In the Dark

What to expect if your child needs an MRI.

The information revolution and the computer age have changed our everyday lives. Tasks that once took long periods of time and great effort are now accomplished with a key stroke. Nowhere is this more evident than in the area of medicine, especially in imaging technology. Although the MRI scanner has been around for a few decades, it has become a standard of care in diagnosing and evaluating treatment modalities in patients of all ages. As computers have advanced in speed and capability, so has MRI technology. Scans that once took hours to complete now only take minutes. Picture resolution has gotten to the point that the physician can see minute details that were previously invisible. Surgeons are able to use these images to plan their surgeries. Precision is no longer left to chance.

Magnetic resonance imaging or MRIs are now a fast non-invasive pathway to the inner workings of the human body. Most MRIs on adults are simple and take about 30 minutes, but the imaging process still requires a patient to lie perfectly still for the entire duration of the scan.

The use of MRI imaging has also become very common in children. Pediatric neurologists might use the technique to evaluate seizure disorders, headaches or growth problems. Pediatricians might use it to evaluate conditions of scoliosis, head size, developmental delay or joint problems. In some instances, the pediatrician might order Gadolinium, a type of dye that is injected intravenously to enhance the images. The main issue with children becomes whether or not they can stay still for the required period of time. The scanner can be a scary place for the child. Most machines are configured as a tunnel. It can make loud noises and emit mild vibrations. Any movement by the patient can degrade the quality of the images, making it difficult or impossible for the radiologist to read the scans.

There are many MRI centers around. Some are hospital-based and many others are private facilities staffed by radiologists. There are only a select few that deal with children. Of the facilities that sedate children, the majority of these are staffed by radiologists that prescribe or administer an oral sedative, the most common of which is chloral hydrate. Although this drug has been used for decades and has a fairly good safety record, it has its disadvantages. The sedation can be unreliable and when it does work, it can last for many hours. Of the remaining centers, very few are staffed with a board certified anesthesiologist trained in sedating children. Although rare, they are very capable of dealing with emergencies and unexpected reactions to sedation. The most common sedative used is propofol, which is administered intravenously. It is extremely reliable and short acting. It is usually administered as an infusion. Once the drug is stopped, the child awakens in about ten minutes. After about 30 minutes, the child is ready to go home.

From a parent’s viewpoint, it can be very difficult to see their child sedated for an exam. It can be a very emotional time, worrying about the child’s well being as well as the exam results. The process needs to be made as easy as possible for both parent and child. The presence of a physician team, consisting of board certified radiologists experienced in reading children’s exams and board certified pediatric anesthesiologists with experience sedating pediatric patients, is important for a quality study that offers a clear diagnosis. The appointment process needs to be efficient and keep in mind the needs of the child. Staffing needs to be sensitive to both parent and child. The secretarial staff should be willing to assist the parent in picking a convenient time for the child’s appointment. Ideally, on the day before the exam, a member of the pediatric anesthesia team should contact the parent to discuss the child’s medical history and go over any questions or concerns regarding the sedation. Upon arrival, there should be a child-friendly waiting area. The pediatric sedation nurse should greet the parent and child and go over any last minute questions.

The MRI process itself should be the easiest part of the day. In most cases, parents can be escorted into the MRI scanning room holding their child as he/she gently falls off to sleep. The anesthesia team will place all of the appropriate monitors on the child and position him/her in the scanner. Parents should have the option of remaining in the room during the entire scan or waiting in the recovery area for their child. Upon completion, parent and child will be escorted to a comfortable recovery area. Once awake and drinking, the patient will be discharged from the facility. The pediatric anesthesia team will make a follow-up phone call the next day to evaluate the patient’s overall experience.

When speaking with your pediatrician or primary care physician and planning for your child’s MRI, be sure that you are being referred to a facility that follows all of the above procedures. You should be assured that you are dealing with a facility that is dedicated to children and their parents. Making the process as efficient and painless as possible is what should be expected in today’s medical environment.

Making a difficult process more tolerable, as well as the safety of your child, should be everyone’s number one priority.