Saturday, April 12, 2008

Planning Ultrasound Rooms

Ultrasound is a diagnostic tool that has evolved greatly in the past 5 years. The systems have branched into 2 primary types: Abdominal and Vascular. The same units can accomplish either procedure, however different software and probes are used. The most common procedure is the fetal ultrasound, used to visualize the fetus of a pregnant mother.

Medical equipment planners can help design a space but offering the design team insight into the use and function of the technology.

I will start with a review of the abdominal ultrasound:

The ultrasound unit is roughly 3/4 the height of a domestic refrigerator and about the same width and depth. There are also very small hand-held units available, but the traditional sized machines are still the primary workhorse in both hospital and outpatient settings. The features and capabilities have grown more robust in a number of ways. The range of options now includes 2D, 3D, and 4D visualization software. There are various probes (The scanning instrument that is tethered to the unit) are also more varied, with each probe "tuned" to scan different body parts and organs.

Here is a video offering some perspective on the use and 2D, 3D and 4D ultrasound.

In addition to fetal ultrasound, the liver, kidneys, and other abdominal structures can be imaged.

With all of these technological enhancements, the requirements for the room itself have remained largely unchanged.

A room that is dedicated to abdominal ultrasound should have the following:
1. An easily darkened room. Any exterior windows should have curtains or blinds capable of being drawn. The room lighting should be on dimmers or switched to allow the lighting to be reduced by at least 70% or more. This allows the monitor to be more easily viewed by both the ultrasound technician and the others.

2. Easy access to a bathroom. For fetal ultrasounds, the patient (Pregnant mom) is asked to drink about 1 litre of water prior to the ultrasound. This fills the bladder and helps to produce a sharper image. The patient is asked to "hold it" for the ultrasound, but will want to use the bathroom almost immediately afterward.

3. Room for family members. Ultrasound is a diagnostic test that produces no x-rays and uses no contrast agents, so a family member can easily accompany the patient into the exam room. An exam table or stretcher is usually placed in the center of the room. While this allows 360 degree access around the patient, the primary reason for this configuration is it allows the ultrasound unit and operator to occupy the space to the right-side of the patient and the left side is available for a family member to stand and view the ultrasound. It also allows easy access for the patient.

4. A remote video monitor placement. The monitor on the ultrasound unit is for the ultrasound technician to use. It may be in a bad location to be viewed by the patient or the family members. A hard copy image is usually printed for the patient to take with them, but it is preferred to allow the others in the room to have easy viewing access. A ceiling or wall mounted video monitor will allow easy viewing and avoid any issues with the patient moving around to view the image or any family member leaning into the technician's "comfort space" to get a closer look.

Vascular Ultrasound:
Physically there is very little difference about an ultrasound unit used for vascular procedures. A vascular ultrasound will look at the structure and blood flow within the heart, the specific valves and chambers of the heart, as well as the veins and arteries that make up the circulatory system. Common ultrasound procedures include the neck, leg and heart. An ultrasound study of the heart is called an echo cardiogram. These are often done using what is called a "stress" test.

The stress test simply refers to elevating the patients heart rate prior of the study. There are two types of stress test: An exercise stress (The patient walks on a treadmill or up and down a small fight of stairs) or a Pharma stress (The patient is given an injection that increases their heart rate.) The pharma stress is used if the patient is physically unable to walk or exercises to increase their heart rate.

In the exercise stress test, the patient immediately moves from the treadmill to a stretcher and lay's down. The technician will conduct the echo (ultrasound) while the heart rate is still elevated to determine if the heart is pumping blood efficiently. The layout of the room is important as the room needs to accommodate the patient, the technician, the ultrasound unit, stretcher, treadmill and EKG unit. This makes for a crowded room! The patient is tethered to the EKG unit with leads that are connected to the EKG machine as they are walking on the treadmill. After reaching the desired heart rate, the patient needs a clear path to the stretcher to lay down.

The room design for a vascular study can ignore the need for bathroom access mentioned in the fetal ultrasound section. The patient is not required to drink water for these procedures. However the space requirements within the room are greater.

Here is a video of what an ultrasound unit looks like. Nothing too interesting about it, but you will see if from variety of angles and perspectives.

You may have noticed from the first video that there is gel applied to the patient. This accomplishes 2 things: Allows the probe to glide smoothly across the skin and also creates a "good connection" for the probe to transfer data across the patients skin. The room will usually have a "gel warmer" which is a small container used to warm the gel to a comfortable temperature. The elevated temperature makes the gel more fluid and offers greater comfort of the patient. (Nobody likes something cold applied to their skin.)

Finally, the introduction of very small handheld units have evolved to cater to the "bedside" ultrasound market. These units are designed to be light and easily carried from room to room. I would call them ultra-portable. They have less features and are not replacements for the full-size units.

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