Non-Sedation Practices for Pediatric MRI Deserve Wider Adoption, Standardization
Key findings
- This international survey-based study aimed to determine the current use of non-sedation practices in pediatric MRI, including which specific techniques are applied and how successful they are
- 64% of the 50 responding institutions reported the use of sedation or general anesthesia in at least 25% of their pediatric patients, and wait times for those procedures were substantially longer than for non-sedation MRI (30 vs. 17 days, respectively)
- 98% of sites reported using at least one non-sedation practice; the most common was the feed and swaddle technique for infants (96% of sites, of which 51% reported success in >75% to 100% of patients)
- Most institutions also used headphones (82%), video goggles (61%), and child life specialists (71%), but other non-sedation practices were used less often and with less success
- Pediatric radiologists should consider broadening the eligibility for non-sedation techniques and standardizing the workflow
Most children and teenagers who undergo MRI can voluntarily lie still, but the use of sedation or general anesthesia (here collectively termed GA) is increasing in line with the growing number of scans acquired in pediatric patients. Besides exposure to potential adverse events, GA-MRI adds cost and extends the duration of the visit.
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Most children and teenagers who undergo MRI can voluntarily lie still, but the use of sedation or general anesthesia (here collectively termed GA) is increasing in line with the growing number of scans acquired in pediatric patients. Besides exposure to potential adverse events, GA-MRI adds cost, increases the wait time for these scarce slots, and extends the duration of the visit.
Michael S. Gee, MD, PhD, deputy chief of Radiology at Massachusetts General Hospital, Camilo Jaimes, MD, chief of Pediatric Neuroradiology, and colleagues recently conducted the first survey to evaluate a broad range of non-sedation practices in use for neonates to adolescents undergoing MRI.
In Pediatric Radiology, they report evidence for the need to broaden the use of non-sedation practices, and they suggest a standardized workflow that could facilitate their adoption.
Methods
The researchers developed a 14-question online survey with subparts. Among other inquiries, it asked about the use and success of ten non-sedation practices:
- In-scanner video goggles (or mirrors to watch movies)
- In-scanner headphones
- Melatonin
- Anti-anxiolytics
- Feed and swaddle for infants
- Natural sleep (preferential scheduling at bedtime for infants and young children)
- Animal-assisted therapy (i.e., therapy dogs)
- Preparation with real MRI simulation (full-scale or small-scale)
- Preparation with virtual reality MRI simulation
- Child life specialist alone or with other techniques
In February 2021, the Society of Pediatric Radiology distributed the survey via email to 1,372 of its members, excluding those in training. Responses from specified sites came from nine countries across five continents, including eight outside North America.
GA Practices and MRI Wait Times
25 of the 50 responding sites reported GA use in 25% to 50% of pediatric patients undergoing MRI. Seven sites (14%) reported GA use in >50% of pediatric patients.
There was marked variability among hospitals in pediatric MRI wait times. However, overall, GA-MRI wait times were almost 50% longer than non–GA-MRI wait times (30 vs. 17 days, respectively).
Non-sedation Options
All but one site (98%) used at least one non-sedation practice. The most commonly used practices were:
- Feed and swaddle—96% of the 49 sites
- Headphones—82%
- Child life specialists—71%
- Video goggles—61%
All other techniques listed on the survey were used by less than half the sites. The average number of practices used per site was 4.5, suggesting opportunities for broader adoption.
Success Rates
On average, respondents estimated the success rate for all non-sedation practices to be moderate (>50% to 75%). The practices most frequently employed across sites were also most often reported to have a high success rate (>75%–100%):
- Feed and swaddle in infants—51% of sites using the technique reported a high success rate
- Video goggles—50%
- Headphones—46%
Child life specialists were most often reported as having moderate success, and natural sleep was most often reported as having only fair success.
The "Try Without" Approach
These results suggest the need to reconsider eligibility for non-sedation techniques. Suggestions for building a non-sedation practice program:
- Define exclusions in writing
- Create an algorithm for determining success or failure, with a pathway to convert to GA-MRI if needed
- List non-sedation practices as an option alongside GA-MRI for referring practitioners to select on request forms
- Have children and teenagers use MRI simulators before booking an MRI scan, if possible, to inform decision-making about the likely success of non-sedation MRI
- Discuss options for non-sedation MRI with families at the time of scheduling, and schedule for success or failure
- If a conversation didn't happen earlier, discuss options for non-sedation MRI with families on the day of the visit
- Have a low threshold to try MRI without GA, as much as personnel and equipment permit
- Model and teach a readiness to accept failure
The article includes a figure showing the authors' expert opinion about the best non-sedation practices for pediatric patients depending on chronological age.
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