Magnetic Resonance Imaging of Children Without Sedation: Preparation With Simulation

doi:10.1097/00004583-199706000-00024

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 36, Issue 6, June 1997, Pages 853-859

https://doi.org/10.1097/00004583-199706000-00024 Get rights and content

ABSTRACT

Objective

It was hypothesized that a scanner simulator that replicates the magnetic resonance imaging (MRI) environment could be used to prepare pediatric subjects for successful completion of a diagnostic-quality MRI examination without pharmacological sedation.

Method

Sixteen healthy children, 6 to 17 years of age, were matched for age and sex with 16 psychotropic medication-naive children with obsessive-compulsive disorder. Distress was measured throughout simulation and scanning procedures using heart rate and a self-report distress scale. Ten healthy children, 6 to 17 years of age, also underwent the same actual MRI scanning procedure but did not undergo the simulation scanning procedure.

Results

Significant decreases in heart rate and self-reported distress level were observed in all subjects during the simulator session that were maintained to the end of the actual scanner experience. All subjects successfully completed MRI examinations without chemical restraint. Subjects who were not trained in the simulator had higher heart rates and self-reported distress levels in the actual scanner than did simulation-trained subjects.

Conclusions

Simulation without pharmacological sedation successfully prepared pediatric subjects in this pilot study for high-quality MRI studies. Subject preparation may be an alternative procedure to sedation for routine MRI examination in healthy and anxious children 6 years of age and older.

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Cited by (147)

Brief mock-scan training reduces head motion during real scanning for children: A growth curve study
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Pediatric neuroimaging datasets are rapidly increasing in scales. Despite strict protocols in data collection and preprocessing focused on improving data quality, the presence of head motion still impedes our understanding of neurodevelopmental mechanisms. Large head motion can lead to severe noise and artifacts in magnetic resonance imaging (MRI) studies, inflating correlations between adjacent brain areas and decreasing correlations between spatial distant territories, especially in children and adolescents. Here, by leveraging mock-scans of 123 Chinese children and adolescents, we demonstrated the presence of increased head motion in younger participants. Critically, a 5.5-minute training session in an MRI mock scanner was found to effectively suppress the head motion in the children and adolescents. Therefore, we suggest that mock scanner training should be part of the quality assurance routine prior to formal MRI data collection, particularly in large-scale population-level neuroimaging initiatives for pediatrics.
Predicting multiscan MRI outcomes in children with neurodevelopmental conditions following MRI simulator training
2021, Developmental Cognitive Neuroscience
Pediatric brain imaging holds significant promise for understanding neurodevelopment. However, the requirement to remain still inside a noisy, enclosed scanner remains a challenge. Verbal or visual descriptions of the process, and/or practice in MRI simulators are the norm in preparing children. Yet, the factors predictive of successfully obtaining neuroimaging data remain unclear. We examined data from 250 children (6–12 years, 197 males) with autism and/or attention-deficit/hyperactivity disorder. Children completed systematic MRI simulator training aimed to habituate to the scanner environment and minimize head motion. An MRI session comprised multiple structural, resting-state, task and diffusion scans. Of the 201 children passing simulator training and attempting scanning, nearly all (94%) successfully completed the first structural scan in the sequence, and 88% also completed the following functional scan. The number of successful scans decreased as the sequence progressed. Multivariate analyses revealed that age was the strongest predictor of successful scans in the session, with younger children having lower success rates. After age, sensorimotor atypicalities contributed most to prediction. Results provide insights on factors to consider in designing pediatric brain imaging protocols.
Evaluation of distraction techniques for patients aged 4–10 years undergoing magnetic resonance imaging examinations
2021, Radiography
The main aim of the review is to identify potentially effective distraction techniques for the 4 to 10 age range whilst reducing the need for sedation. Objectives also included assessment of the applicability of distraction for the 4–10 age range and, where appropriate, to identify potential cost implications and assess the interventions’ impact on image quality.
A priori search terms, inclusion and exclusion criteria were developed and two independent reviewers were employed to assess study quality. Five studies fitted the criteria of the systematic search strategy. The studies implemented a range of distraction and preparatory techniques resulting in paediatric patients being able to complete an MRI scan to a diagnostic level in the 4 to 10-year-old age category with a sedation rate of 5–20%. All interventions included in the review required time with the patient prior to the scan.
There are a range of efficacious techniques that can be employed to reduce the sedation rates in children aged 4–10 years, whilst allowing diagnostic images to be acquired. The introduction of play and the engagement with the patient prior to the scan appear to be indicators of intervention effectiveness. The efficacy of these interventions does not appear to be linked with proprietary equipment.
Age appropriate interventions are necessary for children of different ages and these distraction interventions may be implemented within departments, for little cost, with notable benefits in terms of sedation.
Participant-driven Simulation Protocol With a Mock Scanner for Pediatric Magnetic Resonance Neuroimaging Preparation Without Sedation
2020, Clinical Simulation in Nursing
Citation Excerpt :
Our protocol is designed to fulfill the aforementioned requirements through multistep simulation before actual MRI examination in children and is dedicated to the behavioral and developmental characteristics of each participant. Previous studies have reported successful utilizations of mock scanners for children with NDDs without sedation (de Bie, Boersma, Wattjes, Adriaanse, & de Waal, 2010; Nordahl et al., 2016; Rosenberg, Sweeney, Gillen, & Kim, 1997; Szeszak et al., 2016; Yerys et al., 2009). However, to the best of our knowledge, a series of single-center analyses that targets both typically developing patients and those with NDDs, as well as describes the failed preparations, does not exist.
Simulation using a mock scanner preparation is beneficial for pediatric patients undergoing magnetic resonance imaging (MRI) without sedation for the assessment of neurocognitive function. However, using a simulation protocol for improving the completion of pediatric MRI has not been studied extensively.
A simulation protocol using a mock scanner “Zero-Tesla” preparation immediately before 3T MRI was utilized based on participants’ demographics. The success rate of each protocol step was compared between children with typical development (TD) and those with neurodevelopmental disorders (NDDs).
Two-hundred forty-one children (4-17 years; 152 males, 89 females; 42.3% TD and 57.7% NDDs) were included. Acceptable MRI qualities were obtained for 100 (98.0%) and 130 (93.5%) children in the TD and NDD groups, respectively. In the NDD group, Zero-T application rates were higher in the young childhood (TD vs NDD; 2% vs 56%, p < .001), middle childhood (5% vs 38%, p < .01), and adolescence (0% vs 49%, p < .001) subgroups than those in the TD group.
Use of a simulation protocol could contribute to the successful completion of advanced MRI without sedation in children with TD and NDDs.
Can virtual reality simulation prepare patients for an MRI experience?
2020, Radiography
Citation Excerpt :
An estimated 2 million MRI scans cannot be performed annually due to claustrophobia, resulting in delayed diagnosis and treatment as well as representing a significant time and resource cost to healthcare organisations.12,13 In addition to sedation (that carries its own risk), interventions previously studied that are aimed at reducing anxiety associated with an MRI exam and improving the quality of images and patient experience include psychosocial interventions (e.g., cognitive therapy3,14 and guided imagery15), use of written information,1,3,16,17 video demonstration and telephone information,8 MR-compatible audiovisual systems18,19 and mock MRI.20–22 However, most of these interventions are tailored to younger paediatric patients and not adults, they more often than not depend on the expertise of play specialists and are time consuming, costly, difficult to implement,8 and consequently underutilised.
A Magnetic Resonance Imaging (MRI) examination is often described by patients as frightening and uncomfortable. To prepare patients for an MRI examination, this study explored the use of virtual reality (VR) simulation compared to a mock MRI scan (full-scale MRI machine replica, without internal magnets).
Twenty participants underwent a VR and a mock MRI scan. Ratings of anxiety and how comfortable and relaxed the participants felt were recorded at five touchpoints during and after each simulation. Post-simulation questionnaires were used to gather responses on the experience and preferences.
No significant differences were found in participants’ ratings of how anxious they felt during or between the two simulations (χ2 (9) = 27.269, p = .126), or how relaxed they felt (χ2 (9) = 14.664, p = .101). There were also no significant differences in the reported levels of comfort between the two types of simulation (χ2 (9) = 20.864, p = .013, post hoc tests for all VR versus mock scan rankings p > .05). There were no significant differences in how real the participants thought each simulation felt, or how anxious, relaxed, and comfortable they felt following each type of simulation (p > .05). Although 65% of participants thought the mock simulation felt more real than the VR, 86% found VR simulation to be a helpful way to prepare for a real MRI exam.
VR could be a feasible and accessible alternative to mock scanning. It has the potential to improve patient experiences of potentially stressful MRI examinations.
VR offers clinicians a new cost-effective tool to prepare patients for an MRI examination. VR technology could be used at home, as a training tool, to familiarise clinicians and clinical trainees with the MRI procedure and better understand patients’ experiences.
Anesthesia Exposure during Therapy Predicts Neurocognitive Outcomes in Survivors of Childhood Medulloblastoma
2020, Journal of Pediatrics
To examine the contribution of anesthesia exposure during treatment for childhood medulloblastoma to neurocognitive outcomes 3 years after tumor diagnosis.
In this retrospective study, anesthesia data were abstracted from medical records for 111 patients treated with risk-adapted protocol therapy at St Jude Children's Research Hospital. Neurocognitive testing data were obtained for 90.9% of patients.
For the 101 patients (62.4% male) who completed testing, mean age at diagnosis was 10.1 years, and 74.3% were staged to have average-risk disease. Anesthesia exposure during treatment ranged from 1 to 52 events (mean = 19.9); mean cumulative duration per patient was 21.1 hours (range 0.7–59.7). Compared with normative expectations (16%), the group had a significantly greater frequency of at-risk scores (<1 SD) on measures of intelligence (28.7%), attention (35.2%), working memory (26.6%), processing speed (46.7%), and reading (25.8%). Including anesthesia exposure duration to linear regression models accounting for age at diagnosis, treatment intensity, and baseline IQ significantly increased the predicted variance for intelligence (r² = 0.59), attention (r² = 0.29), working memory (r² = 0.31), processing speed (r² = 0.44), and reading (r² = 0.25; all P values <.001).
In survivors of childhood medulloblastoma, a neurodevelopmentally vulnerable population, greater exposure to anesthesia significantly and independently predicts deficits in neurocognitive and academic functioning. When feasible, anesthesia exposure during treatment should be reduced.

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ARTICLESMagnetic Resonance Imaging of Children Without Sedation: Preparation With Simulation

ABSTRACT

Objective

Method

Results

Conclusions

J Am Dent Assoc

J Behav Ther Exp Psychiatry

J Behav Ther Exp Psychol

J Am Acad Child Psychiatry

J Am Acad Child Adolesc Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

Ammons Quick IQ Test

The assessment of affective disorders in children and adolescents by semi-structured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Episode version

Arch Gen Psychiatry

High-dose chloral hydrate sedation for children undergoing MR imaging: safety and efficacy in relation to age

Am J Roentgenol

Sedation of difficult-to-sedate children undergoing MR imaging: value of thioridazine as an adjunct to chloral hydrate

Am J Roentgenol

ARTICLES
Magnetic Resonance Imaging of Children Without Sedation: Preparation With Simulation