All children under the age of 12 were automatically scheduled for scans using general anesthesia, and the wait time was at least three months. Rachel thought she could help by reviewing the records of the children on the wait list to determine if they would be good candidates for a scheduled practice MRI session, and potentially a non-anesthesia MRI. Using a decommissioned MRI housed in a building across the street, Rachel set up a practice area with a gurney and slide board and offered free appointments to eligible patients.
Appropriate patients were over the age of six and did not have sensory issues or developmental disorders. In addition, the MRI scan had to be a single study no longer than 25-40 minutes. Rachel used images and recorded sounds to imitate a real scan experience and talked to children about contrast scans (if needed) and their individual fears. Some children are scared of the dark environment while others are startled by the loud noises. After preparing children for the practice session and working through their specific concerns, Rachel observed them in the scanner. Children who could stay still in the scanner for two minutes were cleared to schedule an appointment without anesthesia.
Rachel tailors her procedural support to the patient, and uses a variety of techniques to reduce anxiety and promote cooperation. Patients can squeeze balls when they have an urge to move, and some enjoy picturing the bravery they receive from squeezing their “bravery balls.” She also demystifies and normalizes the process by encouraging kids to wear comfortable clothes without zippers so they can avoid changing into a hospital gown.
Since May 2017, 37 patients avoided anesthesia for an MRI scan. Rachel’s success rate is around 93%, and she’s even had success coaching four-year-old patients through the scan. After Rachel’s successful trial run during her fellowship, the child life team proposed starting a child life position in MRI/radiology. The position was created, and Rachel has been working full time in radiology since October 2017. Her results are so promising that the hospital’s Radiology Engineering department is building a customized practice MRI machine with fun colors and stickers as well as an accompanying doll-sized MRI.
It’s hard to overstate the impact of Rachel’s innovation and the benefit to patients, families, the healthcare team, and the hospital. The hospital saves time and money every time a child scheduled for an MRI with anesthesia manages to complete one without. Parents are relieved when their child doesn't need general anesthesia, which always involves a level of risk. Perhaps the most important benefit is the accelerated pace of diagnosis and treatment. For parents, this means less worrying and waiting.
One of Rachel’s patients was a seven-year-old boy with a gait abnormality. After successfully completing a non-anesthesia brain scan, his doctor ordered another scan—this time of his entire spine. The spine scan would take more than an hour and was scheduled with anesthesia. The soonest appointment was in seven months, and the family contacted Rachel to see if she could help. Rachel confirmed there was no medical reason for the scheduling delay and then worked with the child to practice a longer non-anesthesia scan. The scan, which was scheduled for 2 rather than 7 months out, was completed successfully.
Rachel is collecting data about her success rates and would like to hear from other CCLSs working in radiology who have had success with practice MRI sessions. If you would like to contact Rachel, please email her at rakinsinger@llu.edu.