Audiovisual Distraction Increases Success Rates of Sedation-Free Pediatric Magnetic Resonance Imaging

The increasing utilization of magnetic resonance imaging (MRI) in pediatric populations necessitates strategies to mitigate the risks and logistical challenges associated with sedation. Sedation in pediatric MRI procedures poses significant risks and can increase healthcare costs. Therefore, alternative methods to facilitate successful unsedated scans are essential.

This study evaluates the impact of audiovisual MRI (AV-MRI) technology along with predictive patient factors to perform a diagnostic MRI without sedation. Additionally, image quality with motion artifacts was evaluated in sedated patients, versus unsedated patients with AV-MRI.

We analyzed pediatric MRI records from November 2015 to March 2017, comparing data before and after the introduction of AV-MRI. A total of 1167 scans were included, 590 before and 577 after AV-MRI implementation, matched based on age and type of MRI performed. The patient factors that were evaluated for successful unsedated scans include age, sex, AV-MRI vs. non-AV-MRI, procedure category, developmental delay, cerebral palsy, autism, ADD/ADHD, anxiety, behavioral problems, psychological disease, malignancy, seizures, use of an interpreter and first vs. subsequent MRI. Additionally, motion artifacts were examined in 102 pediatric patients who specifically underwent brain MRI scans utilizing a 4-point scale, comparing those completed with and without sedation.

Post-implementation of AV assistance, there was a significant increase in unsedated MRI success rates (odds ratio 3.68, 95% CI: 2.24, 5.62, p < 0.001). Age was a strong predictor of success, with older children more likely to complete scans without sedation (OR 3.2, 95% CI: 1.02, 10.31, p = 0.046). Female children were more likely to complete unsedated scans compared to males. Children with behavioral issues were less likely to complete an unsedated scan. Motion artifact analysis showed more motion in unsedated scans, but all were diagnostic.

AV-MRI technology increases the success rate of sedation-free MRI in pediatric patients, reducing risks and healthcare costs without compromising diagnostic quality. Age and sex are important predictors of success. The study advocates for the broader adoption of AV-MRI and similar technologies to minimize sedation use, thereby improving safety and operational efficiency in pediatric radiology. Future research should explore additional patient factors influencing sedation-free MRI success and extend motion artifact analysis to other MRI procedures.