Magnetic resonance imaging (MRI)

Sedation-free MRI resonates with younger patients
 

MRI (magnetic resonance imaging) is one of the safest technologies that clinicians can use to image the body for signs of illness or injury. Using a powerful magnet, radio waves and advanced imaging technology, MRI produces detailed, cross-sectional images of organs, the skeleton and soft tissues—all without radiation. But for many patients, having an MRI can be a frightening experience. First, there is the big tube or “doughnut” the head and body disappear into. Then patients must lie immobile for the 20 to 45 minutes or more that an imaging study requires. Then there’s the loud clanging, rapid tapping and thumping that a patient hears during an MRI.

Now imagine you're a young child faced with going into the magnet. For many years, Children’s Hospital Boston has put itself in patients’ shoes, using headphones and more recently video goggles to distract older children during MRIs. Children younger than 8 years old were routinely given sedation, but in 2009, a pilot study—Try Without Sedation—was undertaken to reduce the age of children undergoing MRI without sedation to 5 years and even younger.

According to the Director of MRI, Caroline Robson, MB, ChB, there were a number of compelling reasons to try this. “There is growing recognition among clinicians that there may be small, subtle effects of GA [general anesthesia] or sedation on the developing brains of children,” says Robson. “Eliminating unnecessary sedation or GA avoids this risk, as well as the post-anesthesia recovery period.” In addition, wait times for the limited appointments when sedation or GA is offered can be long, and the cost of administering the MRI is lower when it’s not required. “This program is very popular with parents,” says Robson. “We are providing safer care, the experience for the family is better, and the costs are lower. It is a win for everyone.” Try Without Sedation lowers the cost of an MRI by approximately $1,750.

In Try Without Sedation, MR technologists like project leader Stephanie DeHart, RT, examine a protocoled imaging study to determine if it can be completed in the 20 to 60 minutes that best allows children to hold still. Then, during the routine pre-procedure phone screening, Margo Coakley, RN, or another MR nurse involved in the program asks parents whether they might be interested in trying the exam without sedation and if they think their child might be able to remain still for the procedure. When a child is found to be a candidate, the family is scheduled for an evening appointment, when the department is quieter and child life specialist Angela Franceschi, MEd, CCLS II, has time to prepare the child. Franceschi demonstrates the procedure with a doll and a toy MRI, and the family is able to see the magnet up close before the procedure. “I tell children that the MRI is a big camera that takes pictures of the inside of their body,” says Franceschi, “and I ask them to lie as still as a statue, because if they move, the picture will be fuzzy, just like with their parents’ camera.” Patients are given video goggles and headphones, and many bring in their own favorite movie.

Because the appointments are in the evening, children often come in their pajamas. “We bundle them up in blankets and padding before they go into the magnet, and some sleep through the whole procedure,” says Pauline Connaughton, RT, MR technologist. “Others are wide awake and having a great time. They want to stay to see the end of the movie.”

During the procedure, radiologists check the images to ensure the child is holding still enough to give a precise interpretation. By all measures, the program has been a success. Since its start in 2009, more than 230 children have gone through Try Without Sedation, with a 95 percent success rate. Today, the program is routinely offered to children as young as 4, and children as young as 2 and 3 have successfully gone through it.

According to Coakley, the key to the program’s success is its team approach. “The physicians are completely in support of this, and the department gives us the time we need to prepare families in advance. Before families even arrive, a nurse and Angela have already spoken to them, sometimes several times. The MR technologists are great at making them comfortable for the procedure.”

Patient families are pleased with whole experience and usually proud of their child for staying calm and still through the whole procedure. “With sedation, patients can’t eat for eight hours before the procedure; they are here for a couple of hours and then they have to spend one or two hours in recovery,” says DeHart. “Now when they are done, they can just get up and go. They love it.”