To keep up with the pace of medical advancements, healthcare institutions are upgrading to the newest technology and renovating their physical settings to accommodate the purchase of new state-of-the-art equipment.

This is affecting construction planning and design and bringing new challenges and complexities to healthcare projects, such as adjusting floor plans and ceiling heights, revising departmental layouts, and improving infrastructure for telecommunications, electrical and mechanical systems.

While new construction allows one to plan and design to accommodate this equipment and support systems, more often the installation is being inserted into existing facilities where extra space is minimal and additional structural reinforcement is required.

Often, existing hospitals will look to convert a conference room, a waiting room, or other “soft space” adjacent to a more technical space, such as an imaging department, to house new equipment, including MRIs and bi-planes.

More often than not, these spaces can be adapted and reconfigured, but upgrading an existing facility rarely happens without challenges.


Making room for new equipment

Before adding or updating technology, architects and designers need to consider everything from the technical requirements specific to each piece of equipment to the room size and the layout of the facility.

These areas exist in a specific relationship with other departments and this setting, unless it’s outdated or non-functional, needs to be maintained in a renovation. For example, there’s a direct relationship between an X-ray room, MRI, blood test lab, and an ER since people coming in with an emergency may need to have one or more of these procedures. It’s important to maintain those adjacencies as much as possible for better patient care, efficiency, and work flow.

Once a location is found, you need to make sure it can structurally support a project’s needs. Hospital for Special Surgery (HSS, New York City) hired DaSilva Architects (New York City) to install a 1.5T MRI at its new location on East 75th Street.

We decided to install it in the basement of the existing building, where there was empty space with a concrete structure. However, the floor-to-floor height was not tall enough for the MRI, so we had to drop the existing lower-level slab in order to achieve the ceiling height required by the equipment manufacturer. An additional 3 to 4 feet was excavated by cutting the existing floor slab and digging out the dirt and water.

In an urban area, you can never know what you’ll find when you excavate. Here, we found a subsurface water condition that had been taken care of during a previous renovation, so we had to reconfigure the hole so it wouldn’t fill up with water.  We also had to put in new infrastructure, including mechanical, electrical, and lighting systems.

Another challenge was bringing the equipment into the building. First, we worked with the manufacturer to determine a pathway in by cutting a hole in the first-floor slab and dropping the magnet down to the lower level. Once the MRI was loaded, we put in a removable slab to facilitate the machine’s extraction at a later date when it’s no longer functional.


Updating environments

On some projects, the challenges involve bringing existing technology suites up to code. DaSilva recently designed new bi-plane and MRI suites at Lutheran Medical Center to make them compliant with current standards and guidelines.

Since an MRI is a magnetic device, anything made of iron or steel can’t be anywhere near the MRI’s magnetic field. You also need to shield the space so the MRI’s frequency doesn’t get interrupted by sources outside the room. Unlike an X-ray machine where you need to keep radiation from spreading out, an MRI needs to be shielded for its own sake.

The unit also needs electricity and light sources that accommodate the MRI’s technical requirements. For example, any power brought into the room must come through specific conduits that don’t react to the magnet. Light fixtures must be non-magnetic, such as aluminum or vinyl, and you can’t have an incandescent light source since its tungsten filament would be affected by the magnet.

For the installation of the bi-plane radiographic suite, a former waiting room and reception space provided enough room for the new equipment, but the outdated structure and loading capacity weren’t enough to support the weight of the machine and the systems.

To overcome this challenge, we renovated the space with a new concrete slab and added new mechanical and electrical systems and finishes. The suite was located directly above the first-floor coffee shop and the structural work required getting into the ceiling of the coffee shop. Since construction couldn’t be done near the food area, the shop had to be shut down. To keep that downtime as short as possible, the contractor worked 24-hours-a-day and restored the shop’s ceiling within a week.

We also had to address how staff accessed the suite. To better control the entrance, we reorganized the room and the nurses’ area as well as brought it up to codes for infection control by adding a scrub sink and a separate access from the control room into the procedure room.


More changes to come

The increased dependence on technology in healthcare, as well as the rapid speed of change, will force healthcare organizations to make more room for high-tech equipment.

With the high cost of real estate and the limitations of space in urban settings, many of these upgrades and renovations will continue to be done in existing buildings rather than new construction projects. This will force many urban healthcare institutions to continually recycle their existing facilities for new use, making these projects a major factor in construction planning for years to come.

Jaques Black is president at DaSilva Architects and can be reached at