Magnetic resonance imaging (MRI) scanners can be intimidating, to all ages and even to adults. The large machine appears even larger to children, because they are typically smaller. The loud noises, which can typically be heard outside of the exam room, sound like someone pounding. The long tests seem even longer, since time feels relevant to how long you lived. Asking a child to sit still for what feels like an eternity with nothing to entertain them feels like a lost cause most of the time. All of this leads to anxiety and more movement, so physicians tend to order anesthetics for most pediatric MRI scans.1,2 New techniques and characters help kids to overcome these problems and avoid the use of sedation.
Bringing MRI to Size
One method to help deal with the intimidation of the machine is to allow children to become familiar with the machine through play. Some hospitals have miniature MRI machines for their pediatric patients.3,4 These machines allow the kids to become familiar with the process by giving them the opportunity to "scan" their doll or toy before they even see the machine they will be entering. This takes away some of the surprise of both the size of the machine and going into the bore. Their doll or toy lays on the patient platform of the mini machine and can be slid in and out. The machine typically looks like just a plastic MRI machine, but one hospital has a LEGO version. Hospitals have found that these play based techniques help to reduce the anxiety of going into the machine. Therefore, they help to slightly reduce the need for anesthesia.
Augmented reality (AR) can help to acquaint the kids with the exam they are having and make them more comfortable with the machine and how it works.5 One AR option was created specifically for young cancer patients and has videos covering a variety of different procedures and supportive characters. "The Imaginary Friend Society" covers what an MRI is in a fun and interactive way. It also lets the patients have something positive that ties their treatments together. Other AR experiences give tours of the MRI room and answer questions.
Alongside AR, mobile apps are helping children with their education and fears.6 They work similarly to the AR options, bolstering kids and explaining the process. This leads to lowered stress when the time comes for the test. One of these apps, created by Hans Christian Andersen Children's Hospital, was tested on 57 kids, 11 of which were scheduled to have general anesthesia. All 57 of the kids arrived early to their procedure and worked with their radiologist. This resulted in all 57 of them completing their MRI without the use of anesthesia. If these apps and experiences were to be added to standard protocol for pediatric imaging, it could lower the sedation rates and thus the costs.
Blocking the Sound
The noise of an MRI is grating for even people with the most patience. However, hospitals can use mobile apps to replicate the noise of the machine.4 These apps allow the patient to become familiar with the sequences and banging of the machine. This noise is caused by the coils that produce the image of a patient due to the magnets it employs and the nonconformist nature of coils. This is especially true for small children who have imaging done using coils made to fit larger children or even adults. The coils sit further from the body and create more noise due to that. This can also cause worse image quality, because the signal to noise ratio is lowered. Playing the noises from apps on the phone allows doctors to familiarize their pediatric patients with the noise and prepare them for what they will hear.
Additionally, some MRI places have special headsets that can be used in the machines.7 The wires are covered in material that will prevent it from reacting to the magnet. Kids can listen to their favorite songs or internet radio station. In some cases, they can have audio coming through from a movie. This allows them to avoid some of the noise. The familiarity of what they are listening to will also help them to feel more at ease in the bore, rather than having to listen to the unfamiliar noises produced by the machine through the ear plugs that are typically provided.
Encouraging the Connection
Certain hospitals have also received virtual reality goggles that allow their patients to watch their favorite movies.7,8,9,10 These goggles use the same sort of wiring as the headphones to prevent a reaction to the machine. The kids' favorite characters allow them to be distracted from the MRI machine and help to make the experience more fun. This helps the kids to stay still, just like they are when they are at home watching TV. Children as young as four have been able to have MRI scans done without sedation due to the goggles. They have shown a significant reduction in the need for sedation in both children and adults. Patients' favorite characters give them the strength they need to complete the exam.
The use of toys and apps allows kids to become familiar with the procedure and machine before they enter the room. Simultaneously, the mobile sound apps allow radiologists to show children what the test will sound like and what sequences will be used. Specially wired headphones help children avoid some of the frightening noises by replacing the sound with that of music or a movie. Finally, virtual reality goggles give kids the opportunity to watch a movie, causing them to be more confident. All of these techniques help to reduce anxiety and movement during the exams. Sedation becomes less necessary as movement decreases in kids. This ultimately leads to safer and less costly exams.
1. "Magnetic Resonance Imaging (MRI.)" Boston Children's Hospital. Web. 26 October 2018. <http://www.childrenshospital.org/conditions-and-treatments/treatments/mri>
2. "MRI | What to expect." Children's Hospital of The King's Daughters. Web. 26 October 2018. <http://www.chkd.org/Our-Services/Specialty-Care-and-Programs/Lab-X-Ray-and-Medical-Tests/MRI/>.
3. "Doll-Sized MRI Helping Kids Overcome MRI Anxiety." InsideView. Web. 26 October 2018. <https://blog.radiology.virginia.edu/helping-kids-overcome-mri-anxiety/>.
4. Jeff Zagoudis. "Pediatric MRI Calming Techniques." itnonline.com. 19 December 2017. Web. 26 October 2018. <https://www.itnonline.com/article/pediatric-mri-calming-techniques>.
5. Tanya Gazdik. "Pediatric Brain Tumor Foundation Uses AR To Ease Fears." MediaPost.com. 21 May 2018. Web. 26 October 2018. <https://www.mediapost.com/publications/article/319506/pediatric-brain-tumor-foundation-uses-ar-to-ease-f.html>.
6. Wayne Forrest. "Pediatric patients use app to prep for MRI scan." AuntMinnie.com. 2 March 2018. Web. 26 October 2018. <https://www.auntminnie.com/index.aspx?sec=rca&sub=ecr_2018&pag=dis&ItemID=120069>.
7. Joy Hampton. "Virtually relaxing medicine." normantranscript.com. 11 June 2017. Web. 26 October 2018. <https://www.normantranscript.com/news/oklahoma/virtually-relaxing-medicine/article_0e110190-05c3-553e-9047-5330319747e6.html>.
8. Maggie O'Neill. "Finding calm during an MRI." Reno Gazette Journal. 14 August 2018. Web. 26 October 2018. <https://www.rgj.com/story/life/wellness/2018/08/14/finding-calm-during-mri/990765002/>.
9. "Goggles Comfort Children During MRI." Sacred Heart. 11 September 2018. Web. 26 October 2018. <https://www.sacred-heart.org/news/article/?NID=2384>.
10. Taylor Trache. "MRI Tech Helping Children Stay Still." kadn.com. 26 January 2018. Web. 26 October 2018. <https://kadn.com/mri-tech-helping-children-stay-still/>.