Some projects are fairly straightforward: The client articulates a need and we deliver a solution. Problem solved.
Other times, the need appears to be one thing, but as the project moves forward, we realize there’s more to the story. Where taking a closer look reveals a different, larger challenge to be solved.
This was the case when we worked on several imaging replacement projects for Allegheny Health Network's West Penn Hospital. As the plan came together, we realized we needed to stop and study a hidden challenge.
The resulting change in strategy took a smart, well-intentioned idea and made it much, much more effective. What started as a traditional equipment replacement project became a case study in completing a long-term, multi-phased renovation project without interrupting patient care and staff flow.
A Valued Client
West Penn Hospital is in Pittsburgh's Bloomfield neighborhood, just east of downtown. Established in 1848, it was the city’s second chartered public hospital and an important part of healthcare during the iconic steel industry years. It joined the Allegheny Health Network (AHN) in 2013, eventually becoming the system’s flagship for women’s health.
Over the last 10 years, DesignGroup has contributed to more than 100 projects within AHN’s network of 14 hospitals. In this case, West Penn asked us to help design imaging equipment upgrades with minimal operational disruption. And that was the plan, until we took both a closer and wider look at their situation.
Looking Beyond the Initial Plan
Considered an accelerated project, the original goal was to very quickly replace seven end-of-life imaging modalities within existing spaces. As the effort started in 2019, staff began to share inefficiencies with their workflow: support spaces were scattered throughout the floor, patient satisfactions scores for wayfinding and comfort were down, and the 2018 FGI Guidelines which increased the space required for imaging rooms. The team began to wonder, could this project do more to help this department?
We realized replacement projects like this lacked a coordinated, system-wide strategy for growth. If we continued with the fragmented equipment replacement projects, we would miss an opportunity to solve many existing challenges in the WPH imaging Institute affecting staff and patients. We saw value in taking a step back and asking the client, Does this make sense? Is one room the best way to approach this. Is there a better way?
Indeed there was, and it cemented the value of broader master planning and a systematic solution. Leadership at Imaging Institute listened to the concerns and saw the value in a vision for long-term strategic planning and execution. Their advocacy made it possible.
Volume Data Modeling
DesignGroup has deep experience providing early-phase analysis and strategy for healthcare organizations of all sizes. For this project, our team conducted a comprehensive analysis of West Penn Hospital’s existing patient volumes, focusing on current utilization. This data informed our understanding of modality demand, throughput bottlenecks, and capacity gaps across the imaging department over a three-year period.
We also reviewed the department layout and space utilization and found imaging modalities were spread across multiple floors, creating inefficiencies in patient flow and staff operations. The existing MRI department was in the basement (and away from the main elevators), forcing staff and patients to move between floors if multiple images were needed. This process alone created stress for patients and staff alike.
Figure 1 from Anastasia's presentation at Health Facilities Symposium and Expo 2025
We found that much of the existing footprint was underutilized, with a significant amount of space dedicated to administrative functions or redundant circulation rather than clinical use. In collaboration with Imaging Institute leadership, we aligned the planning effort with West Penn’s strategic service lines and future growth projections.
Using market intelligence from the Advisory Board Company, we modeled imaging volume growth over the next five and 10 years specific to the local area. This helped ensure that the replacement strategy would not only meet current needs but also support long-term clinical priorities and regional demand.
After modeling, the projected modality count to support future imaging volumes – combined with increased clearances per the 2018 FGI Guidelines – we determined that the existing third-floor footprint could not accommodate the required growth. The available space fell short of what was needed for the expanded imaging services and updated equipment space requirements.
The Solution
To address the third floor space constraints, the team proposed infilling the existing area between two hospital wings. This solution provided the additional square footage needed to support the full imaging master plan. In fact, the new infill not only centralized imaging services but also created a more efficient, contiguous departmental layout increasing the amount of clinical or revenue generating spaces.
Figure 2 from Anastasia's presentation at HFSE 2025
Working with MBM Construction, H. F. Lenz, and Taylor Structural Engineers, phasing was critical to maintaining continuous imaging operations. The design and construction teams collaborated to conduct a comprehensive, above-ceiling survey of all spaces. This proactive effort helped identify potential issues early, reducing the likelihood of unforeseen conditions that could lead to scope changes, cost increases, and schedule delays. The overall phasing strategy followed a leapfrog (or domino-style) approach where each phase was designed to unlock the next. A single enabling project allowed part of the imaging department to move into renovated space. Which, in turn, freed up the next zone for construction.
This carefully sequenced progression ensured continuous operations, minimized disruption, and avoided the need for temporary external imaging solutions, like a mobile MRI trailer.
A Plan for Uninterrupted Patient Care
To keep imaging services operational during construction, we relied heavily on temporary service relocations and the use of swing spaces. Here’s all it involved:
• The Imaging Institute immediately consolidated or relocated administrative spaces out of the imaging department, which created the logical starting point for Phase 1, radiology.
• The Ultrasound Department was relocated into the vacated General Radiology rooms with little to no renovation after the General Radiology department moved into its newly completed space in Phase 1.
• Nuclear Medicine cases were strategically offloaded to another hospital within the AHN system during a time when that respective department wasn't under construction.
• We also constructed a new SPECT/CT on a separate floor and building adjacent to a similar department, which allowed the Imaging Institute to bring this new and needed service line online sooner and begin generating revenue during construction.
Infill Complexity — Managed Creatively
To enable the infill, two new air-handling units needed to be installed and active before decommissioning the existing unit located within the proposed footprint. The only location for these air-handling units was on the roof of the main hospital, six stories above the imaging department. Large ductwork and structural cages were installed, cascading down the existing facade.
The contractor then erected the permanent roof structure, dismantled the obsolete air-handing unit and roof assembly, and proceeded with slab placement and exterior wall construction. This approach required the contractor to reverse-construct the infill with a top-down, inside-out approach to maintain uninterrupted air flow to the OR department. To ensure patient safety and efficient construction, the hospital shut down a fourth of the nine-story hospital while our team and contractors worked over a four-day period. Everyone played a significant role in ensuring this critical point in the project was successful.
As part of consolidating imaging services on the third floor, the project required relocating the MRI department from the basement. The design and construction team incorporated removable exterior wall panels into the building envelope, enabling the MRI units to be lifted and set in place with cranes from the outside. This strategy minimized disruption within the hospital interior and provided a long-term solution for future equipment replacement.
Planning for the Future
Future volume projections for West Penn indicated that the demand may exceed the capacity of the two Interventional Radiology (IR) rooms, so the team planned, designed, and constructed a shell space identical in size and layout to the active IR suites with the appropriate support spaces such as additional holding bays.
To minimize future disruption, all MEP infrastructure, including medical gas, HVAC ductwork, and electrical systems were routed into the room and capped above the ceiling or within low returns. Lead-lined doors and windows were also installed, and this “shell now, activate later” approach ensured that when the additional IR room is built out, construction will be fully contained within the room boundary without impacting adjacent spaces.
Now approaching year eight of the masterplan, the IR volumes have not grown as anticipated due to network-wide shifts, such as new neighborhood hospitals. Instead, West Penn Hospital’s CT volumes have surged, and with the emergency department (ED) CT nearing end of life, we were able to relocate the newer CT from the third floor into the ED. During the transition, we installed a temporary replacement CT within the shell space maximizing flexibility while minimizing disruption.
Responding to Realities
In total, this project delivered 43,000 square feet of modernized imaging space and replaced or relocated 18 fixed imaging modalities with an average equipment age of 13 years. The varying ages and technical advancements, along with space and infrastructure realities, required a solution that considered patient care and financial stewardship. It involved 2.5 years of design and 4.5 years of carefully phased construction, supported by a $36.5 million construction investment from AHN. All achieved while maintaining uninterrupted patient care.
The result is a right-sized, future-ready imaging department that supports both current operations and long-term growth at West Penn Hospital.
