than others.
A linear accelerator? In Fruitland?
Four St. Luke’s Health System sites in Treasure Valley — Boise, Meridian, Nampa and Fruitland — now house linear accelerators, which create radiation to treat cancers while sparing nearby tissues, said Amy Geyer, senior medical physicist. In addition to Fruitland itself, the clinic serves Ontario, Payette, Weiser and as far as Baker City, Oregon. “This is going to be the closest linear accelerator to many of our rural communities,” she said.
It’s big. Real big. In fact, it’s so big St. Luke’s calls it “the vault.”
“It’s much larger than your average CT scanner,” Geyer said. “The machine rotates around the patient to deliver the treatments.”
The vault itself is complex. “There’s a lot of shielding considerations because of the radiation, as well as some pretty complicated conduits for water,” used to cool the machine, Geyer said. It also has concrete or lead shielding.
And then there’s the door. “Our door is a little special,” Geyer said, due to the linear accelerator’s neutron production. It’s a steel door, with lead and boron and other materials inside to capture the neutrons.
St. Luke’s boiler connected in February 2022. Photo courtesy of St. Luke’s
Fruitland is in the process of upgrading its linear accelerator, Geyer said. “The shelf life is 10 years when you start thinking about replacing it,” she said. And retrofitting a new machine into an existing vault is a little more straightforward than having to build a new vault in the first place, she added.
That said, Geyer still needs to redo all the shielding calculations to ensure the shielding for the previous machine is adequate for the specifications of the new machine, she said. These involve the distance from the center of the machine to the wall, and have to allow for both primary, direct radiation and secondary, scattered radiation, she said.
Altogether, the linear accelerator costs $2 to $5 million, with construction for the retrofit another $1 million or so, Geyer said. Turnaround is typically four months, but Fruitland is doing it in three and a half, “which is incredibly fast,” she said. “Once you get the machine in there, you have to commission it, make sure it’s in spec and is delivering what you think it’s delivering,” which takes a couple of weeks, she said.
And what do you do with an old linear accelerator when you’re done with it? “In our case, the old one is going to be scrapped by the manufacturer,” Geyer said. “It’s an older model.” If the clinic was replacing a newer model with an even newer one, it might send the previous one to a
Third World country to be repurposed there or kept for parts.
“They break down and parts need to be replaced,” she said. “It’s always nice to have a backlog.” Taking a linear accelerator apart into its components “is a sight to see,” she said.
X-rays and giant magnets
Saltzer Health, an Intermountain Healthcare company, had a similar situation when it was building its Health Imaging Center in Meridian, which opened in early 2021. The building was built next to and serves its 24/7 urgent care center, which fills the gap between urgent care and the emergency room (ER), and can save patients a trip to the ER, said Matt Kaiserman, chief operating officer. It houses X-ray, dual-energy X-ray absorptiometry (DEXA), ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) machines.
St. Luke’s second floor duct work shown in February 2022. Photo courtesy of St. Luke’s
“The one that we don’t have is we don’t offer mammography service, though we do have space to expand to that in the future,” Kaiserman said.
Building the imaging center also gave Saltzer the opportunity to upgrade some of its imaging technology, Kaiserman said. For example, its new MRI machine, built by General Electric, uses technology with coils that the technician lays on top of the patient that is more user-friendly and more accurate, he said.
For machines like X-ray and MRI machines, which use various kinds of radiation, walls need to be lined with lead or other materials to ensure that the radiation is contained within the space, Kaiserman said. “So if someone is on the external walls, on the sidewalk, they’re not taking in those radiations,” he explained.
Similarly, because the MRI has a giant magnet, the center can’t have any metal in the room, and is limited in what kind of metal it uses throughout the building, depending on how far away it is from the MRI, Kaiserman said. “It can cause a whole host of safety issues if you have metal objects flying through the air,” he said, noting that even fire extinguishers need to be made out of a separate material.
Moreover, the magnet for the MRI is literally moved in through the wall. “They design the wall in a way that it can be removed to replace or repair the magnet,” Kaiserman said.
How do health care companies design their buildings?
Designing buildings to hold the technology isn’t easy, but medical providers said they work with experts to make sure all the specifications are met before the technology goes in.
“Typically, what you do is you work with the architect, and they are then connecting with engineers and physicists,” all of whom come with health care-specific backgrounds, Kaiserman said. “They help you do an analysis and work through calculations to determine what needs to be done, what materials need to be used and installed and what processes through the state are required to make sure the work is done correctly before you commission your machine.”
Providers also work with local building codes and specifications put forth by industry organizations such as the National Fire Protection Association to determine aspects such as where firewalls are placed, Kaiserman said.
The technology might have an impact on other systems as well, Kaiserman said. “Depending on the type of machines and their specifications, engineers and physicists determine how much heat a machine might put off and how it impacts the HVAC requirements,” he said. “For example, we’ve got an ambulatory surgical center on site, and there’s all sorts of very specific regulations on how many air exchanges there are per hour.”
Allowing for connectivity
Saltzer Health medical professionals. Photo courtesy of Saltzer Health
Similarly, technology that generates images not only can put a big load on the internet but needs to interact with medical records software such as the cardiology picture archiving and communication system (CPACS). “There are all these little pieces of technology that support individual functions,” Kaiserman said.
Even clinics without as much specialized equipment are making more use of technology. For example, starting this year, Primary Health Medical Group will be integrating virtual desktop infrastructure technology (VDI) into its new clinics, said Steve Judy, chief operating officer. “VDI will significantly enhance IT’s ability to deploy computers more rapidly, reduce overall hardware costs and give mobile/remote workforce a more consistent computer experience.”
Primary Health has also set up a Multi-protocol Label Switching (MPLS) private network hosted by Syringa Networks that centralizes its clinic connections into a centralized managed network, Judy said. “Syringa’s private network is more secure and outperforms most public networks,” he said.
And health care companies need to deal with the same cybersecurity issues as any company. “One of the key challenges we face is securing our enterprise from cyberattacks, primarily ransom attacks through employee email phishing,” Judy said. “Although we have different sources of layered protection, including one of the best endpoint protection services in the industry (Falcon by Crowdstrike), we still face a significant threat by a single employee clicking on a phishing email.”
In addition, both HVAC and lighting can be centrally computer controlled. “It allows us to create appropriate temperature set points in all of our rooms with adjustment limits for daily variances and includes the ability for energy savings during non-business hours,” Judy said. “We have lighting control panels that help us regulate the same for lighting efficiency both during work times and non-business hours.”
That said, hospital technology still comes down to people, Kaiserman said. “A lot of who helps to drive these decisions are the care providers,” he said. “Physicians and medical directors are an integral part of this process.”
This article originally published in the Idaho Business Review July 2022 edition of Square Feet.
