Getting an MRI (magnetic resonance imaging) is rarely a pleasant experience. And it is even less so for children. “The child enters the tunnel, it is impressive, very noisy even with earplugs, we ask him not to move during the examination which lasts between 20 and 30 minutes in general and up to 1 hour for cardiac examinations... » Professor Marianne Alison, head of the pediatric imaging department at the Robert-Debré hospital (Paris) and president of the French-speaking society of pediatric and prenatal imaging, is aware of this: for the little ones , taking this type of exam is a difficult time. However, it is essential: MRI produces quality images and reduces exposure to radiation compared to an X-ray scanner.
To help them deal with this noisy and distressing machine, the MRI is scheduled during a nap for the little ones, and combined with sedation or general anesthesia for those over 6 months old if they are agitated. “Anesthesia does not really have an effect on the results of the MRI,” explains Marianne Alison, “but the intervention of the anesthesia team adds an additional link to the patient's care and therefore an organization complex at a time of rationalization of care. » Even if it is now well mastered, general anesthesia is never without risk, and its repetition in toddlers can be harmful, particularly on cognitive development.
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Protocols have therefore been put in place to no longer need it, by better preparing the child to relieve their stress and reduce their anxiety. An American team has developed a kit in 3 stages: the assembly of an MRI model, an augmented reality discovery with a smartphone, then a virtual reality session with a headset so that children and parents become familiar with the 'exam.
Building a cardboard MRI the size of a paperback book allows you to visualize and understand how the device works; to make it their own, the child can color it or decorate it, and have their toys undergo an MRI. Then, the phone is placed on a dedicated space on the model, and the family can then put themselves in the role of the radiologist; an application allows you to create an augmented reality of the sound environment of the exam and offers examples of results. Finally, for older children, a headset allows them to immerse themselves in a virtual reality which retraces the different stages of the examination, from registration at the hospital to switching on the machine, including the undressing and removal of ferromagnetic objects. A game is also offered to the child: butterflies dance around a flower; the more the player remains still, the more butterflies land on the flower. Children who tested the device testified that once in the machine, thinking about butterflies encouraged them to stay still during the exam.
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In France, support practices are also gradually being put in place. “Some MRI manufacturers have developed tools to support children, such as Phillips, which has developed a fun application involving a virtual animal that can be used at home,” explains Marianne Alison. When the child enters the MRI tunnel, he finds the small animal whose image is projected, as well as the familiar voice of the game. This allows him to have reference points with an endearing character. Parental involvement is important because their condition has an effect on that of the child. »
The Robert-Debré hospital also offers “simulation MRIs to assess the child’s ability to hold still during the examination. For this, we use a 3D video system to soothe him, declares Professor Marianne Alison. There are other techniques elsewhere, for example the use of special glasses which can be used in the MRI to view a video during the scan to create a diversion system. »
Children and parents are less stressed and at Robert-Debré, assures Professor Alison, “general anesthesia is in the minority”. “This is a real issue in pediatrics because in this area the examinations take longer than for adults, we cannot have a flow as rapid as for adults. » Reducing waiting times for this examination by optimizing the time spent in the tunnel with trained patients is therefore an important objective. The protocol of the American study was tested on 13 patients, the results collected in questionnaires are therefore difficult to generalize and the study should continue. But experts testify that children, like their parents, want factual information on how the machine works.