Skip to main content
SpringerLink
Log in

Parent perspectives and preferences for strategies regarding nonsedated MRI scans in a pediatric oncology population

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Children with cancer frequently require MRI scans for clinical purposes. Sedation with general anesthesia (GA) is often used to promote compliance, reduce motion, and alleviate anxiety. The use of GA for MRI scans is costly in terms of time, personnel, and medications. In addition, prominent risks are associated with anesthesia exposure in patients with complex medical conditions. Successful behavioral interventions have been implemented in clinical research settings to promote scan success and compliance. To our knowledge, parent/caregiver acceptability of behavioral interventions to promote nonsedated MRI has not been systematically investigated in a medically complex population. As a first step toward developing a protocol-based intervention to promote nonsedated scanning, we conducted a survey to explore parental perspectives regarding acceptability of nonsedated scanning and to gain information regarding preference for specific behavioral interventions to facilitate nonsedated MRI exams.

Methods

Parents or guardians of 101 patients diagnosed with childhood cancer participated in a semi-structured survey via telephone. The sample was stratified by age group (8–12 years; 13–18 years), gender, and diagnosis (solid tumor (ST), brain tumor (BT), and acute lymphoblastic leukemia (ALL)).

Results

The majority of parents indicated that nonsedated MRI scans would be acceptable. Reduced anesthesia exposure was the most frequently identified benefit, followed by decreased irritability post-MRI scan, and shorter appointment time. Challenges included fear of movement and noise during scans and change in routine, with parents of younger children and those with a history of sedated exams identifying more challenges. Behavioral intervention preference differed by patient age and gender; however, education was ranked as most preferred overall.

Conclusion

Parents of children treated for cancer consider behavior interventions to promote nonsedated scanning as acceptable. Patient characteristics should be considered when tailoring behavioral interventions. Results can inform future studies of behavioral interventions to promote nonsedated MRI scans. Future research should also investigate the risks associated with failed exams, both in terms of patient medical care and cost effectiveness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lemaire C, Moran GR, Swan H (2009) Impact of audio/visual systems on pediatric sedation in magnetic resonance imaging. J Magnet Reson Imaging 30(3):649–655. https://doi.org/10.1002/jmri.21870

    Article  Google Scholar 

  2. Schlund MW, Cataldo MF, Siegle GJ, Ladouceur CD, Silk JS, Forbes EE, McFarland A, Iyengar S, Dahl RE, Ryan ND (2011) Pediatric functional magnetic resonance neuroimaging: tactics for encouraging task compliance. Behav Brain Funct 7(1):10. https://doi.org/10.1186/1744-9081-7-10

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rosenberg DR, Sweeney JA, Gillen JS, Kim J, Varanelli MJ, O'Hearn KM, Erb PA, Davis D, Thulborn KR (1997) Magnetic resonance imaging of children without sedation: preparation with simulation. J Am Acad Child Adolesc Psychiatry 36(6):853–859. https://doi.org/10.1097/00004583-199706000-00024

    Article  CAS  PubMed  Google Scholar 

  4. de Amorim e Silva CJ, Mackenzie A, Hallowell LM, Stewart SE, Ditchfield MR (2006) Practice MRI: reducing the need for sedation and general anaesthesia in children undergoing MRI. Australas Radiol 50(4):319–323. https://doi.org/10.1111/j.1440-1673.2006.01590.x

    Article  PubMed  Google Scholar 

  5. Viggiano MP, Giganti F, Rossi A, Di Feo D, Vagnoli L, Calcagno G, Defilippi C (2015) Impact of psychological interventions on reducing anxiety, fear and the need for sedation in children undergoing magnetic resonance imaging. Pediat Rep 7(1):5682. https://doi.org/10.4081/pr.2015.5682

    Article  Google Scholar 

  6. Bharti B, Malhi P, Khandelwal N (2016) MRI customized play therapy in children reduces the need for sedation—a randomized controlled trial. Indian J Pediatr 83(3):209–213. https://doi.org/10.1007/s12098-015-1917-x

    Article  PubMed  Google Scholar 

  7. Edwards AD, Arthurs OJ (2011) Paediatric MRI under sedation: is it necessary? What is the evidence for the alternatives? Pediatr Radiol 41(11):1353–1364. https://doi.org/10.1007/s00247-011-2147-7

    Article  PubMed  Google Scholar 

  8. Hsu YH, Lin FS, Yang CC, Lin CP, Hua MS, Sun WZ (2015) Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy. J Formosan Med Assoc Taiwan yi zhi 114(6):489–497. https://doi.org/10.1016/j.jfma.2013.07.018

    Article  CAS  PubMed  Google Scholar 

  9. Jacola LM, Anghelescu D, Hall L, White L, Russell K, Schreiber JE, Rossi M, Moore A, Gajjar A (2017) The relationship between procedural sedation during treatment and neurocognitive outcomes in survivors of pediatric medulloblastoma. Internation Neuropsychology Society, New Orleans

    Google Scholar 

  10. Peters JB, Anghelescu D, Conklin HM, Hall L, Means BL, Schreiber JE, Rossi M, Wright B, Gajjar A, Jacola LM (2017) The impact of sedation for radiation therapy on performance measures and caregiver ratings of attention in survivors of pediatric medulloblastoma. Internation Neuropsychology Society, New Orleans

    Google Scholar 

  11. Theys C, Wouters J, Ghesquiere P (2014) Diffusion tensor imaging and resting-state functional MRI-scanning in 5- and 6-year-old children: training protocol and motion assessment. PLoS One 9(4):e94019. https://doi.org/10.1371/journal.pone.0094019

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Byars AW, Holland SK, Strawsburg RH, Bommer W, Dunn RS, Schmithorst VJ, Plante E (2002) Practical aspects of conducting large-scale functional magnetic resonance imaging studies in children. J Child Neurol 17(12):885–890. https://doi.org/10.1177/08830738020170122201

    Article  PubMed  PubMed Central  Google Scholar 

  13. Dean DC 3rd, Dirks H, O'Muircheartaigh J, Walker L, Jerskey BA, Lehman K, Han M, Waskiewicz N, Deoni SC (2014) Pediatric neuroimaging using magnetic resonance imaging during non-sedated sleep. Pediatr Radiol 44(1):64–72. https://doi.org/10.1007/s00247-013-2752-8

    Article  PubMed  Google Scholar 

  14. Gale C, Jeffries S, Logan KM, Chappell KE, Uthaya SN, Modi N (2013) Avoiding sedation in research MRI and spectroscopy in infants: our approach, success rate and prevalence of incidental findings. Arch Dis Child Fetal Neonatal Ed 98(3):F267–F268. https://doi.org/10.1136/archdischild-2012-302536

    Article  PubMed  Google Scholar 

  15. Barnea-Goraly N, Weinzimer SA, Ruedy KJ, Mauras N, Beck RW, Marzelli MJ, Mazaika PK, Aye T, White NH, Tsalikian E, Fox L, Kollman C, Cheng P, Reiss AL, Diabetes Research in Children N (2014) High success rates of sedation-free brain MRI scanning in young children using simple subject preparation protocols with and without a commercial mock scanner—the diabetes research in children network (DirecNet) experience. Pediatr Radiol 44(2):181–186. https://doi.org/10.1007/s00247-013-2798-7

    Article  PubMed  Google Scholar 

  16. de Bie HM, Boersma M, Wattjes MP, Adriaanse S, Vermeulen RJ, Oostrom KJ, Huisman J, Veltman DJ, Delemarre-Van de Waal HA (2010) Preparing children with a mock scanner training protocol results in high quality structural and functional MRI scans. Eur J Pediatr 169(9):1079–1085. https://doi.org/10.1007/s00431-010-1181-z

    Article  PubMed  PubMed Central  Google Scholar 

  17. Durand DJ, Young M, Nagy P, Tekes A, Huisman TA (2015) Mandatory child life consultation and its impact on pediatric MRI workflow in an academic medical center. J Am Coll Radiol 12(6):594–598. https://doi.org/10.1016/j.jacr.2014.12.015

    Article  PubMed  Google Scholar 

  18. Vagnoli L, Caprilli S, Robiglio A, Messeri A (2005) Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study. Pediatrics 116(4):e563–e567. https://doi.org/10.1542/peds.2005-0466

    Article  PubMed  Google Scholar 

  19. Harned RK 2nd, Strain JD (2001) MRI-compatible audio/visual system: impact on pediatric sedation. Pediatr Radiol 31(4):247–250. https://doi.org/10.1007/s002470100426

    Article  PubMed  Google Scholar 

  20. Tornqvist E, Mansson A, Hallstrom I (2015) Children having magnetic resonance imaging: a preparatory storybook and audio/visual media are preferable to anesthesia or deep sedation. J Child Health Care 19(3):359–369. https://doi.org/10.1177/1367493513518374

    Article  PubMed  Google Scholar 

  21. Ali SH, Modic ME, Mahmoud SY, Jones SE (2013) Reducing clinical MRI motion degradation using a prescan patient information pamphlet. AJR Am J Roentgenol 200(3):630–634. https://doi.org/10.2214/AJR.12.9015

    Article  PubMed  Google Scholar 

  22. Cejda KR, Smeltzer MP, Hansbury EN, McCarville ME, Helton KJ, Hankins JS (2012) The impact of preparation and support procedures for children with sickle cell disease undergoing MRI. Pediatr Radiol 42(10):1223–1228. https://doi.org/10.1007/s00247-012-2422-2

    Article  PubMed  Google Scholar 

  23. Grissom S, Boles J, Bailey K, Cantrell K, Kennedy A, Sykes A, Mandrell BN (2016) Play-based procedural preparation and support intervention for cranial radiation. Supportive care in cancer: official journal of the multinational association of Support Care Cancer 24(6):2421–2427. https://doi.org/10.1007/s00520-015-3040-y

    Article  Google Scholar 

  24. Munn Z, Jordan Z (2013) Interventions to reduce anxiety, distress and the need for sedation in adult patients undergoing magnetic resonance imaging: a systematic review. Int J Evid Based Healthc 11(4):265–274. https://doi.org/10.1111/1744-1609.12045

    Article  PubMed  Google Scholar 

  25. Rajagopal A, Byars A, Schapiro M, Lee GR, Holland SK (2014) Success rates for functional MR imaging in children. AJNR Am J Neuroradiol 35(12):2319–2325. https://doi.org/10.3174/ajnr.A4062

    Article  CAS  PubMed  Google Scholar 

  26. Voepel-Lewis T, Malviya S, Prochaska G, Tait AR (2000) Sedation failures in children undergoing MRI and CT: is temperament a factor? Paediatr Anaesth 10(3):319–323. https://doi.org/10.1046/j.1460-9592.2000.00510.x

    Article  CAS  PubMed  Google Scholar 

  27. Yerys BE, Jankowski KF, Shook D, Rosenberger LR, Barnes KA, Berl MM, Ritzl EK, Vanmeter J, Vaidya CJ, Gaillard WD (2009) The fMRI success rate of children and adolescents: typical development, epilepsy, attention deficit/hyperactivity disorder, and autism spectrum disorders. Hum Brain Mapp 30(10):3426–3435. https://doi.org/10.1002/hbm.20767

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kitt E, Friderici J, Kleppel R, Canarie M (2015) Procedural sedation for MRI in children with ADHD. Paediatr Anaesth 25(10):1026–1032. https://doi.org/10.1111/pan.12721

    Article  PubMed  Google Scholar 

  29. Vannest J, Rajagopal A, Cicchino ND, Franks-Henry J, Simpson SM, Lee G, Altaye M, Sroka C, Holland SK, Consortium CA (2014) Factors determining success of awake and asleep magnetic resonance imaging scans in nonsedated children. Neuropediatrics 45(6):370–377. https://doi.org/10.1055/s-0034-1387816

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Cancer Institute (St. Jude Cancer Center Support (CORE) under grant [P30 CA21765] and the American Lebanese Syrian Associated Charities (ALSAC). Research was conducted at St. Jude Children’s Research Hospital in Memphis, Tennessee.

Author information

Authors and Affiliations

  1. Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS738, Memphis, TN, 38105, USA

    Breya Walker

  2. Department of Psychology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS740, Memphis, TN, 38105, USA

    Heather M. Conklin, Lacey P. Hall & Lisa M. Jacola

  3. Department of Pediatric Medicine, Division of Anesthesiology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS130, Memphis, TN, 38105, USA

    Doralina L. Anghelescu

  4. Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS220, Memphis, TN, 38105, USA

    Wilburn E. Reddick & Robert Ogg

Authors
  1. Breya Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heather M. Conklin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Doralina L. Anghelescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lacey P. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wilburn E. Reddick
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robert Ogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lisa M. Jacola
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lisa M. Jacola.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

This study was approved by the hospital’s Institutional Review Board. Informed consent was obtained by all individual participants in this study

Electronic supplementary material

ESM 1

(DOCX 37 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Walker, B., Conklin, H.M., Anghelescu, D.L. et al. Parent perspectives and preferences for strategies regarding nonsedated MRI scans in a pediatric oncology population. Support Care Cancer 26, 1815–1824 (2018). https://doi.org/10.1007/s00520-017-4009-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-017-4009-9

Keywords

Search

Navigation