Cath Lab Setup

What a Cath Lab Setup Involves

A cardiac catheterization lab is not a room that happens to contain an X-ray machine. It is a shielded, environmentally controlled, power-conditioned interventional suite built around a fixed C-arm angiography system — and it is regulated as a radiation installation by the Atomic Energy Regulatory Board (AERB) before a single patient can be imaged.

That distinction has commercial consequences. The imaging OEM delivers the gantry, table, detector, generator and workstations — not the shielded shell they sit inside, the electrical backbone and UPS that feed them, the precision HVAC that holds the detector and technical room inside their operating envelope, or the regulatory file that makes it legal to switch on. All of that is the hospital’s problem.

A turnkey cath lab project builds it to the OEM’s drawings across four interdependent workstreams: the radiation envelope, the imaging interface, building services, and the regulatory file.

Interventional capacity in India is expanding fastest in tier-2 and tier-3 districts, where insurance schemes have put angioplasty within reach of populations that once travelled hundreds of kilometres for it — hospitals that are, in most cases, building their first lab.

Cath Lab Setup Cost in India

The shape of the spend matters more than any single figure: the imaging system dominates, and everything else is a small but non-negotiable envelope around it. Ranges exclude GST, duties and base-building shell construction.

Rolled up:

Three variables move these numbers most. Refurbished versus new imaging — a certified refurbished system with a low-hour tube and an OEM-backed service contract can cut the dominant line item by 55-70%, which is how most first-time tier-2 programmes start. Adjoining occupancy — a lab surrounded by corridors and plant rooms is cheaper to shield than one between a ward and a waiting area. Recurring cost — OEM maintenance after warranty, infrastructure AMC, consumables and tube replacement. Software licences (FFR, IVUS, OCT) are quoted separately and add ₹40 lakh to ₹1 crore.

Radiation Shielding Design for a Cath Lab

This is where turnkey cath lab projects are won or lost. “2 mm lead everywhere” is not shielding design — it is guesswork, and it will not survive a radiation survey.

How lead equivalence is calculated

In a cath lab the useful beam is almost entirely intercepted by the flat-panel detector above the patient. The real problem is scatter, deflected off the patient’s body in every direction at every gantry angle. Because the C-arm sweeps a wide arc of projections there is no single primary-barrier wall; every barrier is a secondary barrier assessed against scatter. Each is calculated separately from five inputs:

• Workload (W) — expected tube output in mA-minutes per week, from caseload, fluoroscopy time per case, cine runs and tube current.
• Operating potential (kVp) — sets beam quality and the lead attenuation curve used.
• Distance (d) — patient to a point 0.3 m beyond the far face of the barrier; doubling it quarters the dose.
• Occupancy factor (T) — how much of the time the space beyond is genuinely occupied by the same individual. Control rooms, offices and wards count as fully occupied; corridors and unattended parking lower.
• Shielding design goal (P) — permitted dose beyond the barrier per week, stricter for uncontrolled areas than for controlled areas entered only by monitored workers. Both derive from AERB’s statutory annual limits: 20 mSv occupational, averaged over five years, and 1 mSv public.

The output is a required attenuation per barrier, in millimetres of lead equivalent (mm Pb).

Typical wall, door and glass specifications

Walls usually land at 1.5-2 mm Pb, rising to 2.5-3 mm where a barrier faces a fully occupied uncontrolled area at short distance. The control room barrier and its lead glass viewing window are normally 2 mm Pb, the window sized so the operator sees patient and table without leaving the protected zone. Doors are typically 2 mm Pb with a lead-lapped frame and lead continued into the pocket on sliders. Floor and ceiling are assessed only where occupancy exists above or below, and lead runs from floor level to at least 2.1-2.4 m. Execution then decides whether it passes survey: butt joints without a 10-12 mm overlap, uncapped fixings and unbaffled penetrations are the three failure modes that show up on every survey.

What a shielding layout drawing contains

The document AERB reviews at layout approval is not a floor plan. It shows a scaled plan with internal dimensions and floor area; every adjoining space on all six sides, including above and below, named with its use and occupancy classification; the position of gantry, table, isocentre and detector with the range of beam directions; a barrier-by-barrier schedule of lead equivalence and its calculation basis; the Pb equivalence of the window and every door; and warning lights, interlocks and signage. Alongside it sits the personal protection programme — ceiling-suspended lead acrylic screen, table-side skirt, aprons, thyroid shields, leaded eyewear and TLD monitoring.

AERB Licensing for a Cath Lab, Step by Step

AERB approval for a cath lab is a sequence, and the sequence matters. Doing step two after step three is the most expensive mistake available here.

1. Institution registration on eLORA. eLORA is AERB’s online e-licensing platform, and effectively everything regulatory happens inside it. The hospital registers as an institution; layout approvals, procurement records, licences and renewals live in that account.

2. Layout approval — before you build. The room layout and shielding design go to AERB for review of dimensions, barrier lead equivalence, occupancy of surrounding areas, and the position of equipment and console. Approval is granted for that specific layout and equipment class. Submitting after construction means opening finished walls to add lead — the most avoidable overrun in cath lab work.

3. Equipment type approval and procurement. AERB operates a type-approval regime for medical diagnostic X-ray equipment. Before the purchase order, confirm the model and supplier are AERB-recognised and that procurement is recorded against the institution.

4. RSO nomination and approval. An interventional facility requires an approved Radiological Safety Officer — typically an interventional cardiologist, radiologist or medical physicist at the facility, holding the AERB-recognised RSO certification for diagnostic radiology and approved through eLORA. Certification runs on fixed examination cycles, so enrol the nominee at design stage.

5. Installation and OEM commissioning. The OEM installs the system and performs its own acceptance testing and equipment-level quality assurance.

6. QA testing and pre-commissioning radiation survey. The room is then surveyed by a qualified professional recognised for the purpose — leakage measured at every barrier, at door edges, at the window frame, at the console, and in occupied spaces above and below. Any barrier that fails is remediated and re-surveyed.

7. Licence application and issue. Submitted through eLORA with the layout approval, QA and survey reports, RSO approval and personnel monitoring enrolment. Once AERB is satisfied, the licence to operate is issued to the hospital for a fixed term — commonly around five years — and renewed through the same portal.

Statutory fees apply at several stages; the schedule is published on eLORA and should be confirmed at the time. Licensing is not a one-time event either — TLD monitoring, periodic QA and intimation when equipment is replaced are continuing obligations of the hospital and its RSO. Budget three to six months of regulatory lead time.

Room and Layout Requirements

Procedure room. AERB’s safety code specifies minimum floor areas for X-ray installations — for interventional rooms, generally in the region of 25 sq m. Treat that as a legal floor, not a design brief. A functional single-plane procedure room is 40-55 sq m, around 6.5 m x 7 m: clearance for the C-arm to sweep its full angular range, longitudinal table travel, ceiling rails for monitors and the lead acrylic screen, an anaesthesia position at the head end, and a crash cart clear of the gantry. Biplane rooms need 55-70 sq m.

Control and technical rooms. The control room is 12-20 sq m with a direct sightline through the lead glass window, housing the console and hemodynamic workstation. The technical room is another 12-20 sq m for the generator cabinet, image processing racks, UPS and isolation transformer — routinely under-sized and under-cooled, since it rejects 5-15 kW.

Height and structure. Slab-to-slab of at least 3.4-3.6 m for a ceiling-mounted gantry, leaving a finished ceiling near 2.9-3.0 m under the rails; below about 3.2 m is the most common reason a retrofit location fails. Gantry, monitor suspension, pendants and shields hang from a load-bearing steel grid anchored to the structural slab and designed to the OEM’s point loads — never from the false ceiling. The floor must meet the OEM’s flatness tolerance and needs a trench or underslab conduit route to the equipment bases.

Prep, recovery and support. A lead-lined sliding main door with 1.4-1.5 m clear opening, plus a second door to the prep side. Four to eight recovery bays at 7-9 sq m with monitoring, oxygen and suction — recovery capacity, not lab capacity, usually caps daily throughput. Add sterile and consumable stores, utilities and a staff change with lead apron racking.

Single-Plane vs Biplane vs Hybrid Cath Lab

Single-plane uses one C-arm and covers the overwhelming majority of adult cardiac work: diagnostic coronary angiography, PCI, temporary and permanent pacing, IABP support and peripheral intervention. Lower capital cost, smaller shielded envelope, simpler power and cooling. For nearly every new tier-2 or tier-3 cardiac programme, this is the right answer.

Biplane runs two independent gantries — frontal and lateral — acquiring simultaneously, so one contrast injection yields two orthogonal views. That is decisive where contrast load and procedure time are limiting: neurointervention, paediatric and congenital cardiac cases, complex structural heart work. It roughly doubles imaging capital cost and increases room size, barrier area, electrical capacity and cooling. Justify it on documented case mix.

Hybrid places a fixed angiography system inside a full modular operation theatre — laminar-flow ceiling, ISO Class 5 cleanliness in the surgical zone, surgical lighting, hermetic doors, full anaesthesia infrastructure — so a percutaneous case can convert to open surgery without moving the patient. That is the requirement for TAVI and TAVR, EVAR and TEVAR, and complex structural work. Because AERB radiation requirements and ISO 14644 cleanroom requirements apply simultaneously, shielding and airflow must be resolved together: a lead barrier and a laminar plenum compete for the same ceiling void.

Power, UPS and HVAC Requirements

A cath lab’s electrical profile is unlike anything else in a hospital. Continuous draw is modest, but a cine acquisition pulls an enormous momentary load — fixed systems commonly specify peak demand in the order of 100-150 kVA against an average of a few kVA. So the supply must be sized for the peak, and line impedance from transformer to generator cabinet kept low enough to hold voltage regulation inside the OEM’s band during it: a dedicated feeder, generously sized cable and, often, a dedicated transformer. Get it wrong and the symptom is not a dead machine — it is intermittent image-quality faults and exposure aborts nobody can reproduce.

Around that sit the safety requirements: a dedicated low-impedance earth, typically below 1 ohm, and equipotential bonding of every exposed conductive part in the room, consistent with Group 2 medical locations and the assumptions IEC 60601 makes about patient-connected equipment. Patient-vicinity circuits should run from an isolated power supply with a line isolation monitor, so a first earth fault alarms instead of tripping a circuit mid-procedure. An online double-conversion UPS, typically 20-60 kVA with 20-30 minutes of autonomy, covers monitoring, lighting, the workstation and — by design decision — the imaging chain itself. Fix that scope early: it changes UPS sizing, battery footprint and electrical room layout.

HVAC is two separate problems. The procedure room needs 21-24°C and 40-60% RH, positive pressure relative to the corridor, and 15-20 air changes per hour of HEPA-filtered supply; hybrid labs step up to full modular OT criteria. Humidity is not a comfort parameter — low RH raises static discharge risk around sensitive electronics, high RH risks condensation. The technical room is pure heat rejection: cabinets reject heat continuously whether or not a case is running, and OEMs specify a narrow ambient band, commonly 18-25°C, with a hard limit at which the system throttles or shuts down. It needs dedicated redundant cooling on essential power. And because the shielded envelope is close to airtight, every duct crossing a lead barrier needs a baffled penetration, coordinated on the shielding drawing rather than on site.

Cath Lab Project Timeline

For a greenfield single-plane lab inside an existing building shell:

Total: 16-24 weeks from order confirmation to clinical handover, with AERB activity concurrent rather than sequential. Retrofits inside a live hospital add two to six weeks; biplane and hybrid projects run 26-36 weeks. Where long-lead imaging delivery exceeds these windows it governs everything — which is why the purchase order and the AERB layout submission belong in the same month.

Why RayMedico Projects for Your Cath Lab

Shielding is designed, not assumed. We calculate lead equivalence barrier by barrier from workload, distance, occupancy and design goal, and produce the layout drawing AERB actually reviews — no walls over-specified at your expense, and none that fail survey after the panels are up.

The regulatory file is owned end to end. The AERB licence is always issued to the hospital, not to a contractor — nobody can honestly promise otherwise. What we own is everything AERB reads: layout submission, shielding calculations, drawing set, QA and survey coordination, and the licence documentation package. We flag what sits with you — RSO certification above all — early enough to act on it.

Built to the OEM’s drawings, not around them. Ceiling grid to the manufacturer’s point loads, floor flatness to their tolerance, trench routing, power quality and technical-room cooling to their specification — so imaging engineers arrive to a room needing no rework.

One accountable contract. Civil interface, shielding, modular interiors, HVAC, electrical and UPS, medical gas and pendants, and the regulatory package under one project manager. Where the lead barrier, the air plenum and the pendant grid compete for the same ceiling void, interface coordination is most of the job.

Long-term partnership. Through the RayMedico ecosystem we help equip the room via RayMedico Marketplace and maintain it under AMC, including the validation and survey support AERB renewal needs.

We are not the cheapest cath lab installation company you will get a quotation from. We are the one that treats radiation shielding and AERB compliance as engineering deliverables, not paperwork to be handled later.