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Planning of Radiology Department

Raunaklaxmi Laul

Since the discovery of X-rays by Roentgen in 1895 The planning of the radiology department is based
radiology has come a long way. No other medical upon the daily patients flow, not on the total capacity
science has seen such explosive development. This of the hospital. That means, if up to 100 X-rays needs
facilitates the need for appropriate planning and to be done daily one X-ray machine is sufficient, but
management of radiology departments as it takes into in the setting requiring more than 100 X-rays daily
accounts a hoard of modalities which require careful at least two X-ray machines are required. Similarly,
installation, sophisticated handling, and effective one ultrasound machine is enough if daily up to 80
management. In addition to this there is also need for sonographies needs to be done, for more sonographies
appropriate protective measures to be taken to protect one more machine will be required. So, the strategy for
the staff, patients and the general public from the planning the radiology department is influenced by
radiation hazards arising due to the use of radiations. the workload.
Thus a careful, well-considered planning is needed for
the effective working of a radiology department with
PLANNING CONSIDERATIONS
effective accommodation of any future developments.
The planning strategy has been described under Planning of the department should include three
following headings: critical steps:
zz Modalities 1. Physical planning
zz Planning considerations and organization of 2. Strategic planning
department 3. Visionary planning.
zz Safety considerations and protective measures.

zz Housing modalities for imaging equipment

zz Maintenance and management.

Physical Planning
The physical planning of the department takes into
consideration the area, location and other basic points:
MODALITIES zz Location: The radiology department should be

The radiology department works on basis of variety of preferably located on the ground floor which
modalities incorporated in one department with the facilitates easy access to the patients and also
objective of should be well connected to the OPD, emergency
zz Providing high quality imaging service and the indoor services. The department should be
zz Establishment and confirmation of clinical located away from maternity and pediatric wards
diagnosis to prevent radiation hazards.
zz Providing high quality therapeutic radiology zz Size: The size usually depends on the hospital size

services and the number of machines to be installed but

zz And research and training. it should also be adequate to permit appropriate
Thus, the various imaging modalities used are: ventilation and accommodate radiation protective
zz X-ray machines barriers.
zz Fluoroscopy machine for special procedures zz Area: It should include administrative, ancillary

zz Ultrasound machine with Doppler and auxiliary area in addition to the Functional
zz Computed tomography (CT Scan) area which houses the machinery.
zz Magnetic resonance imaging (MR) zz Administrative area: Includes reception with

zz Mammography patient registration counter and announcing

zz Digital subtraction angiography (DSA). system, Patient waiting, offices of head of the

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 114 Textbook of Radiology: Physics

department and other radiologists on staff, offices and ancillary area with separate air conditioning with
for nursing and technical staff. temperature control for CT and MR, nuclear imaging
zz Ancillary area: It includes film library with record area, X-ray, mammography, procedure room and USG
room, store for supplies, and ample circulation room. There should be adequate air-conditioning
space for patients, staff and trolleys. It should for the digital processing and printing room. If the
also accommodate toilets and changing rooms department needs to have provisions for teleradiology
for staff and patients and seminar room for case then a separate console has to be made with internet
discussions. access. In addition to this adequate imaging soft wares
zz Auxiliary area: Includes patient preparation room with local network connection are to be connected in
and reporting desks. all the radiologists’ rooms to provide easy reporting, it
zz Functional area: It actually houses the necessary should have connection to all consoles for aggregation
machines and hence should be well shielded and of all types of images on the computers. The book and
all the possible protective measures are needed film library should also preferably digitalized and
to be taken to ensure protection of workers and include the seminar room. The store should be well
patients in accordance with the guidelines of equipped with all the required accessories like digital
atomic energy regulatory board. It should include cassettes, X-ray, CT and MR films, lead aprons, gloves
the X-ray rooms with adjacent fluoroscopy room and shields, printing papers, envelopes for film and
for special procedures. A mammography unit report dispatch, stationary, printer cartridges, and
and the DSA unit should also be adjacent to X-ray cleaning material. The record room should be updated
rooms so that all radiation causing modalities are preferably weekly with all modality records arranged
segregated together. CT and MR are to be installed and kept separately. There should be some system in
in such a way that they can have a common working record arrangement so that a certain patient’s record
and reporting console for the ease of the patient on a certain date can be found if required without
and the radiologist. Ultrasound and Doppler problems. The department should be well lit and
should be incorporated together and should have ventilated and kept clean to ensure healthy working
separate toilet facility for patients. In addition to environment.
this a central printing and processing room should The department should be adequately staffed,
be created with adequate implantation of PACS to so that it should work smoothly. Staffing depends
facilitate X-ray and procedure film processing and upon the work load, types and timings of the services
printing and should be connected by local area provided. There should be a standard operating
network to CT and MR console for film printing. procedure for all categories of staff to ensure overall
There should also be rooms for report typing smooth organization and functioning. The staff should
separately for the X-ray, CT and MR, Ultrasound include:
and nuclear imaging modalities. zz Radiologists: Head of department, senior and

All these rooms should be well shielded between junior consultants, senior and junior residents.
actual machinery and the staff area to prevent zz Technical: Supervisor, senior and junior technicians

radiation hazards with and optimal distance of at least for all modalities, radiographers for processing and
3 meters between the machine and the control panel. printing, assistants for ultrasound.
All the machine housing areas and control panels zz Nursing: Sister in charge, both male and female

should have a three phase (40 kilo watts) electrical staff nurses trained in patient preparation and
supply with double earthing and back-up for the emergency care.
central processing units with generators. It should zz Others: Receptionist, typists, storekeeper, cleaning

ideally be separate from the main supply of the rest of assistants and library attendant.
the hospital. The switch should be located at a height zz The technicians should be well distributed to be

of 1270 mm from the finished floor with a copper strip available for working and emergency hours.
below the main switch. Voltage should be ideally of 415
volts, with 50 Hz frequency and 0.36 ohms of resistance
Strategic Planning 
from phase to phase. The generator should be 2 pulse
generator to run the sophisticated machinery in Strategic planning  is an organization’s process
case of an emergency in power failure. Wiring used of  defining  its direction, and making decisions
should be of size 12 square millimeters made up on allocating its resources to pursue this  strategy.
of copper. There should be air conditioning of the As radiology continues to grow, radiologists must
department centrally for the administrative, auxiliary preparing radiology for the future. Decisions in

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 Planning of Radiology Department 115

capital investments, diagnostic clinics, and payment The overall planning of radiation protection should
and liability on loans will require the radiologists to include:
develop and follow up managerial, interpersonal, and zz Staff: The distance between the control panel to

learning skills that were not as necessary in the past. regulate a machine and the actual machine should
be at least 3 meters. Appropriate lead shielding has
to done in all the areas housing radiation with lead
Visionary Planning
equivalence of at least 1.5 cm. All staff members
Visionary  planning is thinking about the future or should be instructed to wear lead aprons, gloves,
advancements in a creative and imaginative way. masks and gonadal and thyroidal shields. All
A person who is ahead of his time and who has a personnel should also use the radiation monitoring
powerful plan for change in the future is an example devices like TLD badges.
of a  visionary. This includes thinking critically and zz Patients: There should be adequate optimization of

constructively about planning future work spaces. radiation dosage to patients by minimizing the area
New approaches to radiology department design are of exposure, use of appropriate devices to control
illustrated by describing care environment and then scatter radiation and periodic quality control and
examining the resultant facility requirements, the calibration of machines. There should also be
architecture is beyond the building design. Facilities patient shielding with thyroid and gonad shielding
programming is not only projecting departmental and menstruating women should be subjected to
need for the near term but raising questions: why, why radiation only after confirming that they are not
not, how, what, when, if’s and but’s be evaluated. pregnant.
zz Public: There should be demarcation of the

SAFETY CONSIDERATIONS AND radioactive areas for public protection. Department

should be located away from main traffic. The
PROTECTIVE MEASURES
construction should be with brick and concrete
Safety measures to be taken while installing a radiology walls at least 1.5 to 2 ft thick. Lead shielding of
department are based on the concept of ALARA which 1.5 mm equivalence should be done along all the
means as low as reasonably achievable radiation. external and internal walls. There should be signs
Radiation protection has to be planned prior to the indicating hazards and light signs to indicate
construction of the department and it should be ongoing of a procedure at all the necessary places.
according to the guidelines of radiation protection rule Radiation warning boards in light yellow color
1971 under atomic energy act 1962. The plan has to be should be put on all the entrances to demarcate
submitted and approved by Atomic Energy Regulatory the departmental area. There should also adequate
Board (AERB) at Bhabha Atomic Research Center, disposal of all radioactive and nuclear wastes.
Mumbai. There should be awareness amongst the staff,
patients and public regarding the radiation hazards HOUSING MODALITIES FOR
and effective protective measures.
IMAGING EQUIPMENT
Radiation hazards can be:
zz Deterministic effects which do not depend on Installation for radiation housing modalities (Fig. 22.1)
radiation dosage like X-rays, fluoroscopy and IITV, mammography,
zz Stochastic effects which depend on radiation CT should be in accordance with guidelines of AERB
dosage safety code made in 1986 which was revised to form the
zz Somatic and genetic effects ‘Medical diagnostic X-ray equipment and installations
zz Acute and chronic effects. code’ which has incorporated all the suggestions of
Acute effects usually occur due to heavy dosage International Commission of Radiation Protection
in short period of time, it consists of convulsions, (ICRP) guidelines. All the departments have to submit
headache, blurring of vision, nausea, vomiting, colicky a layout of the rooms and then obtain a no objection
abdominal pain, aplastic anemia, blood dyscrasias, certificate along with approval of Radiation Safety
and bone marrow depression. Officer before installation. The layout has to be send to
Whereas chronic effects usually occur due to AERB along with the prescribed form and the necessary
continuous short dose exposure. They can be loss fees to obtain approval. Also the list of personnel
of hair, burns, brittle nails, amputations, anemia, working, safety measures taken and TLD badges
leukemia’s, leukopenia, cataract, iridocyclitis, sterility, obtained has to be submitted. License for working is
cancers, and mutations. issued only after inspection of the site by the authority.

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 116 Textbook of Radiology: Physics

Abbreviations: C; changing room, W; washroom, CP; control panel

Fig. 22.1  Installation for radiation housing modalities

The license approved has to be renewed periodically. 1.7 mm lead equivalence should be done on the
In case of obtaining radioactive isotopes for nuclear walls and the doors and windows.
scanning additional approval has to obtained for zz Ventilation and natural light opening should at
periodic availability of radioactive material. There use least be above a height of 2 feet from the finished
has to be strictly monitored. floor.
The required provisions for all the X-ray housing
rooms are: Diagnostic X-ray, Fluoroscopy and IITV,
zz Area should be such that it provides integrated
Mammography, DSA Rooms
facility of the unit, console and the waiting area.
Also the room size should permit installation, use zz Diagnostic X-ray: (500 milliamperes) a single
and servicing of equipment. As the radiation dose room should be of 18 square meters size with
is inversely proportional to the area hence the no dimension less than 4 meters. The brick
rooms should be more than 18 square meters for construction and shielding should be according
diagnostic X-rays and more than 25 square meters to AERB guidelines mentioned above. Two
for CT with no dimension less than 4 meters. There adjacent rooms should have a brick partition
should be preferably one door located such that no with thickness of 23 cm. The tube housing should
primary beam falls on it. be constructed such that the leakage radiation
zz Shielding: It is required for all walls, ceiling and on through the protective tube in any direction is
the floor if the department is not on the ground for not more than 100 square centimeters and
floor. By keeping doors and windows away from the it should not exceed 1 milligray per hour in a
primary beam the cost for their shielding decreases distance of 1 meter from the X-ray unit when the
leading to cost effectiveness. The walls on which tube is operating at maximum kilovolt peak and
the primary beam falls should be 35 cm thick and tube current. There should be a visible mark on
the walls on which it doesn’t should be at least the tube housing to indicate plane of focus. Beam
23 cm thick. In addition to this lead shielding of limiting collimators should be provided with

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 Planning of Radiology Department 117

beam filtration of at least 1.5 mm of aluminum. zz Mammography: The required dimensions are
The cable length of the equipment should not be 10 m2 with 23 cm thick brick construction and
less than 3 m and the control panel should also 1.5 mm lead lined doors. The control panel in the
be at least 2 m away with lead shielding of 1.7 mm room should have a 1.5 mm thick lead protective
lead equivalence. If the machine operates above glass. The tube housing and shielding is similar to
125 kVp then control panel should be constructed that of an X-ray unit. The beam limiting devices
in a separate room. The control panel should used should be such that at any target to receptor
indicate and enable control of exposure distance the beam size should not exceed beyond
parameters and an identifiable indicator to show any edge of receptor. The transmitted dose should
whether the X-ray beam is on/off. There should be less than 1 µGy/exposure at 5 cm beyond the
be an exposure switch to terminate the X-rays breast support with no breast tissue present.
manually or after a preset timer. Radiation leakage Beam filtration should not be less than 0.03 mm
from the transformer surface should not exceed of molybdenum. The cable length should be a
5 µGy in any direction in one hour. There should be minimum of 3 m with a control panel similar to
adequate illumination control. The waiting area is that of X-ray room. The breast compression device
demarcated and should have a conspicuous light should be such that it assures uniform thickness of
to indicate ongoing of procedure. There should be the compressed breast with adjustable degree of
a adjacent changing cubicle preferably in the room compression.
or adjacent to it with shielding of 1.5 mm lead zz DSA: The minimum area requirement is of
equivalence. 18 m2 with no single dimension less than 4 m and
zz Fluoroscopy and IITV: The dimensions of the room the control panel should have a lead viewing glass
should be same as the diagnostic X-ray room with of thickness 2 mm. The construction should be of
similar tube housing. Beam filtration should not 23 cm thick brick wall with 2 mm lead lining the
be less than 2 mm of aluminum. There should be doors and windows. Most of the required structure
a protective lead glass covering the fluorescent is similar to that of an IITV room. The image
screen with a lead equivalence of 2 mm for units intensifier used should have an intrinsic resolution
operating up to 100 kVp. For units operating at of atleast 4 line pairs/mm at a modulation transfer
higher kVp lead thickness should be increased at a value of 0.1. The video camera used should have
rate of 0.01 mm/kVp. Lead rubber flaps of 0.5 mm a signal to noise ratio greater than 500:1. There
lead thickness should be suspended from bottom should be proper use of personnel monitoring
of the screen so that they overlap the fluoroscopy devices.
chair. X-ray tube and screen should be coupled zz CT and MR: CT and MR units should have a
and aligned to move together synchronously and common console since most of the times a
the X-ray beam should pass through the center of correlation and comparison is necessary between
screen in all positions. There should be field limiting both the modalities. The total area comprising of
diaphragms which are manually controlled so that both the units should be 150 m2. As CT generates
when the diaphragm is fully opened and screen is radiation, its layout has to be in accordance with
at maximum distance there is still an unilluminated the AERB guidelines. Area of 25 m2 is used with 23
margin of at least 1 cm along all the edges cm thick brick wall construction with 2 mm lead
of screen. Control knobs should have a shielding shielding on the walls for 100 kVp and additional
of 0.25 mm lead. Table top to focus distance 0.01 mm/kVp from 100 to 150 kVp and 2 mm thick
should not be less than 30 cm and the table top lead shielding on the doors and windows. The
exposure shall not exceed 5 µGy/min. There should console should have a 2 mm thick lead viewing
be a control panel similar to that of X-ray unit. glass. Tube housing is similar to that of X-ray rooms
IITV (image intensifier television system) and the filter provided should be a bow-tie filter for
unit’s tube housing is similar to that of general both beam hardening and beam flattening. Visual
fluoroscopy. It should have a permanently indicators should be placed for control on console
incorporated protective barrier. The transmission and on gantry to indicate scanning in progress.
through the barrier with the scatter should not Space should be enough to facilitate the gantry tilt.
exceed 20 µGy/hour at 10 cm distance from any Adequate warm up of the tube should be done and
accessible surface. Table top exposure should be there should be warning signs put on the doors and
less than 5 µGy/min and entrance exposure should the console to indicate warm-up in progress. There
not be greater than 3 µGy/exposure or 0.3 µGy/ should be provision for oxygen support for patients
frame. and emergency drug tray.

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 118 Textbook of Radiology: Physics

The common console for CT and MR should have Helium should have access around and above the
a 2 mm lead viewing glass on the side adjacent magnet. There should be space for equipment
to CT and radiofrequency (RF) shielded wall and storage and centralized control of temperature and
glass for the MR side. There should be a waiting humidity factors as they affect the cryomagnetic
area for patients especially those on oral dose of CT substance and the magnetic field. Patient gurney
contrast with additional space for patient changing and oxygen support inside the scanner room
room, toilet and reception and doctor’s room. should be made up of MR safe materials. Warnings
MR uses the technology of a high strength are to be displayed on all the entrances to indicate
permanent magnet which generate magnetic field presence of strong magnetic field and access
after passing electricity through magnetic coils should be granted to authorized personnel only.
which are bathed in cryogenic liquids like helium zz Ultrasound with Doppler: Before installation of
to make them superconducting. These magnets are the ultrasound machine PNDT registration has
to be shielded to allow MR scanners to be located to be obtained. The preconception and prenatal
in vicinity of objects sensitive to magnetic fields sex determination act (PCPNDT) keeps check
such as building structure, elevators, vehicles, etc. on illegal sex determination of the fetus. The
Shielding can be done by: machine to be selected on the basis of patients to
—— Radiofrequency (RF) shielding: Done to be scanned and usually it should be well equipped
prevent incidental RF energies from entering with a convex and linear probe, Doppler facility,
the scanning room and disrupting image Intracavitatory probe and if needed provision for
acquisition process. Construction of thin 3D and 4D ultrasound. The machine should have
sheets of copper foils is done on all the integrated facility to store images. The prescribed
walls, ceiling and flooring and all the doors form for PNDT approval then has to be filled with
and windows. All the power cables exhaust the required documents and then the approval
and piping should pass through RF shielded is obtained. The machine can be installed only
enclosure and special RF filters. after the PNDT registration. This also needs to
—— Passive shielding: Done in addition to RF be periodically renewed. In cases of obstetric
shielding in forms of sheets of laminated steel ultrasound consent of the patient has to be taken
alloy and is usually done on opposite walls with completion of forms and records which
interior to that of RF shielding. It is done to are checked by the appropriate authority on
attenuate the magnetic field. It should be inspection. It is also preferable to keep records of
engineered such that minimal distortion of other general ultrasound. A board displaying the
magnetic field occurs at the center of the PCPNDT act and the fact that sex determination is
scanner. Passive shielding is usually provided not be done is to be displayed in English and the
with the scanner. local language at the entrance, waiting and in the
Shimming is done to correct disturbances caused ultrasound room. Ultrasound room area should
by ferromagnetic materials. The shim tolerance is be of 25 m2 for two machines with a partition.
provided with the scanner. For a 1.5 T magnet area The ultrasound facility is to be kept away from
where the magnetic field is equal to or greater than radioactive modalities to avoid radiation hazards.
5 gauss should be restricted and use should be There should be a separate toilet for the ultrasound
allowed only to authorized personnel and patients patients. The room should have provisions for
who have removed all the ferromagnetic substances oxygen support and emergency drugs. If under
and are screened adequately before the scanning. guidance interventional procedures are done
Patients with implants, hearing aids, pacemakers then consent of the patient is taken in writing.
are not suitable to undergo MR scanning High There should be accompanying staff nurses while
amperage power transformers, electric switchgear doing TVS/TRS ultrasound and routinely for
should be kept at a distance prescribed by the assistance.
vendor with the scanner. Vibration testing of the zz Processing and printing room (CR): In addition to
floor has to be done so that it is minimum. Usually there should be a printing and processing room
with departments on ground floor this problem near to the X-ray room of 15 m2. This room should
is minimized. The room should be 30 m2 in area. have the CR facility for processing and printing the
The brick and concrete construction should be digital X-ray images. PACS is to be implanted so
adequate to absorb the acoustic noise emanating that the acquired images are processed and stored,
from the scanner. There should be additional space retrieved and presented in the DICOM format. The
adjacent to scanner room to store the helium tank. CR system is to accompany with a digital cassette

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 Planning of Radiology Department 119

reader and a laser printer. The system should be and cost effective service with increase in the life of
equipped for processing general X-rays, procedure the instruments. In addition to this there has to be an
films as well as mammography and DSA films. annual maintenance contract (AMC) with adequate
The CT and MR console is to be connected by warranty/guarantee and emergency breakdown
local area network to the laser printer for printing maintenance to be provided by the machine vendor.
of CT and MR films. There should be adequately There should be provision for local technical support
trained technicians working in this room to ensure to prevent hampering of work.
proper processing, printing and segregation of data Management issues are to be tackled to ensure
according to the respective modalities. efficient functioning of the department. Planning
of infrastructure, manpower and equipment is to be
done with organizing hierarchy and job responsibility
MAINTENANCE AND MANAGEMENT
distribution with maintaining a standard protocol and
The equipment installed are to be maintained staff discipline. There has to be periodic evaluation
adequately for their smooth working and hence require to ensure adequate input is put forward to achieve
regular technical support in the form of adequate and favorable output in terms of quality of reporting
intelligent use and daily careful handling so that there is and films with intradepartmental and patient
reduction in the usage time, and availability of credible satisfaction.

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