The purpose of this thesis is to do a detailed research on Diagnostic Centre through all the possible ways, know all the current trends, pros and cons through case studies, draw inferences and implement them in the design formulation.
1.2 DIAGNOSTIC CENTRE
The Diagnostic Centre is a place where a person’s physical conditions and diseases are diagnosed and is a resource to help physicians identify the causes of uncharacteristic and uncommon health issues through extensive testing. In some cases, a person’s symptoms are a clear indicator of his or her of illness, and the direction of treatment is obvious to his or her physician. However, in some instances, the source of an ailment can be more difficult to identify and need some advanced technology to diagnose the issues. (BTBHC)
A diagnostic centre mainly renders two types of services viz., Radiological services and Clinical Laboratory services.
The main function of the radiological services is to assist clinicians in the diagnosis and treatment of diseases through the use of radiography, fluoroscopy, radioisotopes and high voltage acceleration. Routine x-ray, normally performed by an x-ray technician, involves x-ray procedure (film exposure) of spine, neck, chest and extremities (legs, arms, hands and feet.).
In advanced high-tech diagnostic centers, the diagnostic radiology department performs other procedures that are part of or related to the x-ray department. Highly sophisticated equipment and machines are used for these procedures. Some examples of the various kinds of equipment are diagnostic ultrasound, computerized axial tomography (CT or CAT scan) and magnetic resonance imaging (MRI).
Diagnostic ultrasound is an imaging technology that is becoming increasingly popular because it does not require potentially harmful radiation. Computerized axial tomography is an x-ray technique that uses a special scanner and computer to produce cross-sectional images of the head or parts of the body. Unlike standard x-rays, which take a picture of the entire part of the body or head, CT scan can image it one “slice at a time”.
The MRI, a marvelous gift of science and technology to medicine, allows a radiologist to see soft tissues (muscles, fat and internal organs) without the use of x-ray. It is safer and has no known side effects.
Mammography, also called breast imaging, is a simple, safe and reliable radiographic examination of the internal structure of the breast. The low-dose x-ray study using the most modern equipment can detect breast cancer years before the patient or the doctor can feel it. (HFPM)
The primary function of clinical laboratories is to perform laboratory tests in the six main fields of bacteriology, biochemistry, histology, serology, hematology and cytology to assist medical staff in making or confirming diagnoses and in the treatment and prevention of diseases. Some of the laboratory tests are specialized tests while others are routine ones such as urine analysis and blood cell counts. (PDMS)
To design a diagnostic centre which ensures an efficient flow of service, minimum movement and more comfort for patients and staff.
· Providing easy access for all the spaces through an efficient space planning.
· To provide contrast between the horizontal and vertical planes through use of colors or materials to have a better visual discrimination.
· Even distribution of light levels in the spaces through use of appropriate light fixtures so as not to create visual barriers of dark and light spots.
· To reduce the use of materials which emit VOC gasses since they may cause irritation to the eyes and respiratory systems for some senior citizens.
· To provide safety in wet areas through use of flooring materials having a high slip-resistant coefficient values.
The number of health ailments and patients are increasing day-by-day so diagnostic centre provides a wide scope for detection of ailments and afford facilities for detailed medical check-up through various diagnostic procedures at a single place.
· Building services like plumbing, sewage, etc.
· Store rooms.
· Laboratory equipment.
3.1. METHODOLOGY CHART
3.2. LITERATURE STUDY
3.2.1. HISTORY OF RADIOLOGY
The X-ray was discovered by ‘Wilhelm Conrad Rontgen’ on 8 November 1895 in Wurzburg, Germany. Rontgen, a professor of physics, conducted experiments on focusing light phenomena and other emissions generated by discharging an electrical current in a highly-evacuated glass tube. To Rontgen’s wonder he noticed that an object across the room began to glow when his cardboard-shrouded tube was charged. This object turned out to be a barium platinocyanide-coated screen, and whilst holding various materials between the tube and screen to test the new rays, Rontgen saw the bones of his hand clearly displayed in an outline of flesh.
Rontgen gave his preliminary report to the Wurzburg Physical–Medical Society, along with the experimental radiographs and by the image of his wife’s hand. By New Year’s Day he had sent the printed report to physicists across Europe. By the January of 1896 the word X-ray got familiar in the world and Rontgen was given the credit as the discoverer of a medical miracle.
He was later awarded the first Nobel Prize in physics in 1901. He donated the prize money to his university and declined to seek proprietary claims on his discovery of the ‘new light’ and explained his discovery and its applications to the world. By mid-January 1896 the headlines in newspapers stated ‘new light sees through flesh to bones’ and ‘hidden solids revealed’. Within a week demonstrations were being set up at colleges, high schools and public venues.
Thomas Edison was eager to ‘perfect’ Rontgen’s discovery. Edison’s work resulted in the development of a hand-held fluoroscope, but he was disappointed at being unable to manufacture a commercial ‘X-ray lamp’ for domestic use. His efforts to obtain an X-ray of the human brain in action kept reporters waiting outside his laboratory for weeks. The much-admired ‘first radiograph of the human brain’ was in reality radiographed in 1896 by H. A. Falk.
Apparatus became widely available and soon special ‘X-ray equipment’ became available at low prices so that anyone could produce an ‘X-ray picture’. Studios were opened to obtain ‘bone portraits’ and poems relating to the X-ray were written. The public was fascinated with all these new developments, but the medical world immediately recognized the enormous importance of the discovery. Soon not only ‘bullets, bones and kidney stones’ were exposed to the Rontgen ray, but the X-rays were experimented on diseases such as tuberculosis and malignancies.
By early 1896 the first angiography which obtains moving-picture X-rays images were obtained. The necessary apparatus such as an evacuated glass tube (with anode and cathode), and a generator (coil or static machine), combined with photographic materials, were easily acquired.
In January 1896, Emil Grubbe, an electrotherapist from Chicago, exposed two patients with cancer, noted palliative effects, but did not publish his results till much later. Grubbé himself underwent over 100 operations, including amputations, as a result of his lifelong exposure to X-rays.
By 1905 many hospitals had ‘X-ray rooms’ with early facilities such as very hot, dark, disorganized rooms with crowded wires and apparatus, and was dangerous for patients and practitioners too. Earlier radiologists were unconcerned about daily exposure to X-rays and continued to gauge the strength of tubes, perform demonstrations, position and steady patients during diagnosis and therapy. Wives and female assistants often served as test subjects to determine if a tube was ‘ready’ for the day’s work. (BHR)
In February 1896 a physics professor at Vanderbilt University in America asked the dean of the medical school to ‘sit’ for an experimental skull X-ray. Three weeks later the dean’s hair fell out. Later in the year further similar results were reported, including redness, numbness, infection and severe pain, all these effects being associated with irradiation. In the early months X-rays were regarded as harmless and soon a variety of zinc ointments were marketed for the reddened noses and hands of ‘X-ray operators’. Although many had noted difficulties with ‘X-ray burns’ it was not until the death of Clarence Dally (the long-time assistant of Thomas Edison in X-ray manufacture and testing) in 1904, that observers finally agreed that the magic new rays could kill as well as cure. Early efforts at protection included lead screens, heavy aprons, metal helmets which caused the practice of radiology to become even more uncomfortable and difficult but provided safety. (TS)
3.2.2 HISTORY OF CLINICAL LABORATORIES
By the mid-1800s, lab tests had been introduced to detect tuberculosis, cholera, typhoid and diphtheria, but cures for these diseases would not come until later. Physicians also began to study pulse, blood pressure, body temperature and other physiological indicators with the help of simple procedures since practical instruments to measure these signs were not developed until the end of the century.
The use of precise measurements in diagnosis became standard in medicine in the early 1900s. Standardized eye tests, weight and height tables, and IQ tests were all part of a movement to identify statistical norms of human physiology and behavior.
The first hospital lab in Britain, which was set up at Guys Hospital, was organized into clinical wards. Two of these wards were designated for medical student rotations and had a small laboratory attached for clinical work.
By 1890, most laboratory procedures in the United States were performed by the physician with a microscope in his home or office. In 1898, Sir William Osler, a Canadian physician, professor, and one of the first well-known authors in the clinical laboratory literature, established ward laboratories at Johns Hopkins Hospital, where routine tests were carried out by attending physicians, and more complex procedures and research problems were referred to the pathology laboratory. An increasing number of useful laboratory tests were discovered in the second half the 1800s, and by the turn of the century, specific chemical and bacteriological tests for disease emerged rapidly.
In the 1880s, the organisms responsible for tuberculosis, cholera, typhoid and diphtheria were isolated; and by the mid-1890s, lab tests had been introduced to detect these diseases. Advances in the analysis of urine and blood gave physicians additional diagnostic tools. These innovations were the result of progress in basic science that made it possible to duplicate successful applications more rapidly than ever before. The earlier advances in immunization, such as smallpox vaccination, had been purely empirical discoveries and were not quickly repeated. Microbiology for the first time enabled physicians to link disease-causing organisms, symptoms systematically. The principles that Pasteur demonstrated in the development of anthrax and rabies vaccines now provided a rational basis for developing vaccines against typhoid, cholera and plague.
3.2.3 CURRENT TRENDS IN RADIOLOGY
The Radiology Department performs examinations and produces images from non-invasive or minimally invasive procedures performed on patients in specially equipped examination rooms. Portable radiographic and fluoroscopic equipment are being used in selected instances for imaging of patients. Patient convenience and accessibility are an integral part of the planning and designing of the Radiology Department. Flexibility and adaptability are main considerations when planning the facility in order to accommodate constant upgrades in equipment technology and treatment. Picture Archiving and Communication System (PACS) has become the standards for the capture, transfer and storage of diagnostic images. This system consists of workstations for image interpretation, a web server for distribution, printers for file records, image servers for information transfer and holding, and an archive for off-line information. PACS reading may be located centrally or remotely. For general viewing by physicians outside the Radiology Service, a typical flat screen monitor will suffice for the reading of images. A high end monitor system should be provided in areas where physician viewing and diagnosis occur.
3.2.4 FUTURE TRENDS IN RADIOLOGY
The science of Radiology has advanced greatly since its early beginnings in the late 1800’s. Whereas before we were able to only image anatomy, we are now able to image function and anatomy, including the workings of organs, cells and molecules. Radiology facilities can expect that image-guidance for minimally-invasive procedures will continue to grow. Additionally, we are likely to see increased use of hybrid modalities, such as CT, which will combine anatomic and metabolic imaging management tools to create a single composite image from multiple imaging sources.
As technology advances, it is important that our imaging facilities be designed to accept whatever changes in equipment and methods are developed. At the same time, the needs of the patient must not get lost in all this change. It is critical to provide an environment that not only addresses the requirements of technology but also addresses the needs of the patient.
3.2.4 SPACES DESCRIPTION
18.104.22.168 RECEPTION AND WAITING AREA
A reception is provided at the entrance of every Diagnostic Centre as a focus and source of information about various services rendered, prices of the services, timings, etc. (Fig.1). Most of the Diagnostic Centre’s offer billing facilities at the reception. Reception should be located at the right place near the entrance so that it is easily identified by the patients or the visitors immediately on entry. Some of the advanced centres have a digital or static signage system which display all the services, costing and timings. Separate counter facilities are usually provided for inquiries and billing. The top of the desk should be suitable for reading and writing at a comfortable height.
Figure 1: A reception desk near the entrance with various facilities for the visitors.
In front or beside the reception area will be the waiting area for patients and visitors. The area will be vast and accommodate many number of seats such as row seating. This should properly be connected with all the common areas such as stairs, lifts, corridors, lobbies and toilets for ease of access by patients, visitors and the staff members. A stand by area for a wheel chair and a stretcher at the waiting area for emergency or critical conditioned patients is always recommended.The furniture and equipment used in the reception are,
· A reception desk with two different height levels which is comfortable for both the visitors and the staff members
· Small storage in the reception desk in the form of draws or shelves.
· Computers connected to the server to refer and store records.
· Seats with proper back rest which provide comfort for long hours.
· Cash counting machine.
· Digital or static signages for advertising and to provide information.
The furniture and equipment used in the waiting area are,
· Comfortable, cushioned or hard, row or individual seating.
· Side tables with magazine holders.
· A wheel chair.
· A stretcher.
· Drinking water dispenser.
Figure 2: X-ray machine with protected operator’s control unit.
22.214.171.124 X-RAY ROOMX-ray uses a very small dose of ionizing radiation to produce pictures of the body’s internal structures. X-rays are the oldest and most frequently used form of medical imaging. They are often used to help diagnosed fractured bones, look for injury or infection and to locate foreign objects in soft tissue. Some x-ray exams may use an iodine-based contrast material or barium to help improve the visibility of specific organs, blood vessels, tissues or bone.
X-ray might be harmful to the body if it is exposed for longer durations or at higher doses. Hence proper protection is required to confine the X-rays up a certain range. Atomic Energy Research Body has set up some guidelines for the safety purpose. Any Diagnostic Centre setting up a
X-ray service must consult AERB with the requirements specified by the body and obtain a No Objection Certificate before making the service available for the public.
The furniture and equipment used in the X-ray room are,
· X-ray equipment along with a track for moving.
· A chest stand placed to the wall in the same line of the main equipment.
· Examination table on which patient lies during the test.
· Foot stand beside the examination table for convenience of the patients.
· Desk, wall or pedestal mounted operator’s console.
· Control unit.
· Protective barrier with 2mm thick lead glass for viewing.
X-ray machine requires a 3-phase line with nominal voltage of 380 V – 480 V.
126.96.36.199 ULTRA SOUND ROOM
Figure 3: Ultrasound machine with an examination table.
Ultrasound is safe and painless, and produces pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or sonography, involves the use of a small transducer (probe) and ultrasound gel placed directly on the skin. High-frequency sound waves are transmitted from the probe through the gel into the body. The transducer collects the sounds that bounce back and a computer then uses those sound waves to create an image. Ultrasound examinations do not use ionizing radiation (as used in x-rays), thus there is no radiation exposure to the patient. Because ultrasound images are captured in real-time, they can show the structure and movement of the body’s internal organs, as well as blood flowing through blood vessels.The furniture and equipment used in the Ultrasound room are,
· Ultrasound machine.
· Examination table.
· Foot stand beside the examination table for convenience of the patients.
· Doctor’s desk with a computer.
· Storage cabinets.
· Film viewer.
· A sink with hot and cold water.
Ultrasound machine requires 120V – 240V power supply. Suitable temperature conditions are 20?C – 26?C.
188.8.131.52 CT SCAN ROOM
Computed tomography, more commonly known as a CT scan, is a diagnostic medical test that, like traditional x-rays, produces multiple images or pictures of the inside of the body. The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or transferred to a CD or DVD.
CT images of internal organs, bones, soft tissue and blood vessels provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels. Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancer, cardiovascular disease, infectious disease, appendicitis.
The furniture and equipment used in CT scan room are,
· CT gantry.
· Movable examination table.
· Operator’s console.
· Injector beside the CT gantry.
· Power distribution unit.
· Review system cabinet.
An observation room is attached to the CT scan room and may contain