Housing medical technology | Idaho Business Review

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Previously, healthcare institutions only worried about beds. Now that health care has become more high-tech, it has to worry not just about beds, but also about linear accelerators, radiation, and giant magnets.

Certainly, the addition of new technologies means an increase in infrastructure demands. This 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 healthcare organizations have seen a rapid increase in the number and type of end-user devices requiring network, wired or wireless connectivity,” said Mark Wennstrom, regional director of information 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 that our core, edge, and wide area network infrastructure, as well as our power, cooling, and space capacity, remain in place. advance on this request.

But some hospital technologies are a bit more demanding than others.

A linear accelerator? In the land of fruit?

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 tissue, said Amy Geyer, a medical physicist main. In addition to Fruitland itself, the clinic serves Ontario, Payette, Weiser and as far as Baker City, Oregon. “It will be the closest linear accelerator to many of our rural communities,” she said.

It’s big. Real big. In fact, it’s so big that St. Luke calls it “the vault.”

“It’s a lot bigger than your average CT scanner,” Geyer said. “The machine revolves around the patient to deliver the treatments.”

The vault itself is complex. “There are a lot of shielding considerations because of the radiation, as well as quite complicated conduits for the water,” used to cool the machine, Geyer said. It also has concrete or lead shielding.

And then there is the door. “Our gate is a bit special,” Geyer said, due to the neutron production from the linear accelerator. It’s a steel gate, with lead and boron and other materials inside to capture neutrons.

St. Luke’s boiler is online in February 2022. Photo courtesy of St. Luke’s

Fruitland is upgrading its linear accelerator, Geyer said. “The shelf life is 10 years when you start thinking about replacing it,” she said. And upgrading a new machine to an existing vault is a bit easier than having to build a new vault in the first place, she added.

That said, Geyer still has to redo all the armor calculations to make sure the previous machine’s armor is adequate for the new machine’s specs, she said. These involve the distance between the center of the machine and the wall and must take into account both direct primary radiation and scattered secondary radiation, she said.

In total, the linear accelerator costs between $2 million and $5 million, with the construction for the renovation costing around $1 million, Geyer said. The turnaround time is usually four months, but Fruitland does it in three and a half years, “which is incredibly fast,” she said. “Once you have the machine installed, you have to commission it, make sure it is to specification and delivers what you think it delivers,” which takes a few weeks, he said. she declared.

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 old model.” If the clinic replaced a newer model with an even newer model, they could send the previous one to a

third world countries to be reused or kept for spare parts.

“They break down and parts have to be replaced,” she said. “It’s always nice to have an order book.” Taking a linear accelerator apart into its component parts “is a sight to behold,” she said.

X-rays and giant magnets

Saltzer Health, an Intermountain Healthcare company, had a similar situation when building its medical imaging center in Meridian, which opened in early 2021. The building was constructed next to its care center in Meridian. 24/7 emergency room, which bridges the gap between urgent care and the emergency room (ER), and can save patients a trip to the emergency room, 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

“What we don’t have is that we don’t offer a mammogram service, although we have space to expand it in the future,” Kaiserman said.

Building the imaging center also gave Saltzer an 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 places on the patient that is more user-friendly and more accurate, he said.

For machines like X-rays and MRIs, which use various types of radiation, the walls must be covered with lead or other materials to ensure the radiation is contained within the space, Kaiserman said. “So if someone is on the outside walls, on the sidewalk, they’re not picking up that radiation,” he explained.

Likewise, because the MRI has a giant magnet, the center cannot have any metal in the room and is limited in the type of metal it uses throughout the building, depending on its distance from the ‘MRI, Kaiserman said. “It can cause a whole host of safety issues if metal objects fly through the air,” he said, noting that even fire extinguishers need to be made from a separate material.

In addition, the magnet for MRI is literally moved through the wall. “They design the wall so that it can be removed to replace or repair the magnet,” Kaiserman said.

How do healthcare companies design their buildings?

Designing buildings to contain the technology isn’t easy, but medical providers said they work with experts to ensure all specifications are met before the technology takes effect.

“Generally what you do is you work with the architect, and then they liaise with engineers and physicists,” all of whom have specific healthcare backgrounds, Kaiserman said. “They help you do analysis and perform calculations to determine what needs to be done, what materials need to be used and installed, and what processes across the state are needed to ensure the job is done correctly before commission your machine.”

Suppliers also work with local building codes and specifications offered by industry organizations such as the National Fire Protection Association to determine aspects such as the placement of firewalls, Kaiserman said.

The technology could also impact other systems, Kaiserman said. “Depending on the type of machines and their specifications, engineers and physicists determine how much heat a machine can give off and how it impacts HVAC requirements,” he said. “For example, we have an outpatient surgery center on site, and there are all kinds of very specific regulations on the number of air exchanges per hour.”

Enable connectivity

Health professionals from Saltzer Health. Photo courtesy of Saltzer Health

Likewise, the technology that generates images can not only put a great load on the Internet, but must 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 that don’t have as much specialized equipment are using technology more. For example, starting this year, Primary Health Medical Group will integrate virtual desktop infrastructure (VDI) technology into its new clinics, said Steve Judy, chief operating officer. “VDI will dramatically improve IT’s ability to deploy computers faster, reduce overall hardware costs, and provide mobile/remote workers with a more consistent computing experience.”

Primary Health has also set up a private Multi-protocol Label Switching (MPLS) network hosted by Syringa Networks that centralizes its clinical connections into a centrally managed network, Judy said. “Syringa’s private network is more secure and outperforms most public networks,” he said.

And healthcare companies face the same cybersecurity challenges as any business. “One of the biggest challenges we face is protecting our business from cyberattacks, primarily ransomware attacks via phishing employee emails,” Judy said. “Although we have different sources of layered protection, including one of the best endpoint protection services in the industry (Falcon from Crowdstrike), we still face a significant threat when a single employee clicks on an email. phishing email.”

In addition, HVAC and lighting can be centrally controlled by computer. “This allows us to create appropriate temperature setpoints in all of our rooms with adjustment limits for daily deviations and includes the ability to save energy outside of office hours,” Judy said. “We have lighting control panels that help us regulate lighting efficiency during working hours and non-working hours.”

That said, hospital technology still depends on people, Kaiserman said. “A lot of those who help make those decisions are the healthcare providers,” he said. “Physicians and medical directors are an integral part of this process. »

This article originally appeared in the July 2022 edition of Square Feet’s Idaho Business Review.


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