Marty Sherriff1, Sarah Fletcher1, David Lardner1, Mercedes Bagshawe1, Lisa Carsolio1, Cathy Smith1, and Catherine Lebel1
1Alberta Children's Hospital, Calgary, AB, Canada
Synopsis
We compared the efficacy of three different preparation methods for
clinical MRI scans without sedation in young children (3-7 years): at-home
resources, a session with a child-life specialist, or a mock MRI session with a
child life specialist. Success rates were excellent at 91%, with no differences
between training groups. Subtle group differences in fear/anxiety ratings
suggest a slight benefit of the mock MRI session in reducing anxiety before
scans.
Background
The lack of ionizing radiation and ability to obtain high-resolution
images of soft-tissue structures such as the heart and brain, make MRI a
favourable choice for pediatric imaging.1 However, there is often difficulty, (or perceived difficulty) in
obtaining useable MRI scans in young children due to motion and/or anxiety
concerns.2 Young children (age <8 years at our study site) are typically
scanned under general anesthetic (GA).3 GA permits the necessary MR images to be obtained without worry of
movement, resulting in reliable high quality scans. However, GA introduces a
small increased risk of side effects for the child,4,5 is costly, and presents logistical challenges for families and
institutions.6 Further, there is ongoing concern about the potential impact of GA in
early childhood on neurological development.7 There is a clear need for methods that allow children to undergo
clinical MRI scans without GA. Previous work in both clinical and research
settings has identified that preparation protocols, including the use of a mock
MRI machine for training, may result in high success rates; however, there may
be barriers to accessing this technology. We aimed to determine whether
different preparation methods would enable young children to successfully
undergo awake MRI scans.Methods
Children
(3-7 years) scheduled for clinical MRI scans at the Alberta Children’s Hospital
were invited to participate and randomly assigned to one of three groups:
home-based preparation materials (including a book and recommended practice games),
a session with a child life specialist (using toys, sound effects and other
play-based materials but without a mock MRI scan), or a mock MRI session (Figure
1) with a child life specialist. Children underwent assigned training sessions
a few days prior to their MRI scan. Self- and parent-reported anxiety were
assessed pre and post-training (for the two training groups), and pre and post-MRI
for all children. Scan success was determined by a radiologist and defined as
obtaining images of high enough quality to answer the clinical question that
prompted the MR scan. Children with unsuccessful scans were scheduled for
another scan under GA.Results
Overall success rate was 91% and did not differ significantly between training
groups (Figure 2). Total anxiety scores were similar across groups both pre-
and post-training (where applicable) and pre- and post-MRI scan. However,
children in the mock MRI training group reported significantly lower fear (child
self-report) and their parents reported less worry and feelings of being upset (parent-report;
Figure 3) prior to the MRI scan. Children with unsuccessful scans were
younger (4.5 vs. 5.7 years, p<0.001; Figure 4 and had significantly shorter
scan durations that their successful counterparts (typically because scans were
ended early). Parent-reported anxiety scores prior to the MRI scan were also
significantly lower in children who were unsuccessful. Child life specialists
and MRI technologists accurately predicted scan success (PPV 95.1% and 93.8%
respectively).Conclusion
The high overall success rate suggests that young children can tolerate
awake MRI scans and do not need to be routinely anesthetized. This would reduce
the risks of side effects and the burden of anesthetized scans on the
healthcare system and the family. All preparation methods tested, including
at-home materials, seem efficacious in producing high success rates, with even most
of the youngest children being successful. This suggests that minimally
resource intensive preparations, delivered by the caregivers at home, could be
implemented in areas where access to child-life specialists and/or mock MRI
scanners may be limited. Group differences suggest that preparation with a mock
MRI machine may reduce anxiety before MRI scanning, which could be beneficial
especially for children undergoing multiple medical procedures.Acknowledgements
No acknowledgement found.References
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