Understanding and Enhancing the Pediatric Radiology Patient's Experience

Leveraging an efficient preparation method into magnetic resonance examinations of young children aged 3-6

PURPOSE

To evaluate the benefits of a multifaceted concept, ANMTE (Appropriate Number of children, appropriate learning Methods, appropriate adaptive Training, and appropriate Encouragement), proposed by our group, in improving the success rate, efficiency and image quality of Magnetic Resonance (MR) examinations for children from 3 to 6 years old.

METHOD

In this study, 150 participants were included from July 2019 to January 2023, including 50 non-sedated children in ANMTE group, 50 in the group with sedative, and 50 in the group with routine preparations. ANMTE refers to appropriate number of children, appropriate learning methods, appropriate adaptive training, and appropriate encouragement, developed by our group for MR examinations of children from 3 to 6 years old. Group differences in success rate, efficiency, and image quality were evaluated across the three groups using Kaplan-Meier, Log-rank and Chi-square test, respectively.

RESULTS

The rates of successful MR examinations were 44/50 (88 %), 45/50 (90 %), and 36/50 (72 %) for ANMTE group, the group with sedatives and the group with routine preparations, respectively (P = 0.03). Image quality of the 3 groups showed no significant group difference (P = 0.067). In terms of the median duration of MR examinations, ANMTE group was comparable to the group with sedative (both were about 10.0 min), but better than the group with routine preparations (16.5 min) (P = 0.024).

CONCLUSION

We demonstrated the feasibility of our comprehensive nursing method ANMTE in MR examinations of young children, similar to the group with sedative at the success rate and image quality as well as the durations of MR examinations. ANMTE has not only better efficiency but also higher safety as it does not require sedative, which could be promising in clinical routine MR examinations for young children aged 3-6 years old.

Newly Developed Methods for Reducing Motion Artifacts in Pediatric Abdominal MRI: Tips and Pearls

OBJECTIVE. The purpose of this article is to review established and emerging methods for reducing motion artifacts in pediatric abdominal MRI. CONCLUSION. Clearly understanding the strengths and limitations of motion reduction methods can enable practitioners of pediatric abdominal MRI to select and combine the appropriate techniques and potentially reduce the need for sedation and anesthesia.

Comparison of three oral contrast preparations for magnetic resonance enterography in pediatric patients with known or suspected Crohn disease: a prospective randomized trial

BACKGROUND

Oral contrast preparation is fundamental to ensuring diagnostic examination quality for magnetic resonance enterography (MRE), yet little is known about the relative palatability and tolerability of various oral contrast agents in pediatric patients with known or suspected inflammatory bowel disease.

OBJECTIVE

We prospectively compared three MRE oral preparations in pediatric patients with known or suspected Crohn disease with respect to patient-reported tolerability and radiologist-determined small-bowel distension and opacification.

MATERIALS AND METHODS

Seventy-five pediatric patients (mean age 14.8 years, 55% female) with known or suspected Crohn disease referred for MRE were randomized to an oral preparation with a sugar alcohol-based flavored beverage (Breeza), polyethylene glycol preparation (MiraLAX), or low-concentration barium sulfate suspension (VoLumen). Patients were instructed to consume oral contrast agent (using a weight-based protocol) beginning 60 min prior to MRE imaging. Following MRE, patients completed a questionnaire regarding their oral preparation solution including: taste (1-5 scale), feeling of well-being (1-5 scale) and willingness to consume again (yes/no). Two radiologists reviewed all MRE exams and rated exams for global features (active disease, overall small-bowel distention [1-4 scale]) and features specific to individual small-bowel segments (extent of distention, maximal luminal diameter, opacification, and susceptibility artifact). Statistical methods included one-way analysis of variance (ANOVA) with Tukey honest difference and Fisher exact tests.

RESULTS

The overall rate of completion of the entire prescribed contrast volume was 53% (40/75), with a significantly higher rate of completion for MiraLAX than for VoLumen (70% vs. 30%, P=0.007). Crossover to a different preparation occurred in nine patients (12%) and was significantly more frequent when the initial preparation was VoLumen versus MiraLAX (29% vs. 0%, P=0.005). Mean subjective taste ratings for both MiraLAX (3.4, P<0.0001) and Breeza (2.8, P=0.006) were superior to those of VoLumen (1.9), which persisted in the subset of patients with MRE evidence of active Crohn disease. Patients who consumed MiraLAX were more likely to be willing to drink it again compared to those consuming VoLumen (82% vs. 46%, P=0.009). Overall small-bowel distention and bowel-segment-specific metrics (distention, maximal diameter, opacification and susceptibility) did not significantly differ among groups.

CONCLUSION

In pediatric patients with known or suspected Crohn disease, MiraLAX and Breeza were rated as more palatable than VoLumen, and all three preparations achieved a similar degree of small-bowel distension and opacification on MRE. Imaging centers performing MRE should stock multiple oral contrast preparations because a sizable proportion of children require more than one agent to ingest the requisite oral contrast volume.

Children centered care: Minimizing the need for anesthesia with a multi-faceted concept for MRI in children aged 4-6

PURPOSE

To evaluate the need for general anesthesia (GA) in MRI in children aged 4-6 years, using a multi-faceted concept, Children Centered Care (CCC), compared to a standard setup.

MATERIALS AND METHODS

In this prospective study of 81 children, we developed and tested a multi-faceted concept, CCC, for MRI in children aged 4-6 without GA, comparing it to a standard setup. The CCC included: 1) an interactive app, 2) a trained pediatric team, 3) a children's lounge with a toy-scanner, and 4) a child-friendly multimedia environment in the MRI room. Patients were included from February-September 2016 and 2017. The use of GA was evaluated, image quality was assessed and a cost-benefit analysis was done.

RESULTS

We included 40 children in the control group and 41 in the CCC group. Mean age was 5.8 years and 48 (59%) were males. Neuro and orthopedic imaging accounted for 58 (72%) and 22 (27%), respectively. With the CCC setup 39/41 (95%) completed a diagnostic MRI without GA compared to 17/40 (43%) in the control group (p < 0.001). Image quality was not different between the groups (p = 0.37). The setup proved cost-effective with a payback time of two years in a Danish setting with 250 eligible patients per year.

CONCLUSION

With the multi-faceted concept CCC, the use of GA for MRI in children aged 4-6 was markedly reduced to 5%, image quality was maintained and the setup was cost-effective.