Magnetic Resonance Imaging (MRI) is a test that uses a magnetic field and radio waves to make pictures of organs and structures inside the body.
In infants and children, MRIs are used to evaluate problems like headaches, seizures, hearing difficulties, abdominal pain, cancers, and congenital anomalies. One of the advantages that MRIs have over a computer tomography scan (CT) is that they don’t expose children to ionizing radiation. One of the disadvantages is the length of an MRI scan. CT scans often take minutes while MRIs can take hours.
Due to several factors — the length of the scan and the anxiety caused by being in an enclosed space that is noisy where movement is limited – infants and children are monitored closely and given a general anesthetic (intravenous (IV) or inhalation (gaseous) medications) to provide loss of consciousness.
General anesthesia in children has received press over the past few years. While general anesthesia is still recommended for most children undergoing urgent and emergent procedures, the recommendations for young children undergoing elective procedures is less definitive. That’s why the University of Vermont Children’s Hospital has explored ways to reduce the number of anesthetics that children receive. One area that we have targeted is MRI scans. Anesthesia for MRIs is used to reduce anxiety and limit movement. We are not worried about treating pain because there is no pain involved. We screen for appropriate patients to have MRI scans done without anesthesia. We have found two groups of children that are especially amenable to non-anesthesia MRIs: infants younger than 7 months and children 5 years and older.
In January, we introduced our “Feed and Sleep” MRIs. These scans are done to coincide with your child’s natural sleep patterns and are customized to your child. If you have a 4-month-old who takes his nap every day at 1:00 p.m. and is a solid sleeper, we schedule his MRI scan to start around 1:00 p.m. If your 6-month-old falls asleep every night at 7:30 p.m., then that’s the time we schedule her MRI.
Parents are asked to not let their child eat or sleep for 5 hours prior to these scans. Children are fed just prior to their MRI and allowed to fall asleep naturally. Their ears are covered with tiny earmuffs and they are bundled in an MRI-immobilizing swaddler. A radiologist carefully reviews the length of the scan to ensure the best possible information is gathered in the shortest amount of time. Since the beginning of 2015, our success rate has been 70 percent.
We also introduced non-anesthesia MRIs for children 5 years old and older using MRI goggles that allow your child to view and listen to a movie during an MRI, or listen to music. We have already seen an improved success rate using this method. In March, we performed 10 non-anesthesia MRIs and all children completed their scans. Once again, a radiologist reviews to reduce the time of the scan and improve our chances of success. The result? We are getting quality pictures without exposing children to the risks of anesthesia, despite the reduced scanning time.
While these methods improve the quality of the patient experience and provide quality information, there are still times that children may need general anesthesia for their MRI. The benefits of the information obtained from the MRI should be discussed with your child’s medical providers. Together, you can make the most appropriate plan. If a non-anesthesia MRI is right for your child, we will do our best to provide safe, high quality care and get the information you need for your child.
Ann F. T. Lawrence, DO, is Director of Pediatric Anesthesia at The University of Vermont Medical Center and assistant professor of Anesthesiology and Pediatrics at the Larner College of Medicine at UVM