Boriosi Juan, Bryndzia Christina, Lasarev Michael, Brucker Justin, Rebsamen Susan, Chapman Teresa, Peterson Brianna, Peters Megan
University of Wisconsin-Madison, H6/562 CSC, 600 Highland Ave, Madison, WI 53792, United States.
UW Health Kids, Madison, United States.
Pediatr Radiol. 2025 Aug 6. doi: 10.1007/s00247-025-06293-4.
Our institution decided to implement an awake MRI scanning quality improvement project using audiovisual distraction (AVD) technology.
To reduce the utilization of minimal/moderate sedation by at least 20% in children 4 to 18 years, while maintaining comparable diagnostic quality and adhering to allotted exam times, through the implementation of an awake MRI program.
This project was conducted at a pediatric sedation clinic between October 2021 and January 2024. We included patients 4 to 18 years of age, scheduled for an MRI at the pediatric hospital, and eligible for either minimal/moderate sedation or AVD. The outcome measure was the percentage of patients referred to our sedation clinic who completed an MRI with AVD and without sedation, analyzed on a statistical process control (SPC) P-Chart. Process measures were the number of children eligible for AVD per month, analyzed on an SPC C-Chart. Balance measures were the number of studies that exceeded allotted exam time or were non-diagnostic.
Of 734 MRI referrals aged 4 to 18 years, 320 patients met inclusion criteria. Two hundred twenty-eight (71.3%) received minimal/moderate sedation (mean age [SD] 9.7 years [± 3.0]) and 92 (28.8%) underwent AVD (mean age 10.0 years [± 2.7]). The average monthly decrease in minimal/moderate sedation use was 28.8 percentage points. The average number of children considered eligible for AVD increased by special cause variation from 3.8 to 7 patients per month. All 92 MRI referrals triaged to AVD completed their MRI successfully without sedation; all studies were diagnostic, and 96% of studies were within the allotted exam time.
We implemented an awake MRI program with AVD that decreased monthly sedation needs by 28.8 percentage points while maintaining a high rate of diagnostic studies and no MRI delays.
我们机构决定实施一项使用视听分心（AVD）技术的清醒MRI扫描质量改进项目。
通过实施清醒MRI项目，在4至18岁儿童中，将最小/中度镇静的使用率至少降低20%，同时保持可比的诊断质量并遵守规定的检查时间。
该项目于2021年10月至2024年1月在一家儿科镇静诊所进行。我们纳入了4至18岁、计划在儿科医院进行MRI检查且适合最小/中度镇静或AVD的患者。结果指标是转介到我们镇静诊所的患者中，通过AVD且未使用镇静完成MRI检查的患者百分比，在统计过程控制（SPC）P图上进行分析。过程指标是每月符合AVD条件的儿童数量，在SPC C图上进行分析。平衡指标是超过规定检查时间或无法诊断的检查数量。
在734例4至18岁的MRI转介患者中，320例患者符合纳入标准。228例（71.3%）接受了最小/中度镇静（平均年龄[标准差]9.7岁[±3.0]），92例（28.8%）接受了AVD（平均年龄10.0岁[±2.7]）。最小/中度镇静使用的月平均下降率为28.8个百分点。每月被认为符合AVD条件的儿童平均数量因特殊原因变异从3.8例增加到7例。所有92例被分诊至AVD的MRI转介患者均成功在未使用镇静的情况下完成了MRI检查；所有检查均具有诊断性，96%的检查在规定的检查时间内完成。
我们实施了一项使用AVD的清醒MRI项目，该项目在保持高诊断率且无MRI延迟的同时，将每月的镇静需求降低了28.8个百分点。
