New Simulation Care Pathway for Paediatric MRI Preparation

Magnetic resonance imaging (MRI) is a common imaging procedure that is safe and non-invasive, as it relies on the use of different magnetic fields. It is the gold standard examination for a wide range of pathologies.

However, it has many disadvantages, including the repetitive noise produced by the coils during image acquisition sequences, which can cause discomfort. The noise level often exceeds 100 dB, while the noise exposure limit for workers is set at 87 dB. There is no regulatory limit for patients. Although it is relatively loud and quite unpleasant, this noise is not harmful to health and does not amplify, contrary to the perception that one may have in the tunnel. Noise-cancelling headphones and earbuds are strongly recommended for patients to reduce any discomfort that may result. In practice, the imaging department requires all patients to wear hearing protection.

Other disadvantages of MRI include confinement in a tunnel and the need to remain completely immobile for approximately six sequences, each of 2 to 5 minutes in duration.

This can be problematic, particularly for patients suffering from pain or respiratory failure, or for agitated individuals who find it difficult to remain motionless in a lying position for long periods of time.

These various issues are particularly relevant in the paediatric population, for whom MRI is the preferred imaging technique due to its safety in terms of radiation exposure.

The specific characteristics of this population require more complex patient management due to the particular constraints of MRI. Acceptance of the following four points appears to be key to its successful implementation: lying down, with the head in a tunnel, intense and repeated noises, and strict immobility for at least 30 minutes. Without these conditions, the images recorded will not provide reliable results that can be used for diagnosis.

To meet these constraints, at Nantes University Hospital, general anaesthesia was routinely administered to children aged 3 to 6 until September 2023. This ensures a 100% success rate for the examination, but it is not a trivial procedure for the child and is stressful for their parents. Since then, a light sedation protocol has been offered as part of the care pathway. This involves the child taking medication one hour and then thirty minutes before the MRI scan to calm them down until they fall asleep.

Unfortunately, access to this MRI under light sedation or general anaesthesia complicates the appointment booking process, as it requires the presence of a medical team during dedicated shifts.

MRI scans under light sedation are scheduled for three slots per week. At the end of 2025, the waiting time was four months for light sedation and six months for general anaesthesia.

In order to improve and speed up the care of children who need to perform an MRI scan, a specific consultation with an immersive four-module programme has been designed at Nantes University Hospital with the aim of optimising the chances of success of the examination without general anaesthesia or sedation, thereby:

* Reduce waiting times for appointments, and thus reduce the period of stress for parents awaiting a diagnosis for their child. * Reduce the time required for the examination. Indeed, an examination under light sedation considerably lengthens the treatment time, with a sedation onset time of approximately 1.5 hours. * Increasing the success rate of MRI scans under light sedation following failure without sedation.

This innovative approach is based on an immersive experience in the form of a course consisting of four modules designed to help children practise four areas that can be challenging for them (immersion in a tunnel, loud noise, the constraints of specific equipment, and immobility). These modules are themed around the marine world, in line with the already approved paediatric radiology programme. It will be offered to children aged 3 to 6 with no cognitive or behavioural disorders.

The modules will be installed in a paediatric consultation room and will be used for half a day each month. When not needed, they'll be put away so the room can be used for consultations.

The aim of our pilot study is to assess the impact of this immersive journey on the success of an MRI scan without general anaesthesia or sedation.