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The healthcare industry has gone through a huge metamorphosis in the last seven to ten years. In the U.S. the not-for-profit community hospitals evolving to managed care and Integrated Health Networks IIHN). The public has realized a change in how they evaluate medical care options and how they receive healthcare and healthcare services. The individual who used to go to his physician for health care nos is required to go through a myriad of managed care providers.

On the delivery side, the manufacturers, vendors and distributors have experience the cost constraints of managed care but in a different fashion. The impact on the healthcare delivery system has been significant and dramatic financially. It is expected to provide healthcare products, services, equipment and information in a much more efficient manner.

As a medical imaging equipment and supply distributor with 35 employees, our position in the marketplace is competitive with companies with more extensive resources at their disposal. When a hospital, medical center or clinic is evaluating vendors for its imaging/capital equipment, the expectation is that we (Associated X-Ray Imaging Corp) will provide the same information, support or services that the larger entities can and will provide. This is of particular importance with medical x-ray equipment in that is may be a replacement system, a newly designed suite or a new construction with engineering �from the ground up�.

In the evaluation process, administrators, CFOs, radiology managers and architects often base their decision regarding imaging equipment on critical engineering and space planning criteria. For example, the design of the room and the allocated space along with the available power, structural steel, etc. may determine the configuration of the system that is ultimately purchased.

I began using Vision Technical 4.0 approximately three years ago for the purposes of planning and engineering these medical x-ray imaging systems. The first step was to familiarize myself with the software to create building layout and adjacent space of a typical x-ray or radiology department or clinical area. The second step was to create and load approximately 30 stencils that represented the typical footprint of the size and shape of the typical x-ray imaging systems that we sell and install. The third step what to incorporate the particular engineering criteria from the manufacturer of the specific system being proposed.

The Process
We use a multi-step process to deliver our services:

The process begins with a typical proposal being presented to the healthcare facility for an imaging system that incorporates a particular x-ray generator, tables, overhead tube crane assemble and upright wall receptor units and other ancillary equipment (transformers and cabinets, etc). The configuration of these components is derived from the clinical and technical requirements of that facility.
The second step in the process is the site visit, which is a crucial step in the process. During the site visit, it is imperative that not only the size and shape of the areas to be used be accurate in measurement, but also the structure and usage above and below the room, as well as those criteria adjacent to the room on that same level. This information is used to formulate the necessary lead radiation shielding required by state or federal regulations. An attempt is made at this juncture to obtain blueprints or as �built� drawings of the space/area involved (or AutoCAD for importing).
Using Visio Technical 4.0, a preliminary or conceptual drawing is prepared and presented to the customer for review. This conceptual drawing basically represents the placement, location and movement of the components that are configured in the x-ray system being proposed. Measurement and patient flow are critical in this review (i.e, will there be patients in wheelchairs through this area? Will there be patients on stretchers through this area? What is the anticipated or projected volume of exams for this room, type of procedures to performed? All these factors are scrutinized to the extent of affecting the design of the ultimate suite. During this step, revision will take place and various components will be rearranged until the customer is satisfied with the design and layout. For new construction and for renovations, this is the point where adequate and appropriate space allocation and location and/or moving of walls becomes critical for future growth and potential upgrades.
The forth step in the process is preparing more detailed drawings for the customer and the architect, as well as site preparation information for the contractors and subcontractors. Equipment and engineering specification are now included in the various layers that will be provided after the contract for the project has been awarded. A typical radiographic or fluoroscopic system has five layers to the drawing.

Frequently, our ability to work with the customer and modify or reconfigure the system to accommodate the existing space makes us the vendor of choice with a creative attitude and approach. Figure 1 shows a typical example of a preliminary drawing for a standard radiographic system to be presented for initial review by the customer. Because the x-ray systems are always color coded, it is easy for the customer (including non-radiology personnel) to differentiate components in the x-ray/imaging system. It is also easy to evaluate clearance measurements as well as the overhead tube crane.

U sually a second site visit would be required with the customer and/or subcontractors to review specifications and engineering requirements that are going to be incorporated as exact location of structural steel, junction boxes, EMT conduits, circuit breakers and any other ancillary components in the system. The various layers for the contractors are also color coded and labeled, making the responsibility of each subcontractor easily discernable.

Figure 2 show an example of an intermediate drawing of a digital radiographic/fluoroscopic system. Note four layers and measurements. This system is a digital acquisition system that incorporates and imaging network, showing the fiber optic path to the laser camera and T1 line.

By using Visio software, I have been able to turn around preliminary and intermediate/final drawings for the customer in a relatively short time. It has also allowed be to produce accurate, easy-to-read and understandable drawings. These layout and technical drawings, as well as an invaluable tool in the management of these complex projects.

This is a reprint of an article appearing in Technical Design Solutions, Fall 1999, Authored by Russ Leibe, Russ is Vice President, Sales and Marketing for Associated X-Ray Imaging Corporation.