A disturbing trend is clearly visible in the marketplace: too many new imaging facilities are out-of-date by the time they are initially operational. Two key factors can make the best intentions go awry. First, despite the proliferation of PACS, very few health care facility planners have experience with building a new filmless facility once, let alone extensive experience gained from previous trials and knowledge of the latest trends in equipment and clinical care.

While filmless is the rule in revitalizing a current footprint or undertaking new construction, the following considerations in designing a digital facility may be news for your planners.

• Digital facilities require a public-access "image service" counter rather than a film library tucked far away from the lobby

• Technology makes physical proximity of radiologists less critical

• Space planning needs to include dedicated workspace for PACS administration and PACS equipment

• Design of radiologist digital interpretation areas must include workstation ergonomics, and an emphasis on temperature, lighting with monitors, and other ambient considerations

Secondly, everyone wants a piece of the pie when a new facility is in the works. And when a new facility is in the works, the temptation exists to ask for the world and negotiate down from there. But over and over, I see this tactic backfire. Hospital planners have developed a hefty dose of skepticism, necessary to sort through the demands.

The solution? Radiology department administrators, practice managers, and radiologists need to be proactive: educate the planners about your operations and share articles about how volume and technology change rapidly. Arrange for them to speak to an objective third-party to gain insight into your facility challenges. Give them a tour of what you have now and your (reasonable) vision for the future. Make your approach reasonable, informed, and forward-thinking. You may find you develop a valuable ally.