This section is intended to be a resource for institutions joining the future of image-guided therapy and surgery. The realization of a space like AMIGO will demand a full team of extraordinary thinkers: designers, builders, clinicians, technical personnel, and administrators – coming to a consensus of vision to make such a project a reality. Previous publications describe the facets of architecture for diagnostic and therapeutic suites [1] and more specifically intraoperative MRI facilities [2]. The specifics of AMIGO’s design and construction process are presented here in stages and describe the team’s interaction.

Understanding the Technology and Its Use: It is imperative to fully understand the systems being introduced into the project and how they will be employed by the end users. The design team worked diligently with stakeholders in the hospital and industry to understand user requirements and system capabilities. Previous installations of similar technology were designed to support only neurosurgery. The team partnered with the integrator (IMRIS Inc., Winnipeg, CA) to expand the capability of the space to support percutaneous intervention, endovascular intervention, minimally invasive surgery, and open surgery throughout the body.

The impact of hanging a moving MRI scanner from the ceiling is central and pervasive throughout the entire process. A Siemens 3-T magnet was retrofitted and integrated by IMRIS. A considerable “no fly zone” was necessitated for the travel of the scanner, and nothing could be placed on the ceiling in its path. In the OR, the surgical table position and boom layout were critical for enabling multiple services to work in the space while being constrained by the no fly zone. The x-ray c-arm travels on ceiling tracks perpendicular to the MRI tracks. Unlike conventional single-purpose ORs, the room setup must be drastically altered to accommodate a given procedure. The table is nominally pivoted towards the MRI scanner but pivots 90° for x-ray-guided procedures and 180° for PET/CT-guided procedures. The x-ray c-arm also travels on the ceiling. Point of care view screens are installed at several locations to accommodate different procedure-specific room configurations. The ceiling-mounted navigation system was located to enable its use in all three table locations. Provisions were made for a work in progress to develop patient flow between the OR and PET/CT room. Demands for circulating space were considered for mobile equipment and personnel to move about while maintaining a sterile field. All these factors were considered in designing the space.

Design Within the Shell Space: The AMIGO Suite encompasses an area of 5,700 ft². The east side of the suite is dedicated to the three procedure rooms including control stations and equipment rooms. An 8-ft-wide corridor is the central spine that serves to spatially open up and connect the control areas with a centralized nursing and flow coordinator station. The west side of the suite supports services: a decontamination room, a clean assembly room, a sterile storage, and two large equipment storage rooms, as illustrated in Fig. 24.2.

Structure: AMIGO is advantageously located two floors below grade on the hospital’s subgrade foundation. The larger and stronger reinforced concrete columns on this level support the ceiling-mounted MRI scanner’s structural steel, causing less concern from vibration than placing the suite on an upper floor. The greatest structural challenge was meeting the steel beam deflection tolerance specification that IMRIS required to support the weight of the MRI as it transits: no more than 1/8″ deflection of steel beam for every 8 ft of beam length. The specific challenge was to maintain this requirement while limiting the dimensions of the steel beam in order to allow infrastructure to fit overhead. The unique design, shown in Fig. 24.3, kept the steel support simple and allowed for maximum flexibility for infrastructure to fit within the ceiling plenum.

Another concern was vibration from outside the hospital that might impact the image quality from the MRI. A major source of vibration is the plant that provides supplemental electricity to the six hospitals in the surrounding Longwood Medical area, located adjacent to the end of the hospital housing AMIGO. To mitigate the effects, large pre-compressed vibration isolation pads were designed for all beam and column connections (Fig. 24.3).

Shielding and Penetration: Along with the shielding vendor (ETS-Lindgren, Glendale Height, IL) and IMRIS, the team designed the shielding efficiently to enclose the two impacted rooms. Both the OR and MRI rooms are six-sided copper RF-shielded boxes to prevent electromagnetic interference from impacting MR image quality. Both the OR and PET/CT rooms are lead shielded. The sliding doors and control room doors in the OR were designed with additional structural reinforcement to support the weight of the copper and lead.

The viewing windows into the OR, MRI, and PET/CT rooms (Fig. 24.4) are oversized and comprised of polarizing privacy glass, lead glass, and RF copper mesh glass. The privacy glass when turned off turns opaque and meets the laser safety requirements to allow laser operation inside the room without additional laser safety measures being installed.

Silicon rolled steel for magnetic shielding was located only on the rear of the MRI room to prevent the MRI scanner’s fringe field from extending into the hallway adjoining the EP labs, to protect patients, personnel, and equipment outside the suite.

Another unique detail in AMIGO is the inclusion of an independent RF-shielded equipment cabinet inside the larger RF-shielded enclosure. This feature allows clinicians and researchers to stage non-MRI-compatible equipment into the interventional environment via waveguides and filtered connectors without affecting image quality (Fig. 24.5). Additional pen panels were added under each control window as well as the MRI equipment room to allow for additional connections with equipment placed outside the RF rooms. All subpanels are modular and can be retrofitted to meet future user requirements (Fig. 24.5).

Location of all filters and waveguides required for all infrastructure (electrical conduits, HVAC ducts, med gas piping, etc.) penetrating the shielded rooms was carefully coordinated to ensure a clean plenum space above the ceiling. Boom mounts were designed to obviate the requirement for kicker supports, a space saving method that allowed for much needed above ceiling space (Fig. 24.6).