In 2013, a new MRI scanner with an 'uncooperative protocol' feature was installed in the breast center at Maimonides Medical Center in Brooklyn, giving way to an idea.
"The new scanner technology shortened the length of time a patient must spend in it and corrected for movement, so our neuroradiologist suggested it might be useful for pediatric cases," said Fatima Janjua, MD, a third-year radiology resident at the institution.
This marked the beginning of a program delivering sedation-free MRI to children that now, in its third year, boasts a 97 percent success rate.
According to Dr. Janjua, successful sedation-free imaging depends on several factors. The child must be assessed for the potential to tolerate the study while awake, and the child and family must be adequately prepared for the process by a child specialist. Developmental challenges, prior health care experiences and length of the study were among the determining factors of a child's ability to tolerate the exam.
"We set the age between 6 and 11 years, but we did not exclude children below the minimum age if they were likely to tolerate MRI without sedation. This year, 14 percent of the successful studies have been of children less than 6 years old," said Dr. Janjua.
Family-Centered Approach is Key
In addition, she noted that a family-centered approach to the care environment is important. "In advance of the procedure, the family is given an education sheet translated into seven languages," Dr. Janjua said. "It tells the parents what to expect and gives them time to prepare themselves and their child at home."
The study was conducted over an 18-month period and included 122 children ages 4 to 15. Of the total population, 113 children completed the MRI scan without anesthesia. "Four of the children were able to tolerate the study until contrast was attempted, but they were not able to tolerate the injection," Dr. Janjua said.
For MRI scans that were partially completed, only the images without contrast were submitted to the radiologist. The remaining five children were unable to tolerate any part of the study.
Partially completed examinations were related to the contrast injection process and to fear of the needle.
Dr. Janjua and her team solved the problem by placing the IV in the patients in another room before starting the MRI scan. That allowed for comfortable positioning and distraction to be used instead of pharmacological pain management.
Using a quality improvement tool to capture wait times and visit duration, the researchers demonstrated a reduction in overall visit durations for patients who underwent elective, sedation-free MRI exams versus those who had exams with sedation.
"We also saw increased referrals from the families who participated in the program as well as referring physicians," Dr. Janjua said.
The change in wait times for sedated-MRI exams also decreased after the initiation of the sedation-free program, despite the facility handling a stable total MRI exam volume.
In addition to sharing study results with other radiologists and department administrators, Dr. Janjua said it may be helpful to include flyers explaining the program in the offices of pediatric subspecialists like neurologists and endocrinologists and others who refer pediatric patients for MRI.
"It is important to have a child life program to provide necessary support," Dr. Janjua said. "Physician and family can discuss the techniques and benefits of the program and make referrals to the child life specialist."