{

Life Cycle for Engineering the Healthcare Service Delivery of Imaging

Jan Twomey, Professor

Industrial and Manufacturing Engineering

{ 1. why?

2. some results of energy consumption

3. some implications

4. continuation of work

Delivery of Imaging Service Robert Dole VA Medical Center, Wichita KS

Wesley Hospital Medical Center, Wichita KS

presentation objectives

{ Healthcare and Energy

Motivation

Healthcare and Energy

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20.00

25.00

30.00

35.00

2007 2012 2017 2022 2027 2032q

uad

rill

ion

Btu

Residential

Commercial

Industrial

Transportation

0.000

0.005

0.010

0.015

Gro

wth

Ra

te

EIA Energy Consumption Forecast by Sector 2009-2035

EIA Forecast Rate of Growth in Energy Consumption

Commercial Sector 2009-2035

Healthcare

Annual Energy Outlook 2011

Healthcare spends $8.8 billion on energy each year to meet patient needs. Most focus (DOE) focus on HVAC improvements.

Electricity use in healthcare

47% of electricity consumption from inside building envelope activities.

Energy consumption healthcare setting

Annual Energy Outlook 2008, EIA

The EPA’s 2005 Compliance Sector Notebook Healthcare Industry reported its findings/ provides guidance as an aggregate according to healthcare facilities and activities (categories of medical wastes).

Existing LCA of laundry & cafeteria services.

New worldwide movement in Healthy Hospitals

• healthcare without harm

• green

• energy efficient

• sustainable

Healthcare and Environment

{ Data collection and analysis

Methodology

{

Life-cycle analysis can be highly detailed and always quantitative assessments that characterize, and assess the environmental impacts of energy use, raw material use, wastes and emissions over all life stages.

Life Cycle Analysis (LCA)

Resource Extraction

End of Life

Mfg & Processes

Product Use

Materials Recovery

Remanufacture

Component Recovery

Disposal

En

erg

y,

Natu

ral

Reso

urces E

mis

sio

ns, W

aste

, Wate

r P

ollu

tion

transport

Product/Process Life Cycle

We conduct LCA for many reasons

Decision-making in industry and government

Strategic planning, investments, product/process design

Marketing Environmental claim, eco-

labeling Communication with

stakeholders Shareholders, regulatory

agencies, policy makers Research and Development Early evaluations of projects,

periodic re-evaluations

Long term: provide healthcare decision-makers a model/simulation tool made up of modules for making cost-effective system-wide operational decisions.

Near term: create a set of modules that represent various environmental impact information for a number of healthcare services and to relate those data to medical outcomes. Imaging (x-ray, CT, MRI)

Dialysis

DNA testing

Approach: detailed level of analysis (lci) on a service by service basis

Our work

Emergency Services

Medical Records

X- Ray Services

X-Ray equipment

Consumables

HVAC

Lighting

Ancillary

CT Services

CT equipment

Consumables

HVAC

Lighting

Ancillary

MRI services

X-Ray equipment

Consumables

HVAC

Lighting

Ancillary

Dialysis Service

Dialysis equipment

Consumables

HVAC

Lighting

Ancillary

Water purification IT Services

Imaging

Environmental Information

research setting: VA

general medical care and surgical hospital

2008 full-time employees 823, (44 physicians, 259 nurses)

2008 average daily census 62 inpatients

2008 outpatient visits 515,296

imaging department 13 technicians

1 CT, 4 x-ray machines

open 24/7

regular hours 7:00-4:30, M-F

CT utilization over 24 hr.

period 20%

tech on call for emergencies

research setting: Wesley

General medical care and surgical hospital

2011 full-time employees 3700, (700 physicians)

2011 average daily census ?

2011 outpatient visits ?

imaging department 80 technicians – 3 shifts

4 CT, 4 Fluoroscopy tables, 9 mobile Fluoroscopy units, 4 X-ray tables, 10 portable X-ray units

open 24/7

regular hours 7:00-4:00, M-F

CT utilization over 24 hr.

period 62%

tech on call for emergencies

{

X-ray images are the most common and widely available diagnostic imaging technique.

Bones, tumors and other dense matter appear white or light because they absorb the radiation.

X-rays may not show as much detail as an image produced using newer, more powerful techniques.

X-ray Imaging

Bhargavan, M. , Sunshine J.; “Utilization of Radiology Services in the United States: Levels and Trends in Modalities, Regions, and Populations”; March 2005, Radiology, 234,824-832.

{

special x-ray equipment and sophisticated computers

greater clarity/more details

best fastest tools for studying chest, abdomen pelvis because it provides detailed, cross-sectional views of all types of tissues

1980– 3 million CT scans in a year

2007 – 70 million scans in a year

CT scan (Computed Axial Tomography)

Landro, L., 2010, "Radiation Risks Prompt Push to Curb CT Scans," The Wall Street Journal New York.

{

• Boundary conditions – • pt point of entry into X-ray or

CT room, setup for next pt begins

• Ends - pt leaves room/room clean up ends

• Metrics – • ave kWh/month, ave kWh/series

• Observational, timed, metered power, hospital records, literature, industrial literature

• laundry & consumables

Data collected

{ Energy consumed delivery of imaging services

Results

.

VA X-ray energy information collected

X-ray GE Room X-ray Philips Room

Area 216 264

Machines/Equipment X-ray machine - GE Definium 8000 X-ray machine - Philips DigitalDiagnost

CR Reader Equipment - FCR XG5000 Image

Reader CR Reader Equipment - FujiFilm FCR Carbon™

Printer - DryPix 5000 Dry Laser Imager FM-DP L

Computers

CR Reader Computer - Dell OptiPlex GX620

Desktop Printer Monitor - Dell 15 inch LCD Monitor

CR Reader Monitor - Elo 1515L 15" Touchmonitor Printer Computer - Dell OptiPlex GX150

Server Computer - Dell OptiPlex 755 CR Reader Computer - Dell OptiPlex GX620 Desktop

Server Monitor - Dell 15 inch LCD Monitor CR Reader Monitor - Elo 1515L 15" Touchmonitor

Lighting 32 watts Florescent T8 Model (5 of them) 32 watts Florescent T8 Model (4 of them)

120 watts Incandescent (8 ot them) 120 watts Incandescent (7 ot them)

Air conditioning Ceiling Ven Ceiling Ven

.

VA CT energy information collected

Main CT Room Control Room

Area (𝒇𝒕𝟐) 364 144

Machines/ Equipment

Philips CT (64 slice) AED (Automated

External Defibrillator) – Crane No other equipment in this area

Lighting 8 × 24" U-Bent Florescent 4 × 24" Straight Florescent

Computers No Computer in this area 4 Computers including CT machine

main computer

Air conditioning

Floor Mount Air Conditioner and ceiling vent

Ceiling Vent

X-ray power signal

Energy consumption measures

Exposure = energy consumed

during scan (active power)

Standby = energy consumed while pt in the room (standby power)

Partial = energy consumed by bed movement, gantry rotation (partial power)

Idle = energy consumed when waiting for next pt (standby power)

{

Energy consumption measures

Exposure = energy consumed during scan (active power) Standby = energy consumed while pt in the room (standby power) Partial = energy consumed by bed movement, gantry rotation (partial power) Idle = energy consumed when waiting for next pt (standby power)

CT power signal

orthopedic scan

{ Loadcontrols portable power cell model PPC-3

n= 75 pts. and 274 exposures for GE in 2010

Standby Energy & Exposure energy

X-Ray Imaging VA (GE Machine)

0.0E+00

2.0E-02

4.0E-02

6.0E-02

8.0E-02

1.0E-01

ave

kW

h

Standby Energy (kWh) Active Energy (kWh)

0

50

100

150

200

Av

erag

e T

ime

(Sec

on

ds)

{ Loadcontrols portable power cell model PPC-3

n= 64 pts. in 2011

Standby energy >> partial & active energy

CT protocols for VA

0

0.2

0.4

0.6

0.8

1

1.2

ave

kW

h

Standby Energy (kWh) Partial Energy (kWh) Active Energy (kWh)

0:00:000:02:530:05:460:08:380:11:310:14:240:17:170:20:10

Av

e (

hh

:mm

:ss)

{

Loadcontrols portable power cell model PPC-3

n= 131 pts. in 2011

Standby energy >> partial & active energy

CT protocols for Wesley

X-ray monthly energy consumed

0

400

800

1200

1600

Exposure

&Standby

Idle Ancillary

Equipments

Lighting HVAC Consumable

Materials

Reusable

Medical

Textiles

156.3

1,247.6

434.1

547.2 501.1

71.5

1,242.8

49.9

575.0

280.8

604.8 612.5

68.6

914.9

Mo

nth

ly E

ner

gy

Co

nsu

mp

tio

n (

kW

h)

Monthly Energy Consumption of GE and Phillips Rooms

Current Condition (GE 44% and Phillips 32% Utilization Ratio)

GE(44%Utilization) Phillips (32% Utilization)

X-ray monthly energy consumed equal utilization 50%

0.00

1.00

2.00

Exposure

&Standby

Idle Ancillary

Equipments

Lighting HVAC Consumable

Materials

Reusable

Medical

Textiles

0.26

1.85

0.65

0.82 0.75

0.12

2.10

0.15

1.04

0.53

1.15 1.17

0.15

2.71 E

ner

gy

Co

nsu

mp

tio

n P

er P

atie

nt

(kW

h)

Energy Consumption per Patient in GE and Phillips Room

(GE and Phillips 50% Utilization Ratio)

GE(50%Utilization) Phillips (50% Utilization)

X-ray energy consumed per series

0.00

1.00

2.00

3.00

Exposure

&Standby

Idle Ancillary

Equipments

Lighting HVAC Consumable

Materials

Reusable Medical

Textiles

0.26

2.11

0.73

0.92 0.85

0.12

2.10

0.15

1.70

0.83

1.79 1.82

0.20

2.71

En

erg

y C

on

sum

pti

on

Per

Pat

ien

t (k

Wh

)

Energy Consumption per Patient in GE and Phillips Room

Current Condition (GE 44% and Phillips 32% Utilization Ratio)

GE(44%Utilization) Phillips (32% Utilization)

{

X-ray

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

22.0

24.0

10% 20% 30% 40% 50% 60% 70% 80% 90%

Ener

gy C

onsu

mpti

on (

kW

h /

Pat

ient)

Total mchine Energy Consumption / Patient

GE X-ray (Solid Color) and Phillips X-ray (Pattern Color)

Philips Total HVAC Energy

Philips Total Lighting (kWh)

Philips Ancillary Equipments

Phillips 24hours Idle Energy

Phillips Average Standby Energy

Phillips Average Exposure Energy

GE Total HVAC Energy

GE Total Lighting (kWh)

GE Ancillary Equipments

GE 24 Hours Idle Energy

GE Average Standby Energy

GE Average Exposure Energy

Different Utilization Ratio for Both GE & Phillips Machines

CT monthly energy consumed

CT energy consumed per series

{ majority of energy consumed while CT and X-ray are sitting idle and by medical textiles

more than HVAC

Imaging: X-ray and CT at the VA

Monthly Energy Consumption by X-ray & CT service with current utilizations

0

400

800

1200

1600

2000

2400

2800

3200

Exposure&Standby

Idle AncillaryEquipment

Lighting HVAC ConsumableMaterials

ReusableMedicalTextiles

Mo

nth

ly E

ner

gy C

on

sum

pti

on

(kW

h)

X-ray GE X-ray Philips CT Scan

{

Imaging: X-ray and CT at the VA

Per patient Energy Consumption by X-ray & CT service with current utilizations

majority of energy consumed while CT and X-ray are sitting idle and by medical textiles

more than HVAC

reducing energy/water/consumption, healthcare services while guaranteeing the quality of patient outcomes.

Simple energy saving (reduce costs)

- turn off x-ray machines, etc.

- CT cannot be turned off, but certain ancillary equipment can be

- replace lighting

- use disposable gowns, and shorts

-

Scheduling/evaluate capacity while

maintain quality of service

Work with CT/X-ray manufacturers to reduce idle energy consumption

Ph

oto

by

Cin

dy

Mil

ler

Valerie S. Wright, Radiology Manager, Robert J Dole VAMC

VA Dialysis Monthly

water purification –pump inside the hospital running continuously utilization low, therefore water purification energy relatively very high portable purification better? energy? quality of care? embodied energy in consumables dominate

0

400

800

1200

1600

DialysisMachine

AncillaryEquipment

Lighting HVAC WaterPurification

ConsumableMaterials

ReusableTextile

77.7 23.5 20.7

325.7

501.3

1,307.3

406.5

Mo

nth

ly E

ner

gy C

on

sum

pti

on

(kW

h)

Dialysis at VA Hospital (46% Utilization)

Monthly consumption 46% utilization

VA Dialysis by Patient

water purification –pump inside the hospital running continuously utilization low, therefore water purification energy relatively very high portable purification better? energy? quality of care? embodied energy in consumables dominate

Per patient consumption

0

15

30

45

60

DialysisMachine

AncillaryEquipment

Lighting HVAC WaterPurification

ConsumableMaterials

ReusableTextile

3.5

1.1 0.9

14.8

22.8

59.4

18.5

Ener

gy C

on

sum

pti

on

Per

Pat

ien

t (k

Wh

)

{ MRI and Ultra Sound

epidemiological study of CT in Sedgwick county ?

burden to society of receiving too many CT scans?

Where to go from here?

CT Scan 13.5%

MRI 4.0%

Ultrasound 24.7%

PET Scan 0.3%

X-ray & Mammography

52%

Radiation Oncology

5.8%

{

Where to go from here?

connection to medical outcomes?

what is radiation waste?

connect with the Healthy Hospital movement

Grad Stud: Fernando Valenzuela & Amin Esmaeili; Post Doc: Ashkan Jahromi; and Medical Physicist Chris Hearn

{ { Post Doc & Students

Seyed Soltani

Amin Esmaeili & Fernando Dominquez

Nicholas Thomas & Ashlee Mcadam

Collaborators

Chuck McGuire, University of Kansas Medical School

Chris Hearn, Radiation Physicist, Wesley Hospital

Val Wright and Tom Sanders,

Robert Dole VA Medical

Center

acknowledgments

The support for this research comes from NSF CMMI 0946342 and DOE: Sustainable Wind Energy and Sustainable Energy Solutions.