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Díaz DE, Tseng WL, Michalska KJ. Pre-scan state anxiety is associated with greater right amygdala-hippocampal response to fearful versus happy faces among trait-anxious Latina girls. BMC Psychiatry 2024; 24:1. [PMID: 38167015 PMCID: PMC10759434 DOI: 10.1186/s12888-023-05403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Unfamiliarity with academic research may contribute to higher levels of anticipatory state anxiety about affective neuroimaging tasks. Children with high trait anxiety display differences in brain response to fearful facial affect compared to non-anxious youth, but little is known about the influence of state anxiety on this association. Because reduced engagement in scientific research and greater mistrust among minoritized groups may lead to systematic differences in pre-scan state anxiety, it is crucial to understand the neural correlates of state anxiety during emotion processing so as to disambiguate sources of individual differences. METHODS The present study probed the interactive effects of pre-scan state anxiety, trait anxiety, and emotional valence (fearful vs. happy faces) on neural activation during implicit emotion processing in a community sample of 46 preadolescent Latina girls (8-13 years). RESULTS Among girls with mean and high levels of trait anxiety, pre-scan state anxiety was associated with greater right amygdala-hippocampal and left inferior parietal lobe response to fearful faces relative to happy faces. CONCLUSIONS Anticipatory state anxiety in the scanning context may cause children with moderate and high trait anxiety to be hypervigilant to threats, further compounding the effects of trait anxiety. Neuroimaging researchers should control for state anxiety so that systematic differences in brain activation resulting from MRI apprehension are not misleadingly attributed to demographic or environmental characteristics.
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Affiliation(s)
- Dana E Díaz
- Department of Psychology, University of California, Riverside, CA, USA.
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, Yale University, New Haven, CT, USA
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Sodhi KS, Maralakunte M, Bhatia A, Lal SB, Saxena AK. Utility of the New Faster Compressed SENSE MRCP at 3 Tesla MRI in Children with Pancreatitis. Indian J Pediatr 2023; 90:1210-1215. [PMID: 36692816 DOI: 10.1007/s12098-022-04403-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/14/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the acquisition time, diagnostic efficacy, and image quality of the newer compressed SENSE 3D MRCP (CS-3D MRCP) with conventional 3D MRCP (C-3D MRCP) in children with pancreatitis. METHODS A total of 24 children (2-17 y) diagnosed with pancreatitis were included in this study. The children underwent CS-3D MRCP and C-3D MRCP sequences. C-3D MRCP and CS-3D MRCP images were evaluated for the acquisition time duration, visualization of the pancreaticobiliary ducts, background suppression, image quality degradation by artifacts, and overall image quality by the two radiologists independently. Paired sample t-test was used to compare the acquisition time, the McNemar test for the image quality features, and the kappa coefficient was used for interobserver agreement. RESULTS A two-fold decrease in the acquisition time of CS-3D MRCP (~148 ± 61 s) was seen, compared to C-3D MRCP (~310 ± 98 s), p < 0.001. The median scores for overall image quality on CS-3D MRCP and C-3D MRCP, respectively, were 2.05 ± 0.52 and 2.21 ± 0.53 (p = 0.18) for both radiologists. No significant difference was seen for the visibility of ducts, background suppression, and artifacts between the two radiologists, with substantial to almost perfect agreement seen for the different findings. CONCLUSION The application of compressed SENSE 3D MRCP in children with pancreatitis results in a two-fold reduction in acquisition time with acceptable image quality. This may help in reducing the need for long sedation in children requiring anesthesia support for the MRCP and potentially help in reducing motion artifacts.
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
| | - Muniraju Maralakunte
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Sadhna B Lal
- Division of Pediatric Gastroenterology and Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India
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3
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Fletcher S, Lardner D, Bagshawe M, Carsolio L, Sherriff M, Smith C, Lebel C. Effectiveness of training before unsedated MRI scans in young children: a randomized control trial. Pediatr Radiol 2023; 53:1476-1484. [PMID: 37010547 DOI: 10.1007/s00247-023-05647-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Young children requiring clinical magnetic resonance imaging (MRI) may be given general anesthesia. General anesthesia has potential side effects, is costly, and introduces logistical challenges. Thus, methods that allow children to undergo awake MRI scans are desirable. OBJECTIVES To compare the effectiveness of mock scanner training with a child life specialist, play-based training with a child life specialist, and home book and video preparation by parents to allow non-sedated clinical MRI scanning in children aged 3-7 years. MATERIALS AND METHODS Children (3-7 years, n=122) undergoing clinical MRI scans at the Alberta Children's Hospital were invited to participate and randomized to one of three groups: home-based preparation materials, training with a child life specialist (no mock MRI), or training in a mock MRI with a child life specialist. Training occurred a few days prior to their MRI. Self- and parent-reported functioning (PedsQL VAS) were assessed pre/post-training (for the two training groups) and pre/post-MRI. Scan success was determined by a pediatric radiologist. RESULTS Overall, 91% (111/122) of children successfully completed an awake MRI. There were no significant differences between the mock scanner (89%, 32/36), child life (88%, 34/39), and at-home (96%, 45/47) groups (P=0.34). Total functioning scores were similar across groups; however, the mock scanner group had significantly lower self-reported fear (F=3.2, P=0.04), parent-reported sadness (F=3.3, P=0.04), and worry (F=3.5, P=0.03) prior to MRI. Children with unsuccessful scans were younger (4.5 vs. 5.7 years, P<0.001). CONCLUSIONS Most young children can tolerate awake MRI scans and do not need to be routinely anesthetized. All preparation methods tested, including at-home materials, were effective.
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Affiliation(s)
- Sarah Fletcher
- Faculty of Medicine, University of British Columbia, T3B6A8, Vancouver, Canada
| | - David Lardner
- Alberta Children's Hospital, T3B6A8, Calgary, Canada
| | | | - Lisa Carsolio
- Alberta Children's Hospital, T3B6A8, Calgary, Canada
| | | | - Cathy Smith
- Alberta Children's Hospital, T3B6A8, Calgary, Canada
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4
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Woodward K, Spencer APC, Jary S, Chakkarapani E. Factors associated with MRI success in children cooled for neonatal encephalopathy and controls. Pediatr Res 2023; 93:1017-1023. [PMID: 35906304 PMCID: PMC10033414 DOI: 10.1038/s41390-022-02180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate if an association exists between motion artefacts on brain MRI and comprehension, co-ordination, or hyperactivity scores in children aged 6-8 years, cooled for neonatal encephalopathy (cases) and controls. METHODS Case children (n = 50) without cerebral palsy were matched with 43 controls for age, sex, and socioeconomic status. Children underwent T1-weighted (T1w), diffusion-weighted image (DWI) brain MRI and cognitive, behavioural, and motor skills assessment. Stepwise multivariable logistic regression assessed associations between unsuccessful MRI and comprehension (including Weschler Intelligence Scale for Children (WISC-IV) verbal comprehension, working memory, processing speed and full-scale IQ), co-ordination (including Movement Assessment Battery for Children (MABC-2) balance, manual dexterity, aiming and catching, and total scores) and hyperactivity (including Strengths and Difficulties Questionnaire (SDQ) hyperactivity and total difficulties scores). RESULTS Cases had lower odds of completing both T1w and DWIs (OR: 0.31, 95% CI 0.11-0.89). After adjusting for case-status and sex, lower MABC-2 balance score predicted unsuccessful T1w MRI (OR: 0.81, 95% CI 0.67-0.97, p = 0.022). Processing speed was negatively correlated with relative motion on DWI (r = -0.25, p = 0.026) and SDQ total difficulties score was lower for children with successful MRIs (p = 0.049). CONCLUSIONS Motion artefacts on brain MRI in early school-age children are related to the developmental profile. IMPACT Children who had moderate/severe neonatal encephalopathy are less likely to have successful MRI scans than matched controls. Motion artefact on MRI is associated with lower MABC-2 balance scores in both children who received therapeutic hypothermia for neonatal encephalopathy and matched controls, after controlling for case-status and sex. Exclusion of children with motion artefacts on brain MRI can introduce sampling bias, which impacts the utility of neuroimaging to understand the brain-behaviour relationship in children with functional impairments.
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Affiliation(s)
- Kathryn Woodward
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Arthur P C Spencer
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Clinical Research and Imaging Centre, University of Bristol, Bristol, UK
| | - Sally Jary
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
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5
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Everts R, Muri R, Leibundgut K, Siegwart V, Wiest R, Steinlin M. Fear and discomfort of children and adolescents during MRI: ethical consideration on research MRIs in children. Pediatr Res 2022; 91:720-723. [PMID: 33879848 PMCID: PMC9064788 DOI: 10.1038/s41390-020-01277-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Regula Everts
- Division of Neuropediatrics, Development and Rehabilitation, Children's University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Department of Pediatric Hematology and Oncology, Children's University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Raphaela Muri
- grid.411656.10000 0004 0479 0855Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.411656.10000 0004 0479 0855Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kurt Leibundgut
- grid.411656.10000 0004 0479 0855Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valerie Siegwart
- grid.411656.10000 0004 0479 0855Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.411656.10000 0004 0479 0855Department of Pediatric Hematology and Oncology, Children’s University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- grid.411656.10000 0004 0479 0855Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maja Steinlin
- grid.411656.10000 0004 0479 0855Division of Neuropediatrics, Development and Rehabilitation, Children’s University Hospital, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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6
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Johnson CA, Garnett EO, Chow HM, Spray GJ, Zhu DC, Chang SE. Developmental Factors That Predict Head Movement During Resting-State Functional Magnetic Resonance Imaging in 3-7-Year-Old Stuttering and Non-stuttering Children. Front Neurosci 2021; 15:753010. [PMID: 34803590 PMCID: PMC8595248 DOI: 10.3389/fnins.2021.753010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
Early childhood marks a period of dynamic neurocognitive development. Preschool-age coincides with the onset of many childhood disorders and is a developmental period that is frequently studied to determine markers of neurodevelopmental disorders. Magnetic resonance imaging (MRI) is often used to explore typical brain development and the neural bases of neurodevelopmental disorders. However, acquiring high-quality MRI data in young children is challenging. The enclosed space and loud sounds can trigger unease and cause excessive head movement. A better understanding of potential factors that predict successful MRI acquisition would increase chances of collecting useable data in children with and without neurodevelopmental disorders. We investigated whether age, sex, stuttering status, and childhood temperament as measured using the Child Behavioral Questionnaire, could predict movement extent during resting-state functional MRI (rs-fMRI) in 76 children aged 3–7 years, including 42 children who stutter (CWS). We found that age, sex, and temperament factors could predict motion during rs-fMRI scans. The CWS were not found to differ significantly from controls in temperament or head movement during scanning. Sex and age were significant predictors of movement. However, age was no longer a significant predictor when temperament, specifically effortful control, was considered. Controlling for age, boys with higher effortful control scores moved less during rs-fMRI procedures. Additionally, boys who showed higher negative affectivity showed a trend for greater movement. Considering temperament factors in addition to age and sex may help predict the success of acquiring useable rs-fMRI (and likely general brain MRI) data in young children in MR neuroimaging.
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Affiliation(s)
- Chelsea A Johnson
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Ho Ming Chow
- Department of Communication Sciences and Disorders, University of Delaware, Newark, DE, United States
| | - Gregory J Spray
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, United States
| | - Soo-Eun Chang
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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Stunden C, Stratton K, Zakani S, Jacob J. Comparing a Virtual Reality-Based Simulation App (VR-MRI) With a Standard Preparatory Manual and Child Life Program for Improving Success and Reducing Anxiety During Pediatric Medical Imaging: Randomized Clinical Trial. J Med Internet Res 2021; 23:e22942. [PMID: 34550072 PMCID: PMC8495586 DOI: 10.2196/22942] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/23/2020] [Accepted: 07/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background The experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed. Objective This study aims to compare the effectiveness of a virtual reality (VR)—based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. Our secondary aim is to compare caregivers’ reported anxiety, procedural data, caregiver usability, child satisfaction, and fun. Methods This unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers’ reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales). Results A total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36%; SPM: 24/84, 29%; and CLP: 30/84, 36%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children’s reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r84=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37). Conclusions Digital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting. Trial Registration Clinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT03931382
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Affiliation(s)
- Chelsea Stunden
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Digital Lab at BC Children's Hospital, Vancouver, BC, Canada
| | - Kirsten Stratton
- Department of Child Life, BC Children's Hospital, Vancouver, BC, Canada
| | - Sima Zakani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Digital Lab at BC Children's Hospital, Vancouver, BC, Canada
| | - John Jacob
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Digital Lab at BC Children's Hospital, Vancouver, BC, Canada.,City University of London, London, United Kingdom
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8
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Tziraki M, Garg S, Harrison E, Wright NB, Hawkes R, Akhtar K, Green J, Stivaros S. A Neuroimaging Preparation Protocol Tailored for Autism. Autism Res 2020; 14:65-74. [PMID: 33150732 DOI: 10.1002/aur.2427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022]
Abstract
This paper describes the key basic elements required for a successful multi-parametric MRI data acquisition in awake children with autism. The procedure was designed by taking into account methodological challenges arising from the acquisition of Resting State fMRI (RS fMRI) data, and factors such as cost, time, and staff availability. The ultimate aim was to prepare an imaging preparation protocol with high transferability to the whole autism spectrum, adaptable for use in a multi-site research with multiple time points. As part of a randomized pharmaco-intervention study, 31 children aged 4-10 years with Neurofibromatosis 1 and autism underwent MR imaging at baseline and end of intervention. The protocol consisted of tailored habituation instructions including gradual exposure to scanner noise, a social stories booklet, positive incentive strategies, and Play Therapy support. Success rate for initial acquisition was 71% for GABA+ MR spectroscopy at either location, 87% for perfusion, and 67% for diffusion assessment, and 71% for RS fMRI. Qualitative data indicated that 84% parents found the habituation protocol helpful. LAY SUMMARY: Here we describe a protocol for brain Magnetic Resonance Imaging (MRI) tailored for children with ASD to help reduce stress and avoid sedation during scanning. This procedure can make advanced medical imaging more accessible and promote a better MRI experience for families of children with ASD.
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Affiliation(s)
- Maria Tziraki
- Psychology Department, CITY College, International Faculty of the University of Sheffield, Thessaloniki, Greece
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Harrison
- NIHR Clinical Research Facility, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Neville B Wright
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rob Hawkes
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kapasi Akhtar
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stavros Stivaros
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester & Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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9
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Arendt CT, Eichler K, Mack MG, Leithner D, Zhang S, Block KT, Berdan Y, Sader R, Wichmann JL, Gruber-Rouh T, Vogl TJ, Hoelter MC. Comparison of contrast-enhanced videofluoroscopy to unenhanced dynamic MRI in minor patients following surgical correction of velopharyngeal dysfunction. Eur Radiol 2020; 31:76-84. [PMID: 32740819 DOI: 10.1007/s00330-020-07098-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/02/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare dynamic magnetic resonance imaging (MRI) with videofluoroscopy (VFS) regarding image quality and assessment of gap size between soft palate (SP) and posterior pharyngeal wall (PPW) in children and adolescents following surgical correction of velopharyngeal dysfunction (VPD). METHODS Twenty-one patients undergoing unenhanced 3-T MRI and contrast-enhanced VFS were included in this IRB-approved prospective study. The MRI scan protocol comprised refocused gradient-echo sequences in transverse and sagittal planes during speech, with TE 1.97 ms, TR 3.95 ms, flip angle 8°, matrix size 128 × 128, and 5-mm slice thickness. Radial k-space sampling and sliding window reconstruction were used to achieve an image acquisition rate of 28 frames per second (fps). VFS with 30 fps was similarly performed in both planes. Closure of the velopharyngeal port during phonation was evaluated by two experienced radiologists. RESULTS Eleven (52.4%) patients displayed a complete closure, whereas ten (47.6%) patients showed a post-operative gap during speech. VFS and MRI equally identified the cases with persistent or recurrent VPD. Differences in SP-PPW distance between VFS (3.9 ± 1.6 mm) and MRI (4.1 ± 1.5 mm) were not statistically significant (p = 0.5). The subjective overall image quality of MRI was rated inferior (p < 0.001) compared with VFS, with almost perfect inter-rater agreement (κ = 0.90). The presence of susceptibility artifacts did not limit anatomical measurements. CONCLUSION Dynamic MRI is equally reliable as VFS to assess persistent or recurrent inadequate velum closure in patients following surgical treatment of VPD. KEY POINTS • Unenhanced 3-T dynamic MRI and contrast-enhanced videofluoroscopy are equally useful for the identification of patients with incomplete velopharyngeal closure during speech. • MRI using refocused gradient-echo acquisition with radial k-space sampling and sliding window reconstruction generates diagnostic images with 28 frames per second. • MRI can offer a radiation-free alternative to currently established videofluoroscopy for young patients.
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Affiliation(s)
- C T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - K Eichler
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - M G Mack
- Radiology Munich, Munich, Germany
| | - D Leithner
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - S Zhang
- Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
| | - K T Block
- Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Y Berdan
- Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - R Sader
- Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - J L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - T Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - T J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - M C Hoelter
- Institute for Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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10
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Howlett M, Chorney J. The MRI Self-Efficacy Scale for Children: Development and Preliminary Psychometrics. J Pediatr Psychol 2020; 45:736-748. [PMID: 32632443 DOI: 10.1093/jpepsy/jsaa045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is a common procedure that can be distressing for children. Although not yet studied in the context of pediatric medical procedures, self-efficacy may be a good predictor of procedural stress and a clinically feasible target for behavioral intervention. The objectives of this study were to develop the MRI Self-Efficacy Scale for Children (MRI-SEC) and assess the preliminary psychometric properties. METHODS Development of the MRI-SEC was informed by literature searches and feedback from healthcare providers. Twenty child-parent dyads naïve to MRI and 10 child-parent dyads with MRI experience completed the MRI-SEC to assess the comprehensibility and ease of use, and to inform item and scale refinement. The final version includes four practice items and 12 items directly assessing MRI self-efficacy. To evaluate the psychometric properties, 127 children (ages 6-12) and parents naïve to MRI completed the MRI-SEC, and a series of measures to assess construct validity. To evaluate test-retest reliability 27 children completed the MRI-SEC a second time. RESULTS The MRI-SEC demonstrated acceptable internal consistency, test-retest reliability, and convergent validity. CONCLUSION Development of the MRI-SEC provides an opportunity to better understand the role of self-efficacy as a predictor of procedural stress and cooperation with MRI, informing reliable prediction of children who may benefit from additional support for MRI and the development of tailored behavioral interventions.
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Affiliation(s)
- Melissa Howlett
- Department of Psychology & Neuroscience, Dalhousie University.,Centre for Pediatric Pain Research, IWK Health Centre
| | - Jill Chorney
- Department of Psychology & Neuroscience, Dalhousie University.,Centre for Pediatric Pain Research, IWK Health Centre.,Department of Psychiatry, Dalhousie University
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Morel B, Andersson F, Samalbide M, Binninger G, Carpentier E, Sirinelli D, Cottier JP. Impact on child and parent anxiety level of a teddy bear-scale mock magnetic resonance scanner. Pediatr Radiol 2020; 50:116-120. [PMID: 31501961 DOI: 10.1007/s00247-019-04514-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/26/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pediatric magnetic resonance imaging (MRI) can be stressful. Mock MR scanners have been proven to be effective in avoiding the use of general anesthesia. OBJECTIVES We prospectively evaluated the impact of a teddy bear-scale model of a mock MR scanner on the anxiety experienced by parents and their children during MRI without general anesthesia . MATERIALS AND METHODS A 1-year prospective study before and after the installation of a mock scanner in a Pediatric Radiology Department of a university hospital. Anxiety levels were self-estimated by children ages 4 to 16 years and by the parents with a visual analogue scale (from 0, completely relaxed, to 100, extremely stressed) at three moments: in the waiting room, in the preparation room after an explanation by the MRI technologists, and at the issue of the MR acquisition images. Two groups were tested: one with a mock MR scanner, the other without. Analysis of variance (ANOVA) and Fisher exact tests were performed. Motion artifacts were studied. RESULTS Ninety-one children and their parents were included. The median age was 8 years (standard deviation [SD]=2). In the post mock period, the ambiance of the preparation room was considered by children as significantly more relaxing in 50% vs. 20% (P=0.004) and the anxiety level of children was significantly lower after the explanation, particularly in girls, but unchanged for their parents. The anxiety levels at the end of the examination were significantly lower for parents. The motion artifacts rate was lower (1.7% vs. 4.7%, P=0.04). CONCLUSION A mock scanner was an efficient tool to improve efficiency of the explanation and to decrease anxiety in children and motion artifacts in pediatric MRI.
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Affiliation(s)
- Baptiste Morel
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France. .,Faculty of Medicine, Francois Rabelais University, Tours, France. .,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.
| | | | - Muriel Samalbide
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France
| | - Gauthier Binninger
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France
| | - Elodie Carpentier
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France
| | - Dominique Sirinelli
- Pediatric Radiology Department, Clocheville University Hospital, 49 Boulevard Beranger, 37000, Tours, France.,Faculty of Medicine, Francois Rabelais University, Tours, France
| | - Jean-Philippe Cottier
- Faculty of Medicine, Francois Rabelais University, Tours, France.,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,Neuroradiology Department, Bretonneau Hospital, Tours, France
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12
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Jaite C, Kappel V, Napp A, Sommer M, Diederichs G, Weschke B, Spors B, von Moers A, Lehmkuhl U, Bachmann CJ. A comparison study of anxiety in children undergoing brain MRI vs adults undergoing brain MRI vs children undergoing an electroencephalogram. PLoS One 2019; 14:e0211552. [PMID: 30845163 PMCID: PMC6405132 DOI: 10.1371/journal.pone.0211552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) of the brain in children and adolescents is a well-established method in both clinical practice and in neuroscientific research. This practice is sometimes viewed critically, as MRI scans might expose minors (e.g. through scan-associated fears) to more than the legally permissible “minimal burden”. While there is evidence that a significant portion of adults undergoing brain MRI scans experience anxiety, data on anxiety in children and adolescents undergoing brain MRI scans is rare. This study therefore aimed to examine the prevalence and level of anxiety in children and adolescents who had MRI scans of the brain, and to compare the results to adults undergoing brain MRI scans, and to children and adolescents undergoing electroencephalography (EEG; which is usually regarded a “minimal burden”). Method Participants were 57 children and adolescents who had a brain MRI scan (MRI-C; mean age 12.9 years), 28 adults who had a brain MRI scan (MRI-A; mean age 43.7 years), and 66 children and adolescents undergoing EEG (EEG-C; mean age 12.9 years). Anxiety was assessed on the subjective (situational anxiety) and on the physiological level (arousal), before and after the respective examination. Results More than 98% of children and adolescents reported no or only minimal fear during the MRI scan. Both pre- and post-examination, the MRI-C and the MRI-A groups did not differ significantly with respect to situational anxiety (p = 0.262 and p = 0.374, respectively), and to physiological arousal (p = 0.050, p = 0.472). Between the MRI-C and the EEG-C group, there were also no significant differences in terms of situational anxiety (p = 0.525, p = 0.875), or physiological arousal (p = 0.535, p = 0.189). Prior MRI experience did not significantly influence subjective or physiological anxiety parameters. Conclusions In this study, children and adolescents undergoing a brain MRI scan did not experience significantly more anxiety than those undergoing an EEG, or adults undergoing MRI scanning. Therefore, a general exclusion of minors from MRI research studies does not appear reasonable.
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Affiliation(s)
- Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Viola Kappel
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Adriane Napp
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Sommer
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Diederichs
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- GeRN-Gesellschaft für Radiologie und Nuklearmedizin GbR, Wilhelmshaven, Germany
| | - Bernhard Weschke
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Spors
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Arpad von Moers
- Department of Pediatrics, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Ulrike Lehmkuhl
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian J. Bachmann
- Department of Child and Adolescent Psychiatry, LVR-Klinikum Düsseldorf/ Kliniken der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Ong Y, Saffari S, Tang P. Prospective randomised controlled trial on the effect of videos on the cooperativeness of children undergoing MRI and their requirement for general anaesthesia. Clin Radiol 2018. [DOI: 10.1016/j.crad.2018.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Phan TV, Smeets D, Talcott JB, Vandermosten M. Processing of structural neuroimaging data in young children: Bridging the gap between current practice and state-of-the-art methods. Dev Cogn Neurosci 2018; 33:206-223. [PMID: 29033222 PMCID: PMC6969273 DOI: 10.1016/j.dcn.2017.08.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/28/2017] [Accepted: 08/17/2017] [Indexed: 11/25/2022] Open
Abstract
The structure of the brain is subject to very rapid developmental changes during early childhood. Pediatric studies based on Magnetic Resonance Imaging (MRI) over this age range have recently become more frequent, with the advantage of providing in vivo and non-invasive high-resolution images of the developing brain, toward understanding typical and atypical trajectories. However, it has also been demonstrated that application of currently standard MRI processing methods that have been developed with datasets from adults may not be appropriate for use with pediatric datasets. In this review, we examine the approaches currently used in MRI studies involving young children, including an overview of the rationale for new MRI processing methods that have been designed specifically for pediatric investigations. These methods are mainly related to the use of age-specific or 4D brain atlases, improved methods for quantifying and optimizing image quality, and provision for registration of developmental data obtained with longitudinal designs. The overall goal is to raise awareness of the existence of these methods and the possibilities for implementing them in developmental neuroimaging studies.
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Affiliation(s)
- Thanh Vân Phan
- Experimental Oto-rhino-laryngology, Department Neurosciences, KU Leuven, Leuven, Belgium; icometrix, Research and Development, Leuven, Belgium.
| | - Dirk Smeets
- icometrix, Research and Development, Leuven, Belgium
| | - Joel B Talcott
- Aston Brain Centre, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Maaike Vandermosten
- Experimental Oto-rhino-laryngology, Department Neurosciences, KU Leuven, Leuven, Belgium
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15
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McGlashan HL, Dineen RA, Szeszak S, Whitehouse WP, Chow G, Love A, Langmack G, Wharrad H. Evaluation of an internet-based animated preparatory video for children undergoing non-sedated MRI. Br J Radiol 2018; 91:20170719. [PMID: 29688030 DOI: 10.1259/bjr.20170719] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We evaluate the value of an internet-based educational animated video designed to prepare children for MRI scans, and whether this video reduces scan-related anxiety in children with a neurological disorder, and healthy controls. METHODS Participants completed a pre- and post-scan questionnaire evaluating participant online viewing behaviour, understanding of the MRI procedure, anxiety regarding the MRI, impact of animation in preparing the child and whether the child's expectation of the MRI scan matched their experience. RESULTS 21 children were recruited (12 healthy controls) ranging in age from 6.5 to 11.5 years. The animation was successfully accessed by participants on a range of digital devices and had high levels of approval. Children who viewed the animation had a good understanding of the MRI procedure and low anxiety levels prior to the scan, and reported that their expectations broadly matched the real-life MRI experience. Children reported that the animation positively impacted on their preparation with similar ratings before and after the scan, and the impact on preparation was rated greater by younger children. There were no group differences between healthy children and those with the neurological disorder for ratings of anxiety, impact on preparation and expectation of the experience. CONCLUSION This evaluation demonstrates accessibility, acceptability and relevance of internet-based educational animation for typically developing children, and children with a neurodisability aged 6 to 11 years, with positive impact on preparation for MRI. Advances in knowledge: The internet-based educational animation provides a widely accessible tool to support preparation of children for non-sedated MRI.
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Affiliation(s)
- Hannah L McGlashan
- 1 Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham , Nottingham , UK
| | - Rob A Dineen
- 1 Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham , Nottingham , UK.,2 Sir Peter Mansfield Imaging Centre, University of Nottingham , Nottingham , UK
| | - Sofia Szeszak
- 1 Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham , Nottingham , UK
| | - William P Whitehouse
- 3 Division of Child Health, University of Nottingham, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Gabriel Chow
- 4 Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust , Nottingham , UK
| | - Andrew Love
- 5 School of Art & Design, Nottingham Trent University , Nottingham , UK
| | - Gill Langmack
- 6 School of Health Sciences, University of Nottingham , Nottingham , UK
| | - Heather Wharrad
- 6 School of Health Sciences, University of Nottingham , Nottingham , UK
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16
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Szeszak S, Man R, Love A, Langmack G, Wharrad H, Dineen RA. Animated educational video to prepare children for MRI without sedation: evaluation of the appeal and value. Pediatr Radiol 2016; 46:1744-1750. [PMID: 27568023 DOI: 10.1007/s00247-016-3661-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/06/2016] [Accepted: 06/21/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND MRI scans can be distressing for children and often require sedation. Educating children about what to expect reduces anxiety and increases likelihood of successful non-sedated MRI scans. Multimedia tools are a popular means of education. Animated video could provide a free, accessible method of preparing children for MRI scans. OBJECTIVE To evaluate a new animation video for preparing children for MRI, specifically for decreasing in-scanner motion and examination failure. MATERIALS AND METHODS We recruited 24 healthy children ages 5-11 years. Participants underwent pre- and post-viewing questionnaires and structured interviews. We then compared median Likert scale score changes between pre- and post-animation questions and analyzed the interview framework. Participants were filmed viewing the animation to calculate time spent looking at the screen to assess how well the video retained children's attention. RESULTS There were significant improvements in median scores regarding what to expect, checking for metal and keeping still. There were no significant changes in other knowledge-based topics. There were significant improvements in median scores for anxiety-based topics. On average, children watched the screen for 98.9% of the 174-s animation. CONCLUSION The animation improved knowledge, reduced anxiety, retained attention and was enjoyed by participants. It can be accessed freely via the Internet to help prepare children ages 5-11 for having an MRI scan.
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Affiliation(s)
- Szofia Szeszak
- Radiological Sciences, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK
| | - Rachel Man
- School of Art & Design, Nottingham Trent University, Nottingham, UK
| | - Andrew Love
- School of Art & Design, Nottingham Trent University, Nottingham, UK
| | - Gill Langmack
- Health E-learning and Media group, School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Heather Wharrad
- Health E-learning and Media group, School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Robert A Dineen
- Radiological Sciences, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK. .,Sir Peter Mansfield Imaging Centre, Queen's Medical Centre, University of Nottingham, Derby Road, Nottingham, NG7 2UH, UK.
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17
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Does preparation of children before MRI reduce the need for anesthesia? Prospective randomized control trial. Pediatr Radiol 2016; 46:1599-605. [PMID: 27314584 DOI: 10.1007/s00247-016-3651-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/15/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Magnetic resonance imaging has been recognized for years as the safest and most precise imaging method, particularly for children. The accuracy of MRI depends on avoidance of patient movement during the study. This may be difficult for children and may require anesthesia. OBJECTIVE We evaluated an introductory instruction program as an assistive tool in performing MRI without anesthesia. MATERIALS AND METHODS In one institution, 121 children were randomized to undergo full interactive pre-MRI instruction (n=64), which included an instructional booklet, movie and simulator practice, or partial instruction (n=57), comprised of the booklet only. All researchers and health care professionals involved, except for the one who instructed the families, were masked to the group allocation. Parents' anxiety, according to the Spielberger state anxiety inventory, was measured. RESULTS Median age was 7.4 years (range: 5 years-16 years). Anesthesia was required for fewer children who received full compared to partial instruction: 17 (27%) vs. 27 (47%), P≤0.02. The median anxiety level prior to instruction was higher than the median level after instruction, for both the partial and full instruction groups. CONCLUSION Instruction including simulator practice was associated with a decreased need for anesthesia among children undergoing MRI scans.
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18
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Does preparation of children before MRI reduce the need for anesthesia? Prospective randomized control trial. Pediatr Radiol 2016. [PMID: 27314584 DOI: 10.1007/s00247‐016‐3651‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Magnetic resonance imaging has been recognized for years as the safest and most precise imaging method, particularly for children. The accuracy of MRI depends on avoidance of patient movement during the study. This may be difficult for children and may require anesthesia. OBJECTIVE We evaluated an introductory instruction program as an assistive tool in performing MRI without anesthesia. MATERIALS AND METHODS In one institution, 121 children were randomized to undergo full interactive pre-MRI instruction (n=64), which included an instructional booklet, movie and simulator practice, or partial instruction (n=57), comprised of the booklet only. All researchers and health care professionals involved, except for the one who instructed the families, were masked to the group allocation. Parents' anxiety, according to the Spielberger state anxiety inventory, was measured. RESULTS Median age was 7.4 years (range: 5 years-16 years). Anesthesia was required for fewer children who received full compared to partial instruction: 17 (27%) vs. 27 (47%), P≤0.02. The median anxiety level prior to instruction was higher than the median level after instruction, for both the partial and full instruction groups. CONCLUSION Instruction including simulator practice was associated with a decreased need for anesthesia among children undergoing MRI scans.
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19
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MRI Customized Play Therapy in Children Reduces the Need for Sedation--A Randomized Controlled Trial. Indian J Pediatr 2016; 83:209-13. [PMID: 26477350 DOI: 10.1007/s12098-015-1917-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an MRI-specific play therapy intervention on the need for sedation in young children. METHODS All children in the age group of 4-10 y, who were advised an MRI scan over a period of one year were randomized. Exclusion criteria included children with neurodevelopmental disorders impairing cognition and children who had previously undergone diagnostic MRI. A total of 79 children were randomized to a control or an intervention condition. The intervention involved familiarizing the child with the MRI model machine, listing the steps involved in the scan to the child in vivid detail, training the child to stand still for 5 min, and conducting several dry runs with a doll or a favorite toy. The study was approved by the Institute ethical committee. RESULTS The need for sedation was 41 % (n = 16) in the control group and this declined to 20 % (n = 8) in the intervention group (χ(2) = 4.13; P = 0.04). The relative risk of sedation decreased by 49 % in the intervention group as compared to the control group (RR 0.49; 95 % CI: 0.24-1.01) and this difference was statistically significant (P = 0.04). The absolute risk difference in sedation use between intervention and control group was 21 % (95 % CI 1.3 %-40.8 %). Even on adjusting for age, relative risk of sedation remained significantly lower in children undergoing play therapy as compared to the control (RR 0.57, 95 % CI: 0.32-0.98) with P value of 0.04. CONCLUSIONS The use of an MRI customized play therapy with pediatric patients undergoing diagnostic MRI resulted in significant reduction of the use of sedation.
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20
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Chou IJ, Tench CR, Gowland P, Jaspan T, Dineen RA, Evangelou N, Abdel-Fahim R, Whitehouse WP, Constantinescu CS. Subjective discomfort in children receiving 3 T MRI and experienced adults' perspective on children's tolerability of 7 T: a cross-sectional questionnaire survey. BMJ Open 2014; 4:e006094. [PMID: 25320001 PMCID: PMC4201995 DOI: 10.1136/bmjopen-2014-006094] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To explore the possible discomfort perceived by children participating in 7 T MRI research, and the age range in which children are most likely to tolerate it well. DESIGN A cross-sectional survey using age-appropriate questionnaires containing six measures of subjective discomfort (general discomfort, dizziness, noisiness, claustrophobia and feeling of cold or warm). SETTING For children, 3 T clinical scanner in a tertiary referral teaching hospital; for adults, 3 and 7 T scanner in a university research building. PARTICIPANTS Non-sedated children and young people under 18 years of age who underwent 3 T clinical MRI for brain or musculoskeletal scans and adult volunteers attending 7 T with or without 3 T for brain scans. RESULTS 83% (89/107) of involved individuals returned questionnaires. The most common discomfort among 31 children receiving 3 T MRI was noisiness (39%), followed by cold (19%), general discomfort (16%), dizziness (13%) and claustrophobia (10%). The noise was reported more frequently in children younger than 12 years than those older (p=0.021). The most common discomfort for 58 adults receiving 7 T MRI was noisiness (43%). In adults, there was a higher frequency of general discomfort during 7 than 3 T scans (p=0.031). More than 85% of adult respondents thought children aged 12-17 years would tolerate 7 T scans well, but only 35% and 15% thought children aged 10-11 and 8-9 years, respectively, would. CONCLUSIONS Noisiness was the most common discomfort across all ages in 3 and 7 T scanners. Although general discomfort was more common during 7 than 3 T scans in adults, most adults thought children aged 12 years or more would tolerate 7 T MRI well. Cautious enrolment of children in 7 T MRI study is warranted, but until there is more evidence of how well those aged 12 years or more tolerate 7 T MRI, we would caution against enrolling younger children.
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Affiliation(s)
- I-Jun Chou
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
- Division of Paediatric Neurology and Paediatric General Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Christopher R Tench
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Penny Gowland
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Tim Jaspan
- Department of Radiology, Nottingham University Hospitals Trust, Nottingham, UK
| | - Rob A Dineen
- Department of Radiology, Nottingham University Hospitals Trust, Nottingham, UK
- Division of Radiological and Imaging Sciences, University of Nottingham, Nottingham, UK
| | - Nikos Evangelou
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rasha Abdel-Fahim
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - William P Whitehouse
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Paediatric Neurology, Nottingham Children's Hospital, Nottingham University Hospitals Trust, Nottingham, UK
| | - Cris S Constantinescu
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Prediction of compliance with MRI procedures among children of ages 3 years to 12 years. Pediatr Radiol 2014; 44:1302-9. [PMID: 24859264 DOI: 10.1007/s00247-014-2996-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/01/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A number of children are unable to comply with an MRI procedure and require general anesthetic. However, we lack information about which factors are associated with MRI compliance in young children. OBJECTIVE To determine the strongest predictors of MRI compliance, focusing on variables that can be easily rated by patients' parents. MATERIALS AND METHODS A sample of 205 children ages 3-11 years (mean age 6.6 years) who were at risk of non-compliance were recruited from a children's hospital. Their parents completed a behavior assessment scale for children as well as a questionnaire that assessed their expectations of compliance and perception of their child's typical medical compliance. The children subsequently completed a mock MRI with an educational play therapist and a clinical MRI, with the quality of the scan scored by the MRI technologist. RESULTS Overall, 88.3% of children complied with the clinical scan and achieved diagnostic images, with age unrelated to compliance in this well-prepared patient group. The strongest predictors of MRI compliance were parental expectations and ratings of how well the child typically copes with medical procedures. Non-compliance was related to child attention problems and to poor adaptability among children. A total of 64 preschool-age children (91.4%) and 110 school-age children (95.7%) were correctly classified as compliant or non-compliant based on these predictor variables. CONCLUSION A child's temperament, medical experiences and parental expectations provide important information in predicting which children successfully comply with an MRI procedure and which require general anesthesia. Further study is needed to explore the utility of these variables in predicting compliance at sites that do not have access to an MRI simulator.
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22
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Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis. Eur Radiol 2013; 24:327-34. [DOI: 10.1007/s00330-013-3036-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
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Haddad ADM, Platt B, James AC, Lau JYF. Anxious and non-anxious adolescents' experiences of non-clinical magnetic resonance imaging research. Child Psychiatry Hum Dev 2013; 44:556-60. [PMID: 23232793 DOI: 10.1007/s10578-012-0350-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Magnetic resonance imaging (MRI) has become a ubiquitous research tool for developmental neuroscientists interested in brain structure and function in children and adolescents. However, ethical concerns are sometimes raised about using MRI with children and adolescents, especially when participants have anxiety. We asked 17 clinically/sub-clinically anxious and 19 non-anxious adolescents about their experiences of taking part in MRI for research purposes. Although the anxious group reported experiencing more anxiety during the scan, these differences had attenuated by the time participants got home. We found no evidence that anxious adolescents would be less likely to choose to have another scan or would feel more nervous during another scan. There was some evidence that more trait anxious adolescents found the MRI study enjoyable. These findings should give ethics committees, clinicians, and parents confidence that so long as researchers exercise appropriate care, MRI research is acceptable to adolescents, including those with clinical anxiety.
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Affiliation(s)
- Anneke D M Haddad
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3UD, UK.
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24
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Shechner T, Wakschlag N, Britton JC, Jarcho J, Ernst M, Pine DS. Empirical examination of the potential adverse psychological effects associated with pediatric FMRI scanning. J Child Adolesc Psychopharmacol 2013; 23:357-62. [PMID: 23738869 PMCID: PMC3689936 DOI: 10.1089/cap.2012.0076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Over the past decade, the number of functional magnetic resonance imaging (fMRI) studies has increased dramatically. As MRI scans may be anxiety provoking, performing them in a research setting, particularly with children already prone to anxiety, raises questions about ethics as well as methodological feasibility. It is essential to address these questions before expanding the use of this technique to clinical settings, or more widely in the context of pediatric psychopharmacology and biological psychiatry research. The current study investigates the psychological reactions of anxious and non-anxious children and non-anxious adults to an fMRI scan. METHODS Eighty-seven anxious children, 140 non-anxious children, and 98 non-anxious adults rated their emotional reactions to an fMRI scan. RESULTS Results indicated that anxious and non-anxious children reported no greater anxiety after fMRI scanning than did adults. In addition, no age-related differences in distress were observed. These data demonstrate that anxious children, healthy children, and healthy adults have similar emotional reactions to fMRI scanning. CONCLUSIONS The observed findings suggest that the potential for fMRI to produce anxiety should not impede its widespread use in clinical research, psychopharmacology, and biological psychiatry.
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Affiliation(s)
- Tomer Shechner
- Section on Developmental Affective Neuroscience, The National Institute of Mental Health, Bethesda, MD 20892, USA.
| | | | | | - Johanna Jarcho
- The National Institute of Mental Health, Bethesda, Maryland
| | - Monique Ernst
- The National Institute of Mental Health, Bethesda, Maryland
| | - Daniel S. Pine
- The National Institute of Mental Health, Bethesda, Maryland
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Hemke R, van Veenendaal M, Kuijpers TW, van Rossum MAJ, Maas M. Increasing feasibility and patient comfort of MRI in children with juvenile idiopathic arthritis. Pediatr Radiol 2012; 42:440-8. [PMID: 22246410 PMCID: PMC3316772 DOI: 10.1007/s00247-011-2306-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 08/30/2011] [Accepted: 09/17/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND MRI is the most sensitive imaging modality in juvenile idiopathic arthritis (JIA), but has practical limitations. Optimizing the scanning protocol is, therefore, necessary to increase feasibility and patient comfort. OBJECTIVE To determine the feasibility of bilateral non-contrast-enhanced open-bore MRI of knees and to assess the presence of literature-based MRI features in unsedated children with JIA. MATERIALS AND METHODS Children were classified into two clinical subgroups: active arthritis (group 1; n = 29) and inactive disease (group 2; n = 18). MRI features were evaluated using a literature-based score, comprising synovial hypertrophy, cartilage lesions, bone erosions, bone marrow changes, infrapatellar fat pad heterogeneity, effusion, tendinopathy and popliteal lymphadenopathy. RESULTS The MRI examination was successfully completed in all 47 children. No scan was excluded due to poor image quality. Synovial hypertrophy was more frequent in group 1 (36.2%), but was also seen in 19.4% of the knees in group 2. Infrapatellar fat pad heterogeneity was more prevalent in group 2 (86.1%; P = 0.008). Reproducibility of the score was good (Cohen kappa, 0.49-0.96). CONCLUSION Bilateral non-contrast-enhanced open-bore knee MRI is feasible in the assessment of disease activity in unsedated children with JIA. Signs differing among children with active and inactive disease include infrapatellar fat pad heterogeneity and synovial hypertrophy.
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Affiliation(s)
- Robert Hemke
- Department of Radiology, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Mira van Veenendaal
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital AMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Taco W. Kuijpers
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital AMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Marion A. J. van Rossum
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children’s Hospital AMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands ,Department of Pediatric Rheumatology, Jan van Breemen Institute, Dr. Jan van Breemenstraat 2, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
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Westra AE, Zegers MPA, Sukhai RN, Kaptein AA, Holscher HC, Ballieux BEPB, van Zwet EW, Wit JM. Discomfort in children undergoing unsedated MRI. Eur J Pediatr 2011; 170:771-7. [PMID: 21120526 PMCID: PMC3099003 DOI: 10.1007/s00431-010-1351-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 11/04/2010] [Indexed: 11/29/2022]
Abstract
Magnetic resonance imaging (MRI) scans for research purposes usually do not directly benefit the children scanned, so that review boards need to assess whether the risk of harm or discomfort is minimal. This study aimed at providing empirical data on discomfort related to unsedated MRI in children aged 5-12 years. Secondary objectives were to determine whether lower age is associated with higher levels of discomfort and to investigate which other characteristics of subjects and/or procedures may be associated with higher levels of discomfort. Self-report scores, observation scores, heart rate standard deviation scores, and incremental salivary cortisol levels were obtained from 54 children aged 5-12 years with non-acute conditions undergoing diagnostic MRI. Of the 54 children, 10 scored relatively high values on the self-report score and on one or two of the other measures, and another 15 scored relatively high on the self-report score alone. Rather than an age effect, associations were found between parents' trait anxiety and observation score values and between use of contrast fluid (requiring the insertion of a venous cannula) and high incremental salivary cortisol levels. In conclusion, MRI-related discomfort may be regarded as minimal for more than half of children aged 5-12.
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Affiliation(s)
- Anna E. Westra
- Department of Pediatrics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Maria P. A. Zegers
- Department of Pediatrics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Rám N. Sukhai
- Department of Pediatrics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Ad A. Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands
| | - Herma C. Holscher
- Department of Radiology, Haga Teaching Hospital/Juliana Children’s Hospital, The Hague, The Netherlands
| | - Bart E. P. B. Ballieux
- Department of Clinical Chemistry, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik W. van Zwet
- Department of Biostatistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan M. Wit
- Department of Pediatrics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Goericke SL, Dudda M, Schweiger B, Forsting M. Neuroimaging in a Three-Year-Old Girl - MRI without Anesthesia: Easier than One Thinks. A Case Report. Neuroradiol J 2010; 23:613-5. [PMID: 24148683 DOI: 10.1177/197140091002300511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/28/2010] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) is the imaging modality of choice in the diagnosis of structural brain abnormalities in children. Routine scans are usually not reliable in pediatric neuroimaging without sedation before the age of seven. Before this age sedation or general anesthesia with procedural risks and additional costs might be needed. We report on MRI in a 3.1-year-old patient referred after a first seizure performed with a combination of role model and self-experience. MRI with high imaging quality was performed without the need for anesthesia in our daily routine. The imaging procedure was performed without previous preparation needed and within target date.Our reported technique of a combination of role model and self-experience, avoiding anesthesia in a 3.1-year-old girl is suitable for children and it is applicable in the daily routine.
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Affiliation(s)
- S L Goericke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen; Essen, Germany -
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28
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Mock MRI: reducing the need for anaesthesia in children. Pediatr Radiol 2010; 40:1368-74. [PMID: 20186541 DOI: 10.1007/s00247-010-1554-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 12/23/2009] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND With a longer waiting list for paediatric MRI performed under general anaesthesia (GA) and considering safety concerns, the Royal Children's Hospital Brisbane established a mock MRI service. The aim of this service is to reduce the requirement for MRI under GA. OBJECTIVE The objective of this study was to test the hypothesis that the percentage of children ages 3 years to 14 years in the study period that required general anaesthesia would be less with mock MRI when compared to standard practise. MATERIALS AND METHODS A retrospective audit of clinical data was conducted to examine the impact of mock MRI on the GA rate for clinical MRI. RESULTS Results indicated the addition of a mock MRI reduced the need for GA most significantly for children ages 3 to 8 years. In this age group, the rate of GA was 16.8% lower than that of the non-mock MRI group (P = <0.05). CONCLUSION Mock MRI reduces the need for GA in children with the greatest effect evident in children aged between 3 and 8 years.
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Hallowell LM, Stewart SE, de Amorim E Silva CT, Ditchfield MR. Reviewing the process of preparing children for MRI. Pediatr Radiol 2008; 38:271-9. [PMID: 18084752 DOI: 10.1007/s00247-007-0704-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 11/12/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND MRI is a common medical imaging investigation. Patients, including young children, can be required to keep still for up to 60 min for the study to be completed successfully. Children often find the confined space, noise, need to lie still and possibility of intravenous administration of contrast agent anxiety-provoking and sometimes so distressing that they are unable to cope and require general anaesthesia. OBJECTIVE A practice MRI intervention was introduced at the Royal Children's Hospital in Melbourne, Australia. The program is conducted by educational play therapists in conjunction with the Department of Medical Imaging. This study explored the effectiveness of this intervention. MATERIALS AND METHODS The intervention was conducted in a practice MRI unit devoid of magnets. Data were collected as a clinical audit with respect to age, gender, times of scans, position in bore, diagnostic scans and movement artefact. Epidata and Stata were used to analyze the data. RESULTS A total of 291 children were included; their ages ranged from 3 years 7 months to 17 years (mean 7.9 years), and 48.8% were male. Of the 291 children, 218 (74.9%) were considered a pass at practice, 35 (12 %) were considered borderline pass, and diagnostic images were obtained from 218 (96%) of those children who went onto a clinical MRI. CONCLUSION We conclude that practice MRI intervention facilitated by educational play therapists is a useful intervention in supporting children to cope with MRI without general anaesthesia.
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Affiliation(s)
- Leanne M Hallowell
- Department of Educational Play Therapy, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, Australia 3052.
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de Amorim e Silva CJT, Mackenzie A, Hallowell LM, Stewart SE, Ditchfield MR. Practice MRI: reducing the need for sedation and general anaesthesia in children undergoing MRI. ACTA ACUST UNITED AC 2006; 50:319-23. [PMID: 16884416 DOI: 10.1111/j.1440-1673.2006.01590.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of this study was to evaluate the effectiveness of a practice magnetic resonance unit, in preparing children to undergo magnetic resonance procedures without general anaesthesia (GA) or sedation. The records of children who attended the practice MRI between February 2002 and April 2004 were retrospectively reviewed. Each record was assessed as to whether the child had passed or failed the practice MRI intervention. Those children who were considered to have passed and were proceeded to a clinical non-GA MRI had the report of the clinical scan reviewed. If the scan had been reported as non-diagnostic because of movement artefact it was classified as a failed scan, otherwise it was considered a pass. One hundred and thirty-four children undertook a practice MRI (age range 4.1-16.1 years, median age 7.7 years, 47% boys) and 120/134 (90%) passed the practice session. In all, 117/120 (98%) subsequently had a clinical non-GA MRI and 110/117 (94%) passed (median age 7.8 years, 47% boys). Preparation is a safe and effective method to reduce the need for sedation and GA in children undergoing a clinical MRI scan. It provides a positive medical experience for children, parents and staff, and results in cost savings for the hospital.
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Affiliation(s)
- C J T de Amorim e Silva
- Department of Medical Imaging, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
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