Monroe Carell Children's Hospital Vanderbilt
from Advance Magazine Jan 5, 2009
Salvadorini Consulting installed this system at Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville TN in the Winter of 2008.
Pediatric Exams are easier for both the Child patient and the MRI Technologist.
Undergoing an MRI scan is no one's idea of a good time. The repetitive, hammering sounds, the close quarters of the bore and the sheer length of the exam can leave even the bravest among us feeling a bit disoriented, claustrophobic and flat-out frightened.
Now imagine what it must be like for a child.
Pediatric patients, possessed of short attention spans and a penchant for fidgeting, are bound to have a tougher time keeping their composure during an MRI procedure, which requires patients to remain perfectly still for an extended period of time.
Take 7-year-old Ian, for instance. This past December, when Ian arrived at Monroe Carell Jr. Children's Hospital at Vanderbilt for an MRI scan of his head, he was a bundle of nerves. Like many children his age, Ian rarely stays still for very long. His mother was doubtful that he would be able to stay still while confined in the large, loud scanner for the half-hour or so the exam would take.
In the past, a patient like Ian would have been sedated. But now there was another option. In mid-October Children's Hospital at Vanderbilt began providing its pediatric MRI patients with goggles, headphones and videos of television shows and movies to help kids like Ian combat anxiety and avoid sedation.
In Ian's case, it was an episode of SpongeBob SquarePants that did the trick. A model patient throughout the exam, he stayed stock-still until emerging from the scanner, and he and his mother were soon on their way home.
Young Ian is just one example of the many pediatric MRI patients whose experience at Children's Hospital at Vanderbilt has been made quicker and more comfortable with the installation of the new video technology. And providing the little ones with something to watch on TV has made life easier for the facility's MRI technologists, too, as a few staff members recently told ADVANCE.
Steering clear of sedation
For children, keeping still is often the most challenging part of undergoing an MRI, said Shannon Bozeman, RT(R)(MR), specialty technologist supervisor in the pediatric diagnostic imaging program at Nashville, Tenn.-based Children's.
"While adults understand this concept," Bozeman said, "pediatric patients often don't."
The recently acquired CinemaVision High Definition system, a gift from the Junior League of Nashville to the pediatric diagnostic imaging program, "has given us a new tool in keeping children entertained and therefore still for MRI scans," she said. For the facility's MRI technologists, that translates to more accurate images and a reduced need for re-scans. It also means that technologists can complete a scan without the intervention of the sedation team, said Kim Halliburton, CNMT, MA, CRA, director of pediatric diagnostic imaging.
"That's a plus for the technologist," she said. "The tech has better control of his or her patient schedule. He or she isn't dependent on the schedules of other staff members-waiting on IVs, consent forms, discharges, etc."
The system includes headgear, goggles and cords, contains no metal parts that could be drawn into the MRI magnet, and allows the staff to communicate with patients through the headphones and a microphone on the patient's headset.
Children can bring in their own favorite videos or choose from a selection of TV shows and movies-SpongeBob SquarePants or The Incredibles, for example-before entering the scanner. Using a fiber-optic signal, the goggles give patients the illusion of viewing characters such as Mr. Incredible, Elastigirl and SpongeBob's closest pal Patrick on a movie theater-size wide screen.
"This gives children a focus, and the headphones enable the patient to hear the movie," Bozeman said. "And it helps protect the patient from the loud noise of the MRI scanner."
Most importantly, the use of the goggles can eliminate the need to sedate children from about age 7 and up, she added.
While it's often necessary for pediatric patients, sedation carries risks for allergic reactions, a sudden drop in blood pressure and respiratory depression, Bozeman explained. Additional time is also required for sedation, as the patient must arrive one hour before the exam and remain for 30 to 60 minutes after for the medicine to wear off, she said.
Staying on schedule
The time saved is important to maintaining a demanding outpatient schedule. The MRI suite at Children's Hospital at Vanderbilt, home to two MRI scanners, sees an average of 18 patients a day, Halliburton said, noting that emergency department and in-patient requests also have to be accommodated.
Ultimately, about 85 percent of their MRI patients are sedated, and the department had been eager to decrease sedations for some time before installing CinemaVision, according to Halliburton. The system is certainly helping to drive that number down.
"To date, all of the sedation cases that we have converted to goggle cases have been successful conversions," she said. Currently, "we have about two or three patients a week who are able to have their MRIs done without sedation that we believe would have had to be sedated without the option of a movie to watch," Bozeman added. "This saves money and time, and can be safer for the patient."
Patients like Ian, precisely the type of child who would have required sedation for an MRI in the past, Bozeman said.
Halliburton is optimistic that the department will be able to increase its number of "conversion cases" and aid a greater number of kids like Ian in the months to come, noting that "we're still a little early in the process."
But the system has already benefited many pediatric patients at Children's Hospital at Vanderbilt, even those who wouldn't require sedation at all, Halliburton said. Anxiety is only natural for a child undergoing an MRI scan, even for those who know what to expect.
"It's just not an experience they typically look forward to," she said.
Indeed, Bozeman said that once Ian settled in with SpongeBob, "he never moved again until the test was complete. His mother was relieved to avoid sedation, and to be able to go home as soon as the MRI was done."
See the Video Testimony from Hamilton Health Sciences MRI and listen to the MRI technologist describe the reduction in Childrens sedation they have been able to achieve.