Background

MRI scans is a radiation free diagnostic tool providing high contrast resolution [1], allowing for excellent delineation of pathology and anatomical structures, and it is frequently pivotal in directing an appropriate treatment plan.

As a highly motion-sensitive imaging method, MRI scans in the paediatric age group can be challenging especially in those aged 3-7 years old. [2] Children in this age group are often curious yet lack understanding and patience, an unfamiliar environment can easily trigger anxiety. [2] Separation from parents and exposure to loud noises during scans can further exacerbate their distress, compromising their ability to remain still inside the scanner. [3] Common methods of immobilization, such as soft pads and sandbags, are often ineffective for young children. As such general anesthesia (GA) [4] or monitored anesthesia care (MAC) is common in paediatric MRI. Additional anaesthesia procedural times and side effects of sedative-hypnotic agents need to be taken into consideration. [5,6]

Studies have explored non-pharmacological interventions for young children undergoing MRI, [7] including pre-scanning preparation methods such as mock scan with a child-life specialist and home-based preparation by parents. [2] However, these methods require substantial time and are conducted days ahead of the actual scans. Given these constraints, practitioners struggle to find the best approach. A successful MRI scan requires collaboration among radiographers, radiologists, child-life specialists [8], parents, and patients themselves.

Teaching Point

The five key factors identified by the MR team at the Hong Kong Children’s Hospital (HKCH) for performing supplementary MRI scans on pediatric patients are:

1. Provision of a children friendly environment: Incorporation of child-friendly elements into the design of the scan rooms and equipment to create a calm and pleasant environment for patients. Adoption of an MRI compatible audio- visual system in the form of a set of video goggles and headphones provides entertainment programs such as movies during scan has proven effective in reducing the need for sedation and further enhances patient satisfaction.

2. Developing rapport and trust with patients: Building trust with patients and parents is pivotal. Engagement of child life service enables young children to actively participate and better understand the examination process in a simulation or play environment, fostering parent-child communication and empowers children. MRI simulator to perform mock scans in preparation for the actual examination enables the patient to have a better understanding of the procedure and hence better able to adapt to the actual scanning. Support from child-life specialist inside the scan room helps the child to stay calm and cooperative.

3. Communication among practitioners: Effective communication between radiographers, radiologists and child-life specialists is essential. Prior to the scan, it is important to discuss scan protocols with the reporting radiologists to streamline the exam and minimize table time. This collaboration ensures that the necessary imaging sequences are obtained while reducing unnecessary scan time.

4. Tailoring scan technique and shortening scan time: Pediatric patients often experience fear and anxiety during medical procedures, particularly when it involves intravenous cannulation. When clinically appropriate, perform plain scans without intravenous contrast injection. Without needles patients may be more willing to follow instructions and cooperate during the scan. Minimizing the duration of the scan is crucial. By limiting the number of sequences and utilizing fast and single-shot sequences such as HASTE, TRUEFISP for T2 weighted imaging, and FLASH for T1 weighted imaging, the scan time can be significantly reduced. This not only increases the chances of obtaining clear images but also improves the overall success rate of the scan.

5. Parental support: Allowing parents, guardians or soft toys to accompany the child during the imaging process can provide comfort and reduce anxiety. The presence of a familiar person or a beloved toy can help relax the child and create a more positive experience. Parent-child combo is also useful.

By considering these factors and implementing strategies to address them, healthcare professionals can significantly improve the success rate of MRI scans for pediatric patients. Creating a safe, comfortable and supportive environment, minimizing scan time, and utilizing effective communication techniques can contribute to a positive experience and ensure high-quality imaging results.

Summary

Building rapport, effective communication, engagement of child-life specialists and familiarization of MRI techniques are crucial factors for successfully conducting MR imaging in children aged 3-7 without sedation. Sharing the experiences of the MR team at Hong Kong Children's Hospital can be valuable for other MR centers and practitioners, as it can help streamline workflow, reduce procedure time, and optimize the utilization of MR facilities.

Acknowledgements

Professional advice was provided by child-life specialist from Playright.