There’s an old adage in the aerospace industry: “Everyone and everything must pay their way onto an aircraft.” I learned of this during my PhD years when I was designing an aircraft cabin that helps people in economy class sleep better. After my PhD, I began working with Micro-X on the design research for the Head CT and found that the adage applies to ambulances too.
Australian ambulances, in particular, are packed with equipment and supplies. Introducing a technology like the Head CT, no matter how portable it was, still required justification. We knew from the start that there was a big need for this technology, but we also learned that the need, while perhaps most important, is still only part of the answer. It wasn't enough to answer, “Do we need it?”; we also had to answer, “Will it fit?”, and, “Will they use it?”
There are many vehicle types around the world that are converted into ambulances, but the most common ones are the Ford Transit and the Mercedes-Benz Sprinter, often found in North America, Australia, and Europe. The Toyota HiAce is typically used in Asia, Africa, and some countries across Oceania. There is also the difference in left-hand and right-hand operations globally. In Australia, the Sprinter is the most common base vehicle, but it comes in different wheelbases and heights. Furthermore, each state, health organisations and operating authorities tend to customise the vehicle layout according to their own requirements. However, although complex, it didn't mean that the Micro-X Head CT couldn’t be designed so it can be integrated into most ambulances.
We found that the best way to solve this problem was to start not with the vehicle, but with the user. How paramedics preferred to collect, position, and load the patient onto the vehicle was nearly universal. After close collaboration with the Melbourne Mobile Stroke Unit (MSU) crew and paramedics across South Australia (SA), Victoria (VIC), and New South Wales (NSW), we began by locating the Head CT in the most ideal location so that when the patient and the stretcher are loaded from the ground onto the ambulance, the patient is already in position for scanning. We then worked with the Micro-X engineering team to create layout options for placing other system components, such as the generator in underused areas such as below the cabin seat.
To address the variation of ambulance interior design, the design team developed a uniform casing that would encase all the imaging components that the operators needed to interact with. This allowed the product to be supplied as a kit that can be integrated into different ambulance bodies. We started with the standard wheelbase Sprinter —the most common Australian ambulance and a vehicle type with the tightest yet possible dimensions to accommodate the Head CT.
After making sure things can be built into the wall cabinetry, we had to ensure it was compatible with the existing ambulance setups and that paramedics could still move around the vehicle once the CT was deployed. To ensure this, we scanned both SA and VIC Sprinter ambulances to obtain accurate parameters for the design. We then digitally simulated how the Head CT would be integrated into each ambulance layout to ensure fit and usability. We also knew that the SA and VIC ambulances were not the only vehicles in use, so we created a generic ambulance with cabin dimensions similar to the Transit, Sprinter, and HiAce to further illustrate the integration and workflow of the Head CT.
An Operations Manager at Ambulance VIC told us, “Just because it’s in an ambulance doesn’t mean a paramedic will use it. You can’t tell someone on the road what to use. They have to want to use it.”
In our collaboration and many hours of conversations with paramedics and members of the Melbourne MSU crew, it became apparent that emergency responders need to feel like the Head CT is “ready to scan” if they are going to use it. As such, “readiness” became the guiding design characteristic of the scanner, encompassing its ergonomics, operation procedures, communication, and form factors. We broke down the current workflow of paramedics in a stroke emergency into a second-by-second journey analysis and modified the workflow to ensure fluency and easy adaptation of the Head CT into existing practices and concerns.
At any given moment, the device had to convey that it’s ready to be deployed, to scan, and to be put away. One example is the way the detector is installed into the X-ray emitter array. There are multiple ways to do this, but we opted for a loading mechanism that takes the weight off the operator and ensures perfect alignment between the two components without requiring much thought. Another example is the custom patient positioning device we developed just for the Head CT. We put in a lot of research, development and testing so it was ergonomically inclusive and comfortable for the duration of the scan, ensuring a clear image. It took a lot of guesswork out of aligning the patient to the scanner’s iso-centre while protecting the detector from potential damage. We also made sure it folded flat for easy storage.
The Head CT was also designed to constantly and clearly communicate its status, such as: safely stowed, on, scanning, and safe to put away. Signifiers on the casing indicate when something is locked in place and when it’s been released. The lights around the scanner are visible from any viewing angle into the ambulance cabin and changes colour to show when it’s ready, when it’s scanning, and when the job is done
It was also important not to just design things in a virtual environment. We built a full-scale wooden mock-up of the SA ambulance layout and installed the Head CT kit so we could physically experience the fit and flow of the vehicle and the equipment together. The Head CT geometry, the detector delivery mechanism and the patient positioning device all went through many iterations and refinements and for each change a full size mock-up was built and tested for usability within the ambulance analog.
This is an important aspect of design research. To build things out and to refine in cycles of iteration. Our process in designing the Micro-X Head CT for ambulance integration and it’s human factors involved sketches and drawings, computer models, full size and scaled mock-ups as well as virtual reality but most importantly over four years of collaboration with Micro-X engineers, clinicians, radiographers and first responders. We wanted this life-saving technology to be accessible for everybody one day so we made sure to involve all the stakeholders from the first few sketches.
Dr Nyein Chan is the Program Director of Imaging Technology Design Research at Monash University’s Design Health Collab. Nyein oversees a portfolio of design research projects that includes the Micro-X Head CT and the Micro-X Self Screening Airport Security Checkpoint. Nyein is also a senior lecturer and chief examiner at Monash Art Design and Architecture.
There’s an old adage in the aerospace industry: “Everyone and everything must pay their way onto an aircraft.” I learned of this during my PhD years when I was designing an aircraft cabin that helps people in economy class sleep better. After my PhD, I began working with Micro-X on the design research for the Head CT and found that the adage applies to ambulances too.
Australian ambulances, in particular, are packed with equipment and supplies. Introducing a technology like the Head CT, no matter how portable it was, still required justification. We knew from the start that there was a big need for this technology, but we also learned that the need, while perhaps most important, is still only part of the answer. It wasn't enough to answer, “Do we need it?”; we also had to answer, “Will it fit?”, and, “Will they use it?”
There are many vehicle types around the world that are converted into ambulances, but the most common ones are the Ford Transit and the Mercedes-Benz Sprinter, often found in North America, Australia, and Europe. The Toyota HiAce is typically used in Asia, Africa, and some countries across Oceania. There is also the difference in left-hand and right-hand operations globally. In Australia, the Sprinter is the most common base vehicle, but it comes in different wheelbases and heights. Furthermore, each state, health organisations and operating authorities tend to customise the vehicle layout according to their own requirements. However, although complex, it didn't mean that the Micro-X Head CT couldn’t be designed so it can be integrated into most ambulances.
We found that the best way to solve this problem was to start not with the vehicle, but with the user. How paramedics preferred to collect, position, and load the patient onto the vehicle was nearly universal. After close collaboration with the Melbourne Mobile Stroke Unit (MSU) crew and paramedics across South Australia (SA), Victoria (VIC), and New South Wales (NSW), we began by locating the Head CT in the most ideal location so that when the patient and the stretcher are loaded from the ground onto the ambulance, the patient is already in position for scanning. We then worked with the Micro-X engineering team to create layout options for placing other system components, such as the generator in underused areas such as below the cabin seat.
To address the variation of ambulance interior design, the design team developed a uniform casing that would encase all the imaging components that the operators needed to interact with. This allowed the product to be supplied as a kit that can be integrated into different ambulance bodies. We started with the standard wheelbase Sprinter —the most common Australian ambulance and a vehicle type with the tightest yet possible dimensions to accommodate the Head CT.
After making sure things can be built into the wall cabinetry, we had to ensure it was compatible with the existing ambulance setups and that paramedics could still move around the vehicle once the CT was deployed. To ensure this, we scanned both SA and VIC Sprinter ambulances to obtain accurate parameters for the design. We then digitally simulated how the Head CT would be integrated into each ambulance layout to ensure fit and usability. We also knew that the SA and VIC ambulances were not the only vehicles in use, so we created a generic ambulance with cabin dimensions similar to the Transit, Sprinter, and HiAce to further illustrate the integration and workflow of the Head CT.
An Operations Manager at Ambulance VIC told us, “Just because it’s in an ambulance doesn’t mean a paramedic will use it. You can’t tell someone on the road what to use. They have to want to use it.”
In our collaboration and many hours of conversations with paramedics and members of the Melbourne MSU crew, it became apparent that emergency responders need to feel like the Head CT is “ready to scan” if they are going to use it. As such, “readiness” became the guiding design characteristic of the scanner, encompassing its ergonomics, operation procedures, communication, and form factors. We broke down the current workflow of paramedics in a stroke emergency into a second-by-second journey analysis and modified the workflow to ensure fluency and easy adaptation of the Head CT into existing practices and concerns.
At any given moment, the device had to convey that it’s ready to be deployed, to scan, and to be put away. One example is the way the detector is installed into the X-ray emitter array. There are multiple ways to do this, but we opted for a loading mechanism that takes the weight off the operator and ensures perfect alignment between the two components without requiring much thought. Another example is the custom patient positioning device we developed just for the Head CT. We put in a lot of research, development and testing so it was ergonomically inclusive and comfortable for the duration of the scan, ensuring a clear image. It took a lot of guesswork out of aligning the patient to the scanner’s iso-centre while protecting the detector from potential damage. We also made sure it folded flat for easy storage.
The Head CT was also designed to constantly and clearly communicate its status, such as: safely stowed, on, scanning, and safe to put away. Signifiers on the casing indicate when something is locked in place and when it’s been released. The lights around the scanner are visible from any viewing angle into the ambulance cabin and changes colour to show when it’s ready, when it’s scanning, and when the job is done
It was also important not to just design things in a virtual environment. We built a full-scale wooden mock-up of the SA ambulance layout and installed the Head CT kit so we could physically experience the fit and flow of the vehicle and the equipment together. The Head CT geometry, the detector delivery mechanism and the patient positioning device all went through many iterations and refinements and for each change a full size mock-up was built and tested for usability within the ambulance analog.
This is an important aspect of design research. To build things out and to refine in cycles of iteration. Our process in designing the Micro-X Head CT for ambulance integration and it’s human factors involved sketches and drawings, computer models, full size and scaled mock-ups as well as virtual reality but most importantly over four years of collaboration with Micro-X engineers, clinicians, radiographers and first responders. We wanted this life-saving technology to be accessible for everybody one day so we made sure to involve all the stakeholders from the first few sketches.
Dr Nyein Chan is the Program Director of Imaging Technology Design Research at Monash University’s Design Health Collab. Nyein oversees a portfolio of design research projects that includes the Micro-X Head CT and the Micro-X Self Screening Airport Security Checkpoint. Nyein is also a senior lecturer and chief examiner at Monash Art Design and Architecture.
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Read about the design of Micro-X's Head CT from Dr Nyein Chan Aung, Monash University Design Health Collab.
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