VHA Chapter 295: Imaging Services - WBDG

PG-18-9 – SPACE PLANNING CRITERIA295 – Imaging ServiceMarch 1, 2022PG-18-12: A Department of Veterans Affairs’ Design Guide Standard for planning, designand construction of VA healthcare facilities, a Program Guide (PG) that provides designguidance for VA Medical Centers (VAMCs) and Community Bases Outpatient Clinics (CBOCs).The narrative section details functional requirements, and the Room Template sectiondetails the planning and design of key rooms in PG-18-9. Not all PG-18-9 chapters have acorresponding PG-18-12 Design Guide; one Design Guide can cover more than one PG-18-9chapter.Provider: An individual who examines, diagnoses, treats, prescribes medication, andmanages the care of patients within his or her scope of practice as established by thegoverning body of a healthcare organization.Room Area: The square footage required for a clinical or non-clinical function to take placein a room / space. It takes into account the floor area required by equipment (medical andnon-medical), furniture, circulation, and appropriate function / code-mandated clearances.Room area is measured in Net Square Feet (NSF).Room Code (RC): A unique five alpha-numeric code assigned to each room in the PG-18-9Standard. Room Codes in PG-18-9 are unique to VA and are the basis for SEPS’s Space Tablefor VA projects.Room Criteria Statement (RCS): A mathematical / logical formulation assigned to each room/ space included in PG-18-9 incorporating answers to Input Data Statements (IDSs) todetermine the provision of the room / space in the baseline space program or Program forDesign (PFD) for a project.Room Efficiency Factor: A factor that provides flexibility in the utilization of a room toaccount for patient delays, scheduling conflicts, and equipment maintenance. Commonfactors are in the 75% to 85% range. A room with 80% room efficiency provides a buffer toassume that this room would be available 20% of the time beyond the planned operationalpractices for this room. This factor may be adjusted based on the actual and/or anticipatedoperations and processes of the room/department at a particular facility.SEPS: Acronym for Space and Equipment Planning System which produces equipment listsand Program for Design for a healthcare project based on specific information entered inresponse to Input Data Questions.SEPS Importer: A style-based format developed to allow upload of RCSs and IDSs to SEPS toimplement and operationalize space planning criteria in PG-18-9 in the SEPS digital tool.This format establishes the syntax used in the RCSs and allows the use of Shortcuts.Shortcuts allow developers of space planning criteria statements to simplify RCSs makingfull use of their logical and mathematical functionality. A shortcut can refer to an RCS, aroom in any FA or a formula. Shortcuts are [bracketed] when used in FAs and RCSs and arelisted along with their equivalences at the end of the Space Planning Criteria section.Space Planning Concept Matrix (SPCM): A working document developed during the chapterupdate process. It lists all the rooms organized by Functional Area and establishes ratiosbetween the directly and the indirectly workload driven rooms for the planning range6 of 67

PG-18-9 – SPACE PLANNING CRITERIA295 – Imaging ServiceMarch 1, 2022defined in this document. The matrix is organized in ascending workload values in rangesreflecting existing facilities and potential future increase. Section 5 of this document SpacePlanning Criteria reflects the values in the SPCM.Stop Code: A measure of workload including clinic stops forecasted by the Office of Policyand Planning (OPP) for all Strategic Planning Categories at Medical Center and OutpatientClinic levels.Telehealth: The use of technology, such as computers and mobile devices, to managehealthcare remotely. It includes a variety of health care services, including but not limited toonline support groups, online health information and self-management tools, email andonline communication with health care providers, remote monitoring of vital signs, video,or online doctor visits. Depending on the concept of operations for this space, it may beequipped as an exam room or as a consult room with video/camera capability.Utilization Rate: A factor used in the calculation of a directly workload-driven roomthroughput. It represents, in a percent value, the room is idle based on the planningassumptions. For example, if a directly workload-driven room is available for use 8 hours aday, the Utilization Rate represents the assumed time it will be used, an 85% utilization rateindicates, for planning purposes, the room will be used 6.8 hours a day. An additionaldirectly workload-driven room will be provided in the calculation once the previous roomhas reached 100% utilization. The utilization Rate is embedded in the Room Throughputvalue calculated in Section 3 of this document.VA Room Family (VA RF): An organizational system of rooms / spaces grouped by function, a‘Room Family’. There are two “Orders” in the VA RF: Patient Care and Patient Care Support;Patient Care features four sub-orders: Clinical, Inpatient, Outpatient and Residential Clinical.There are also four sub-orders in the Patient Care Support order: Building Support, ClinicalSupport, Staff Support and Veteran Support. Each room in a Family has a unique Room Codeand NSF assigned based on its Room Contents and function which correspond to the specificuse of the room. The same RC can be assigned to different Room Names with the samefunction in this document and can be assigned an NSF that varies based on the PG-18-5Room Contents assigned to the room.VA Technical Information Library (TIL): A resource website maintained by the FacilitiesStandards Service (FSS) Office of Construction and Facilities Management (CFM) containinga broad range of technical publications related to the planning, design, leasing, andconstruction of VA facilities. VA-TIL can be accessed at: https://www.cfm.va.gov/TIL/Workload: Workload is the anticipated number of procedures, clinic stops, clinic encountersetc. that is processed through a department/service area. The total workload applied todepartmental operational assumptions will determine overall room requirements bymodality.Workstation: Area outfitted with equipment and furnishings, typically allocated 56 NSFeach. Managers and other staff with no direct reports as well as part-time, seasonal, andjob-sharing staff may qualify for a workstation. Such environments are particularly7 of 67

PG-18-9 – SPACE PLANNING CRITERIA295 – Imaging ServiceMarch 1, 2022conducive to team-oriented office groupings. These environments work best when theyhave access to conference and small group meeting spaces.3 OPERATING RATIONALE AND BASIS OF CRITERIAA. Space planning criteria have been developed based on research of clinical and non-clinical activities performed in the functional areas of VA Imaging Services facilities.These criteria are predicated on established and/or anticipated best practice standardsas well as applicable policy requirements for Imaging Services in the Department ofVeterans Affairs and are the basis for generation of a baseline space program for theImaging Services components of a VA construction project. These criteria are subject tomodification and adjustment relative to developments in state-of-the-art equipment,medical practice, and subsequent detailed planning and design.B. Update of the PG-18-9, PG-18-5 & PG-18-12 Standards is a research based effortexecuted with participation of VHA Imaging Services Subject Matter Experts (SMEs), VAConstruction and Facilities Management Office (CFM) professional staff and specialtyconsultants hired for the task. Based on a review of current applicable VHA policies andguidelines, and imaging technology developments the Space Planning Concept Matrix(SPCM) was developed. The SPCM details all the baseline components a VA ImagingServices department, renovation or new facility project, should include. The FunctionalAreas, Rooms, room quantities and square footages (NSFs) included in the PG-18-9standards document are based on the SPCM discussed, agreed upon by all participantsand approved by VA VHA.C. The Imaging Services Planning Range, the maximum number of directly workload-drivenimaging / scanning rooms, in this document is 40 imaging / scanning rooms – allmodalities. The maximum number of imaging / scanning rooms by modality is asfollows:1. General Radiography: 82. Chest Radiography: 23. Radiography / Fluoroscopy: 24. Multipurpose Radiography / Fluoroscopy: 25. Prone Breast Imaging: 16. Standing Breast Imaging: 27. ABUS Scanning: 18. Ultrasound: 69. Bone Densitometry: 110. CT: 511. MRI: 412. Nuclear Medicine: 113. SPECT/CT: 414. Thyroid Probe: 115. PET/CT: 216. PET/MRI: 18 of 67

PG-18-9 – SPACE PLANNING CRITERIA295 – Imaging ServiceMarch 1, 2022If a project requires provision of imaging / scanning rooms above these values, pleaserefer to CFM for guidance.D. Rooms in the Imaging Services space planning document are organized in fourteenFunctional Areas (FAs) as follows:1. FA 1: Imaging / Scanning Room Calculation2. FA 2: Imaging Services Reception Area3. FA 3: General Radiology Area4. FA 4: Breast Imaging Area5. FA 5: Ultrasound Area6. FA 6: Bone Densitometry Area7. FA 7: Computed Tomography (CT) Area8. FA 8: Magnetic Resonance Imaging (MRI) Area9. FA 9: Nuclear Medicine (NM) Area10. FA 10: Positron Emission Tomography (PET) Computed Tomography (CT) - PET/CTArea11. FA 11: Positron Emission Tomography (PET) Magnetic Resonance Imaging (MRI) PET/MRI Area12. FA 12: Imaging Services Support Area13. FA 13: Imaging Services Staff and Administrative Area14. FA 14: Imaging Services Academic Education AreaE. Based on its intended function, each room / space in a PG-18-9 Functional Area (FA) isassigned a:1. Room Name (RN),2. Room Code (RC),3. Room Area, the Net Square Feet (NSF) and its corresponding “soft metric” NetSquare Meters (NSM),4. Unique Room Criteria Statement (RCS) correlated to answers to Input DataStatements (IDSs) or SEPS Importer Shortcuts (at end of Section 4), and5. Room Comment if needed.F. Section 4 Input Data Statements (IDSs) and Section 5 Space Planning Criteria in thisdocument have been uploaded / implemented and tested in the Space and EquipmentPlanning System (SEPS), a web-based software for use in federal projects. Plannersworking on a VA Imaging Services project can develop a baseline space program, theProgram for Design (PFD), by answering the IDSs in SEPS. These answers triggermathematical and logical calculations embedded in the unique RCSs and generate thebaseline PG-18-9 Standard-based PFD as the starting point of the project’s spaceplanning process. Once the baseline space program has been vetted by the VISN /facility leadership, SEPS produces the list of contents for each room in the project basedon the corresponding PG-18-5 Standard.G. Determination of the number of imaging and scanning rooms, the directly workloaddriven rooms, for a project is based on answers to the projected workload IDSs, pleaserefer to item R below for the calculation methodology.9 of 67

PG-18-9 – SPACE PLANNING CRITERIA295 – Imaging ServiceMarch 1, 2022H. Imaging Services modality Workload Projections for a specific VA Medical Center projectare provided by the VHA Support Service Center (VSSC) or VA Central Office (VACO). Themodality workload projections are generated by methodology based upon the expectedveteran population in the respective market / service area.I.The modality projected workload is divided by the calculated annual room throughput(refer to Table 1) to determine the number of modality imaging / scanning roomsrequired. Assignment of Class 1 or Class 2 to the resulting number of modality imaging /scanning rooms is determined by the Facility Procedure Complexity Level (FPCL)designation (refer to Table 2).J.Determination of the number and NSF of most of the Reception, Clinical Support andSupport rooms, the indirectly workload driven rooms, is based on assigned ratioscorrelating directly and indirectly workload driven rooms as detailed in the SPCMdocument. Additionally, some rooms are generated by answers to Mission or Staffing.K. Rooms in FA 2 Reception Area and FA 12 Support Area will generate if the total numbercombined imaging / scanning rooms in a project is between 1 and 43 except for Lowenergy Isotope “hot” patient Waiting which correlates to the number of SPECT / Thyroidscanning rooms only.L. Clinical Patient Care rooms in FAs 3 through 11, will generate based on the ranges foreach corresponding modality detailed in C, I and J above.M. Some office space as well as workrooms in FA 12 Staff and Administrative Area willgenerate based on answers to the staffing IDSs; the rest of the office spaces,workrooms, conference rooms, toilets, and showers will generate via ratios to the 1 – 40imaging / scanning room range.N. The Room Codes included in this chapter stem from the VA Room Family. A uniquesupport space is assigned a unique Room Code and adopts the square footage, asneeded, correlated to the room contents assigned which in turn corresponds to theimaging / scanning 1 to 40 range for those rooms in FAs 3 to 11. A unique clinical spaceor a direct clinical support room, i.e. control room, system components room, etc.typically does not feature variable NSF. Patient Care room names for rooms unique tothis chapter end in “, Imgng Svcs”. Patient Care Support room names end in “, BldgSprt”, “Clncl Sprt”, “Stff Sprt”, or “, Vet Sprt”, correlating to Building, Clinical, Staff orVeteran Support room families.O. Section 5, sub-section O lists the SEPS Importer Shortcuts used during Sections 4 & 5implementation in SEPS. These shortcuts are inserted into the Room Criteria Statement(RCS) for each room which upon upload into the Space and Equipment Planning System(SEPS) allows planners developing VA healthcare projects determine quantity andsquare footage of each room by performing mathematical or logical calculations.Shortcuts can refer Input Data Statements (IDSs), Rooms or calculation parametersstemming from the SPCM.10 of 67

PG-18-9 – SPACE PLANNING CRITERIA295 – Imaging ServiceMarch 1, 2022P. The following Sections in this document have been implemented and tested in theSpace and Equipment Planning System (SEPS):1. Section 4: Input Data Statements,2. Section 5: Space Planning CriteriaQ. SEPS is accessible to government healthcare planners and private sector consultantsworking on VA HC projects during their Period of Performance (PoP) through theMAX.gov website; government provided Training is a requisite for access.R. SEPS incorporates a Net‐to‐Department Gross factor (NTDG) factor of 1.55 for ImagingServices and a Building Gross factor of 1.35 in the space calculation to generate theDepartment Gross Square Feet (DGSF) and the Building Gross Square Feet (BGSF)respectively for the project based on the aggregate resulting Net Square Feet (NSF) foreach range. Planners can adjust the BGSF factor in SEPS; the NTDG factor is fixed.S. Refer to the chapter corresponding PG-18-5 Equipment Guidelist for the Room Contentassignment for each room during the planning phase of a project.T. Refer to the chapter corresponding PG-18-12: Design Guide, if available, during theplanning and design phases of a project. Not all PG-18-9 clinical chapters have acorresponding PG-18-12 document, please refer to the VA-TIL.U. The space planning and design Program Guides: PG-18-9, PG-18-5, and PG-18-12 areavailable at the Department of Veterans Affairs Office of Construction and FacilitiesManagement (CFM) Technical Information Library (TIL) website.V. Calculation of the workload-driven rooms is based on the following parameters:1.2.3.4.Operating days per year: 250Hours of Operation per day: 8Average length of modality encounter (ALoE) (in minutes): see Table 1Room Utilization: 85% of annual throughputWorkload driven room annual throughput calculation:Operating days per year x Hours of operation per day / ALoE / 60 minutes AnnualEncountersExample:250 operating days per year x 8 hours of operation per day / 40 / 60 minutes 3,0003,000 annual encounters in an imaging / scanning rom assuming 100% utilization.3,000 x 85% 2,550 annual capacity12,900 annual encounters / 2,550 5.05 Workload-Driven Rooms5 x 2,550 12,750 annual encounters5 Workload-Driven Rooms provided11 of 67

PG-18-9 – SPACE PLANNING CRITERIA295 – Imaging ServiceMarch 1, 2022TABLE 1: SCANNING / IMAGING ROOM WORKLOAD PARAMETER CALCULATIONANNUALANNUALAVERAGEROOMROOMLENGTH OFTHROUGHTHROUGHENCOUNTERPUTPUT(ALoE)(Encounters) (Encounters)FAIMAGING / SCANNING ROOM(Minutes)100%85%FA 3 General Radiology Room158,0006,800FA 3 Chest Imaging Room158,0006,800FA 3 Radiology / Fluoroscopy (RF) Room304,0003,400Multipurpose Radiology / FluoroscopyFA 3602,0001,700(RF) RoomFA 4 Prone Breast Imaging Room602,0001,700FA 4 Standing Breast Imaging Room304,0003,400FA 4 ABUS Scanning Room304,0003,400FA 5 Ultrasound Room304,0003,400FA 6 Bone Densitometry Room304,0003,400FA 7 CT Scanning Room304,0003,400FA 8 MRI Scanning Room452,5002,125FA 9 Nuclear Medicine Scanning Room452,5002,125FA 9 SPECT/CT Scanning Room452,5002,125FA 9 Thyroid Probe Scanning Room304,0003,400FA 10 PET/CT Scanning Room452,5002,125FA 11 PET/MRI Scanning Room602,0001,70012 of 67

PG-18-9 – SPACE PLANNING CRITERIA295 – Imaging ServiceMarch 1, 2022TABLE 2: MODALITY CLASS 1 / CLASS 2 IMAGING / SCANNING ROOM PROVISION BY FACILITYPROCEDURE COMPLEXITY LEVEL (FPCL)FPCL FPCL FPCLMODALITY1a1b1cFPCL 2FPCL 3Class 1 Radiology Room nononoyesyesif ICU or E

Imaging / Radiology: The medical specialty that utilizes imaging examinations with or without ionizing radiation to affect diagnosis or guide treatment. Techniques include radiography, tomography, fluoroscopy, ultrasonography, Breast Imaging, computed . Magnetic Resonance Imaging and Nuclear Magnetic Resonance. All refer to the same process.