Ron was provided descriptions of three case studies to review: 1) Improving the design of a CT suite recommended by a vendor, 2) Expediting the installation of a radiographic room for the Emergency Department, and 3) Refining the design of filmless reading rooms for the transition to digital. The document then provides more details on each case study, including initial conditions, proposed designs, outcomes, and key takeaways emphasizing the use of techniques like workflow analysis drawings, simulation, and addressing all stakeholders' needs.

2. Ron,
Attached are the descriptions of three case studies.
Would you like to review the outcomes?
#1. To improve upon the design of a CT suite
recommended by a vendor.
#2. To expedite the installation of a radiographic room for
use by the Emergency Department.
#3. To refine the design of filmless reading rooms for the
transition from film-based reading rooms to digital reading
stations.
Ken

3. Example #1. Vendor’s recommended CT Design
Questions, concerns, suggestions for improvement?

4. Questions, concerns, suggestions for improvement?
4’ 11”

5. Questions, concerns, suggestions for improvement?
4’ 11”
Key Takeaway
Be extremely cautious of
installation advice provided
by vendors.

6. Example #2. Actual Case Study
Expedite installation of an emergency radiographic room
Room dimensions:
20’ x 24’
Starting Point:
• Current room to be taken out of service within 30 days
• Am not to look at anything else whatsoever for following reasons:
1. Any other changes would jeopardize getting this room installed
quickly.
2. There are – and will NOT be - any funds approved for doing
anything else for at least one year if not more.
6

7. Typical radiographic equipment
• Chest board for chest x-rays on back wall
• Radiographic table on which some patients lay
• X-ray tube hangs from ceiling mounting so it can move
about the room to aim in any direction
• Casework for supplies
Source: Google: Radiographic room design. Then select: “Images for radiographic room design”,

8. Key Takeaway
Always identify an existing
site to use as a benchmark
for your design early in
your planning process.
Typical radiographic equipment
• Chest board for chest x-rays on back wall
• Radiographic table on which some patients lay
• X-ray tube hangs from ceiling mounting so it can move
about the room to aim in any direction
• Casework for supplies
Source: Google: Radiographic room design. Then select: “Images for radiographic room design”,

9. Assignment
Seen below is a layout for a radiographic room that pops up if you go to the Google site
listed below*. Using this layout or other information from this web site, create a layout on
the attached slide which is to be turned in at the start of class on Tuesday.
*To see this drawing as well as many photographs of radiographic rooms, Google: Radiographic
room design. Then select: “Images for radiographic room design”, “Images for . . .”

10. Assignment
Seen below is a layout for a radiographic room that pops up if you go to the Google site
listed below*. Using this layout or other information from this web site, create a layout on
the attached slide which is to be turned in at the start of class on Tuesday.
Key Takeaway
Be extremely cautious of
advice from Internet.
Watch for red flags.
*To see this drawing as well as many photographs of radiographic rooms, Google: Radiographic
room design. Then select: “Images for radiographic room design”, “Images for . . .”

11. Classroom exercise #1 for ISE 541
Recommended design for a radiographic room
Turn in at start of class on Tuesday
Print Name (legibly) _________________
11

12. Actual Case Study
Expedite installation of an emergency radiographic room
Room dimensions:
20’ x 24’
Starting Point:
• Current room to be taken out of service within 30 days
• Am not to look at anything else whatsoever for following reasons:
1. Any other changes would jeopardize getting this room installed
quickly.
2. There are – and will NOT be - any funds approved for doing
anything else for at least one year if not more.
12

13. 2
4
3
ED
Supplies
1
Existing Conditions
Emergency 1. Current ED Radiographic Room to be taken out of service within 30 days to create new Corridor
Department 2. CT for Emergency use is in NE corner of Radiology Department
3. Single slice CT is obsolete, not used for Emergency work. CT to be replaced in future.
13
4. Second MRI needed. Plans being developed to install in vacant interventional room.

14. 2
4
Key Takeaway
Create a “Functional Drawing”
for conducting an initial
current state assessment to
ED
Supplies
3
understand the big picture.
1
Existing Conditions
Emergency 1. Current ED Radiographic Room to be taken out of service within 30 days to create new Corridor
Department 2. CT for Emergency use is in NE corner of Radiology Department
3. Single slice CT is obsolete, not used for Emergency work. CT to be replaced in future.
14
4. Second MRI needed. Plans being developed to install in vacant interventional room.

15. New corridor
Outcomes:
1.Expanded space allocated from renovation from Angio Supply Room only to that seen above
2.Gained approval to install new CT within this space..
15

16. New corridor
Outcomes:
1.Created an MRI suite which also freed up space for future interventional work..
16

17. Key Takeaway
Use “Functional Drawing
Tools and Techniques to
improve upon drawngs
done by architects..
New corridor
Outcomes:
1.Created an MRI suite which also freed up space for future interventional work..
17

18. Net Result of Intervention and
Use of Tools
• Radiographic room was enlarged and
redesigned.
• An Emergency Room suite was created
with CT and Radiographic Rooms along
with ancillary support spaces..
• A second MRI was justified and installed
within space previously occupied by a CT

19. Example #3: Dartmouth-Hitchcock Medical Center
“Minimizing the spaghetti.”

20. Conditions of Engagement:
1. “To look only at design of new filmless radiology
reading rooms (PACS) and nothing else.”
2. “Do not expect to make any changes as project
is over budget and behind schedule.”
3. “CT suite is absolutely off limits. It is done.”
KJA

21. Example of one of the proposed designs for
filmless reading room.
What, if any, changes would you propose for
this reading room? KJ/MCExam

22. AHRA 2003 Annual Meeting
Optimizing Radiology
Workflow and Productivity
Monte G. Clinton, FAHRA
Administrative Director
Dartmouth-Hitchcock Medical Center
monte.g.clinton@hitchcock.org
Kenneth C. Johnson
President
Kenneth Johnson and Associates, Inc.
kjandassoc@aol.com

23. Dartmouth-Hitchcock Medical Center

24. Dartmouth-Hitchcock
Medical Center Hospital
Corridor

25. Workflow Analysis Techniques
Create drawing to illustrate workflow at 15,000’
Case Study: Dartmouth-Hitchcock Medical Center
“No changes to be made to basic design, but was given
approval to suggest refinements.”

26. Workflow Analysis Techniques
Continue to zoom in and analyze workflow from everyone’s
perspective.
OP, ED
IP

27. Workflow Analysis Techniques
Analyze workflow by tracing everyone’s footsteps
Key Takeaway
Use “Spaghetti Drawings” to
first understand workflow, then
improve upon it.
Color Code
Red = Patient
Blue = Technologist
Green = Radiologist

28. Workflow Analysis Techniques
Analyze workflow by tracing everyone’s footsteps
Color Code
Red = Patient
Blue = Technologist
Green = Radiologist

29. Workflow Analysis Techniques
Zoom in until at “ground level.”
Yellow shaded
area represents Note challenge in
operator’s line of getting patient
vision when into room,
looking at particularly if IV
console. To see pole, etc.
patient, operator
looks to left.

30. Workflow Analysis Techniques
Simulate the design using scale models putting yourself in the
driver’s seat.
Proposed design before simulation

31. Workflow Analysis Techniques
Involve radiologists and all staff in simulating various designs.
Design resulting from simulation.

32. Workflow Analysis Techniques
Involve radiologists and all staff in simulating various designs.
Key Takeaway
Conduct full-scale mock-
ups or use scale models to
develop designs and
illustrate the final outcome
you desire..
Design resulting from simulation.

33. Workflow Analysis Techniques
Strive to minimize the travel for all parties
(Minimize the spaghetti)
Design resulting from simulation.
4th CT moved to Emergency Department.

34. Net Result of Intervention and
Use of Tools
• One CT was moved to ED.
• CT Suite was redesigned to improve
workflow.
• Designs of PACS reading rooms were
significantly improved upon.
KJ/MC

35. Comments?
Questions?
Feedback?
Monte G. Clinton, CRA, FAHRA
monte.g.clinton@hitchcock.org
Kenneth C. Johnson, President
kjandassoc@aol.com