Optimal support for children during MRI with Ambient Experience

Young children are often scanned using sedation or anesthesia to secure efficient workflows and high-quality images. Awake scanning presents advantages such as shorter waiting lists [1], reduced hospital time [2], lower cost [2,3], decreased risk of unexpected incidents [4-6] and reduced exposure to potentially neurotoxic anesthetic agents [7-9]. Effective stress management is crucial during awake scans to mitigate heightened anxiety, that can contribute to pediatric medical traumatic stress [10,11] and impact workflow.

This study investigated Ambient Experience’s effectiveness in reducing stress in pediatric patients aged 6-12 years. Children were either scanned with Ambient Experience (intervention group), or without (control group). We evaluated children’s situational anxiety levels (general feelings of stress, worry, nervousness, or unease) and the incidence of scan-related issues (e.g., repeat sequences, lengthy pauses between sequences, failure to obtain diagnostic images).

Patients were recruited from hospitals located in Poland, Spain, Denmark, Germany, Belgium, and France, and included children scheduled for a first head-first, awake MRI. After enrollment, patients were randomly assigned to the intervention or control group.

The Philips MRI systems equipped with Ambient Experience (Fig. 1), is designed to create a calming atmosphere and provide guidance and positive distraction during the scan.

Five calming five-minute Disney clips were created, featuring well-known animated characters, to provide comfort to children through familiarity (Fig. 2). The content created has gentle, slow-paced visuals, because fast-paced content can reduce young children’s ability to follow instructions or regulate their behavior [12-15]. Since head motion and eye movements during an MRI may cause motion artefacts, character movement was focused on center-screen. Pre-made sets of clips were created, varying from 15-25 minutes, and displayed on the interface, showing the first clip’s character image. Control was provided to improve patient calmness [11,16] by allowing children to choose the first clip to watch.

Data were collected using questionnaires for patients and staff, and by extracting data from MRI system logfiles (i.e., exam length, number of repeat scan sequences, number of pauses between sequences).

When entering the MRI room, patients in the intervention group selected pediatric content, which was displayed on the in-bore screen, visible in a head-mounted mirror (Fig. 3), and accompanied with sound and light.

175 children (89 girls, 84 boys, two unrecorded) participated in the study. Most children (78%) had a head/brain MRI, and one in three children (34%) required an intravenous injection for contrast. 60% of the patients had never had an MRI before.

The study showed that Ambient Experience significantly reduced scan issues for younger children (aged 6-10 years). This effect holds regardless of whether scan issues are reported by staff or measured directly in the MRI log files. Next to reducing scan issues, Ambient Experience significantly reduced stress levels in younger children (aged 6-10 years), as rated by staff. Younger children’s stress levels decreased to levels comparable to those of older children (age 10+ years), who experienced low stress levels regardless of condition.

The intervention did not significantly affect stress levels or the incidence of scan issues for older children included in this study (10+ years), who showed low stress levels and for whom scan issues were rare. While it seems likely that younger children stand to benefit most from audio-visual interventions, in the current study, the content of the clips may have been more engaging for younger children. Future research should employ clips that are more engaging for older children (10+ years).

Overall, the current research indicates that providing children with a calming environment and child-friendly in-bore content can reduce stress levels (as reported by staff) in young children (aged 6-10 years). Moreover, it can support clinicians by reducing scan issues and disruptions, thereby improving the workflow and facilitating clinicians to achieve high-quality diagnostic images.

While the study was not focused on anesthesia reduction, the intervention lowered younger children’s level of stress and scan issues to the level of older children, potentially lowering the threshold for awake scanning. Further research is needed to explore the role of child-friendly content in reducing the need for anesthesia in pediatric MRI.

A child friendly Audio-Visual intervention during MR imaging procedures delivers benefits for patient experience and workflow efficiency. The current study showed a reduction in stress levels, as well as fewer operational disruptions during an MRI exam for pediatric patients (aged 6-10 years).

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