Ideas for Hospitals, Centers and Practices

First Things First
Siemens Installs 500th SPECT-CT Scanner

First Things First

?When a patient finds out they have cancer, their mind starts to race and there are all different kinds of emotions that emerge. Some people become very determined. Some become angry. Some become confused. Some become hopeless and depressed. But at 10 am next Tuesday, they all have to go to the radiation center, whatever their feelings are,? said Edward J. Kaplan, MD, medical director of 1st Line Oncology, Coconut Creek, Fla.

Unfortunately, until recently, treatment environments often mirrored these emotions. Sterile atmospheres, rundown facilities, and intimidating machinery often contributed to a patient?s anxiety and concern. But it doesn?t have to be that way.

Research in evidence-based design has shown that improving the atmosphere and/or layout can positively impact both the quality of patient care and the facility?s financial performance. A review of the relevant literature by Ulrich et al concluded, ?Well-designed physical settings play an important role in making hospitals safer and more healing for patients and better places for staff to work.?1

Research in evidence-based design has shown that the right setting can positively impact patient outcome as well as financial performance.

Kaplan did not know about this research when he designed and decorated 1st Line, which opened in August, but he did know he wanted to build a facility that would make people feel good. ?To me, when people are sick, they really seek and need to be somewhat coddled, or at least handled more gently. They are not looking for a sterile environment. They are looking for nurturing,? said Kaplan.

So Kaplan designed a facility that would ease patients? anxieties using himself as a guide. ?I asked myself, ?How does that make me feel?? Everybody might agree the Mona Lisa is a nice piece of artwork, but it might not make them feel good. I decided that it was important in the cancer environment to lay the palette out to make people feel good,? said Kaplan.

The Palette

Although some of the floor plan was predetermined by requirements for the radiation therapy equipment, Kaplan essentially had a blank canvas?the facility was new construction built to his specifications, which mirrored a luxurious spa. Every detail from the coffee maker to the linear accelerator was designed with the patient?s comfort in mind.

The waiting room features complimentary Wi-Fi Internet access, large flat-screen televisions, a coffee/espresso-maker, and comfortable seating. Design elements incorporate iridescent tiles, faux glass, faux wood flooring, and push-button doors. Infection control measures include easily accessible sinks (near the door rather than the back of the room) and hands-free technologies (eg, sinks and towel dispensers).

?There are certain things we can?t do,? said Kaplan, noting water effects and fragrances can irritate patients with full bladders or chemotherapy-induced nausea. ?But that doesn?t limit us,? he added.

The Canvas

Cost did not prove to be a large limitation either. ?The path of least resistance is to go with contract-grade materials, but I don?t think it costs a whole lot more,? said Kaplan.

Design elements, such as paint and flooring, may require a slightly larger investment, but not excessive. ?Paint is paint, and the color you choose is up to you,? said Kaplan.

Some decisions reflected dual purposes. For instance, glass panels on the office doors not only add a design element, but also provide benefits in lighting, security, and communication.

Kaplan did turn to a decorator two-thirds through the project to help him find the elements he envisioned. ?I didn?t have access to the styles and the resources that reflected what I wanted. I knew what I wanted, I just couldn?t find it anywhere,? said Kaplan.

The Brushes

Kaplan did find he had options in terms of the technologies he wanted to bring in and chose those he felt would accommodate his vision and the center?s workflow. Equipment was selected with an eye not only for performance and functionality but also for the patient experience.

Rather than select a leading linear accelerator, Kaplan acquired one from a smaller firm, Sweden?s Elekta, that he felt offered an improved experience. Because the system (the Elekta Synergy) incorporates a room partition, the patient does not need to be exposed to a cold treatment room or an intimidating machine. Upgrades can be handled simply through software, without requiring significant downtime or labor; maintenance can be managed remotely.

The entire office, in fact, is digital, with films and files completely electronic. ?We never lose a record. We have no clutter. And we have instantaneous access to patient files,? said Kaplan.

The Masterpiece

The result is a center that patients and staff want to be in. Kaplan recounts numerous instances of positive feedback?from patients, clinicians, vendors, and even hospital CEOs.

Patients are less distracted and able to absorb what they are told as well as ask intelligent questions. They are more relaxed and fidget less, making setup easier, exams smoother, and treatment more consistent.

The resulting buzz is a marketing boon. ?I think that by enhancing the facility, it establishes an identity for us,? said Kaplan. He envisions a center serving both domestic and international patients. Located near three airports, the spa-like facility could become a destination for medical tourists from Central America, South America, and the West Indies.

It could also become a new model for oncology centers. With organizations, such as The Center for Health Design and Planetree, Derby, Conn, expanding the research and awareness of evidence-based design, more centers may follow Kaplan?s lead in putting first things first.

?Renee Diiulio


  1. Ulrich RS, Zimring C, Zhu X, et al. A review of the research literature on evidence-based health design. Health Environments Research and Design Journal. Summer 2009;1:3.

Siemens Installs 500th SPECT-CT Scanner

Amidst the current global economy, health care companies must re-evaluate their business models and many are considering the optimization of return on investment for capital equipment purchases.

According to Markus B. Lusser, vice president, global sales and marketing, Siemens Healthcare, Molecular Imaging, his company?s diagnostic SPECT-CT solution is a prime example of how to reach cost savings without compromising patients? health care options. Lusser also predicts that in a few years, every nuclear medicine department in the United States will own a SPECT-CT.

?Unique capabilities of second-generation hybrid systems such as Siemens Biograph mCT demonstrate a solid shared services model and a new return on investment approach for health care,? Lusser said. ?By employing one system with premium capabilities to serve two departments, nuclear medicine and radiology, there is not only an opportunity to generate a constant revenue stream due to a new operational structure, but also a tremendous diagnostic and patient benefit of collecting complimentary datasets in one setting.?

The Malvern, Pa, company recently announced the 500th installation of its SPECT-CT product at The Centre hospitalier universitaire de Sherbrooke in Quebec. The hospital purchased a Symbia T6-slice SPECT-CT system earlier this summer.

While Lusser admits that the United States has one of the slowest global adoption rates, he still sees a continued interest in the technology. ?It?s especially important to notice that we experienced in the first half of 2009, despite the tough economic environment, an all-time high in our SPECT-CT mix with roughly 50% of all variable-angle gamma cameras sold as SPECT-CTs,? he said, adding that Siemens has installed about 200 diagnostic SPECT-CT systems in the United States. Michael Reitermann, chief executive officer, Molecular Imaging, Siemens Healthcare, accounted for the demand by explaining, ?We believe this trend is due to the increase in clinical applications offered by hybrid SPECT-CT and also due to the increase in the need to use hybrid imagers as multipurpose cameras, often serving both radiology and nuclear medicine imaging departments.?

With common applications in clinical and oncological studies, some of SPECT-CT?s latest clinical applications include aiding in surgical planning and evaluation of bone lesions, neuroendocrine tumors, lymphoscintigraphy and thyroid carcinomas, and parathyroid adenomas.

Whether they are large research institutions or smaller community hospitals, Siemens? US customers run the gamut. ?We don?t see a clear pattern toward certain customers who are more prone to buy SPECT-CT systems,? Lusser continued. ?Most users who have experienced the clinical value of PET-CT or read studies acquired on high-quality SPECT-CTs see the immediate value of investing into such systems as they see long-term clinical as well as workflow benefit of having access to this technology.?

Lusser notes that while SPECT-CT has generated much interest, it will not completely replace stand-alone imaging systems.

?The market has already demonstrated the complete dominance of advanced hybrid systems in PET-CT, as sales and manufacturing of stand-alone PET are all but nonexistent,? Lusser said. ?However, I don?t believe the exact same fate can be foretold regarding hybrid SPECT-CT systems. While there has been a tremendous market reception for hybrid diagnostic SPECT-CT, and even our own sales figures reflect a clear trend toward hybrid diagnostic SPECT-CT technology, there will always be a role for stand-alone SPECT studies, especially in clinical areas such as cardiology.?

?Ed Wilson