Medical imaging is increasingly moving out of hospital systems and into independent clinics, driven by lower costs and an increase in frontline diagnostics like cardiac CT. Freestanding practices gain operational flexibility by branching out on their own, but they also face smaller budgets and may lack hospital-grade infrastructure.
As a consequence, there are additional logistical challenges that smaller clinics need to consider before buying large equipment like a CT scanner. These range from building considerations, including structural and electrical capacity, to third-party dependencies involving landlords, contractors, and utility providers.
Because clinics typically operate with leaner resources than a hospital system, facility planning becomes more consequential. Not all of the challenges fall within a clinic’s direct control, which makes vendor experience matter as much as the equipment itself. Last-minute realizations for independent teams are more costly, and obstacles with retrofitting a building can delay installation for months.
Brandon Bush, Head of operations, ArinetaArineta
Here are the common infrastructure problems that independent clinics are likely to encounter, plus less-obvious requirements for CT scanners and advice for planning and dealing with third parties.
Electrical challenges
The most frequent installation challenges are electrical, structural, and physical access. Of the three, electrical problems are the most common because an existing building often does not have the power supply threshold required to meet the National Electrical Code (NEC) codes for a medical imaging suite, which can be double what is required to run exam rooms, basic diagnostic equipment, lighting, etc.
It’s a common situation: the clinician knows which device they need and has the procurement budget, but they can’t move forward because the power supply of the building is no different than an average home. Because hospitals are built to contain multiple high-draw imaging devices, they typically already have the necessary infrastructure that smaller clinics don’t.
There are two likely resolutions to a problem like this. One involves negotiating with the municipal utility provider to modify grid access to the building. The other is to purchase a generator that can provide adequate power. Both have their drawbacks: if a utility service determines that the building can support an increased load, then the solution is to install a larger meter and service connection. 
Joe Mason, Head of service, ArinetaArineta
However, if the existing infrastructure is already near capacity, the utility provider may have to upgrade their own equipment, which is substantially more expensive and usually cost-shared with the clinic. Generators are one way to avoid this, but they may require additional certifications or trigger inspection requirements. A generator also requires ongoing fuel management and maintenance that a small clinic may not be staffed to handle.
Structural, physical access challenges
Structural and physical access challenges are not as common as power supply issues, but smaller practices still run into them. For example, a CT scanner weighs approximately 2,300 pounds, with the room load requirements being around 3,500 to 4,000 pounds accounting for the full installation. This presents a significant challenge for clinics in multi-story buildings, especially those that didn’t commission a structural engineering assessment prior to signing a lease.
While structural reinforcement is possible in some buildings, it can cost from tens of thousands of dollars into six figures and requires substantial coordination with the building owner and whoever occupies the space below. Yet, that is still better than the worst case, which is discovering the problem after installation, which creates a liability for the clinic.
Clinics in multi-story buildings are also likely to run into the third infrastructure challenge: physical access for the installation. Standard commercial elevators may not be large enough to fit all types of CT scanners, even if weight isn’t a problem. Since the facility can’t be built around the machine, every step of the journey has to be thoroughly planned to accommodate street access, narrow hallways, tight turns, and the possibility of having to partially dismantle and reassemble the device.
Realistic requirements
CT scanners require a number of special infrastructure modifications that clinics should plan for well in advance. One of those is the size of the imaging suite: planning must account for the scanner room itself, a separate control room or alcove for the technologist, and equipment or mechanical space.
The total footprint for a conventional CT suite typically runs from several hundred to over a thousand square feet depending on configuration. Smaller CT scanners may be advantageous for clinics with suite size limitations.
Radiation shielding is another requirement, laid out in the National Council on Radiation Protection and Measurements (NCRP) Report No. 147, which entails lining all the walls, doors, floors, and ceilings around the machine with lead, including lead glass in the operator’s viewing window. That shielding is typically 1/16 inch thick, but the exact thickness specification is determined by a licensed radiation physicist who issues a formal shielding design report based on the specific scanner model, the room layout, how frequently the scanner will be used, and what occupies the adjacent spaces.
It’s important for smaller clinics to be aware that a room next to an office where people sit all day requires different calculations than a room next to a storage closet.
Specialized HVAC systems
Specialized HVAC systems are also necessary for keeping CT scanners at the correct temperature and humidity. A typical operating environment needs to stay, at minimum, between 64 and 75 degrees Fahrenheit and as close to 72 as possible. Humidity must be held between 30 and 70 percent, and exceeding either range risks equipment damage and image quality degradation.
When it comes to choosing an HVAC system, there are two main scanner cooling configurations. Water-cooled systems require more maintenance and are more sensitive to temperature fluctuations, while air-cooled systems pull dust and particulate into the gantry more readily, creating its own maintenance requirements. Either way, a clinic converting a standard commercial space needs an HVAC assessment as part of site planning, not as an afterthought.
Building certifications
The requirements for building certifications vary by state and regulatory body, and approval takes significant time. Typically, state health departments regulate the facility license for medical imaging, a process that often takes two to three months. On top of that, accreditation through bodies like the American College of Radiology adds another four to six months from application to approval.
In states with Certificate of Need laws, there is an additional regulatory layer that can add six to twelve months before a facility is even permitted to install certain equipment. Medicare and commercial payer credentialing runs in parallel but adds another 60 to 120 days on top of that.
Navigating third-party dependencies
When navigating relationships with landlords, utility services, electricians, and other third-parties, it’s important to remember that leverage is weakest when the need is most urgent. Ultimately, a clinic cannot force an unwilling landlord to approve structural or electrical modifications.
Ideally, these conversations should begin before signing a lease so that the landlord knows what to expect. A clause requiring landlord cooperation with medical equipment installation, or written pre-approval for specific modifications, is far easier to obtain before the lease is signed than after.
For utility issues, the best plan is to engage early and through a licensed electrical contractor who has an existing relationship with the utility, building the timeline into the project plan rather than treating it as a parallel fast-track problem. Vendor relationships also matter, because buying a scanner from a company that has navigated these situations across many installations will mean having access to that institutional knowledge. Buying on price alone doesn’t necessarily provide the same benefits.
Planning for success
While many clinics think of these issues separately, the truth is that device procurement and facility infrastructure are the same decision-making process, and treating them as sequential is where installations run into trouble. Independent clinics should incorporate building logistics into their plans as early as possible, and considering how you may want your practice to grow in the future is key to making the process smoother down the road. For example, a clinic that knows it will eventually expand to accommodate PET or MRI can build multiple scanning rooms around a central monitoring area, saving space in the long term.
Staffing considerations also matter early in the process. Qualified CT technologists can be difficult to find because of how demand is currently outpacing supply. But building a patient waitlist without solving the staffing question erodes brand reputation and trust and sets a negative tone for what patients can expect from the clinic.
Facility planning
After working through enough of these installations to recognize the patterns, one thing becomes clear: the clinics that struggle are rarely underfunded or underprepared in the clinical sense. They are underprepared on the facility side, and they find out too late to course-correct without cost. Meanwhile, the ongoing shift to outpatient imaging will only bring more practices through this process. Making facility planning part of the procurement conversation from the start is what separates a smooth launch from an expensive one.
Brandon Bush is head of operations and Joe Mason is head of service at Arineta, a manufacturer of cardiac CT systems.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
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