To many young patients, getting an MR exam can feel like being underwater or on a spaceship, with unfamiliar sights and loud noises. The radiology department at Texas Children's Hospital The Woodlands leans into that feeling, with a CT scanner disguised as a submarine and an MR suite designed to look like outer space, complete with technologists who refer to head coils as space helmets.

The facility worked with a company called Comfort Health Solutions last year to create various themed exam rooms, including one with space murals on the wall and skins covering the Siemens Healthineers scanners. The day the space went live, one of the technologists even donned an astronaut suit with the Texas Children's logo and his name on it, along with a plastic space helmet from Amazon.

“One of the first patients had gotten his MR — everything was great, he loved the room — and he was walking out, I'll never forget, he was holding hands with his mom, and he kind of tugged on mom's arm and the mom bent down and he said, ‘Mom, they even have a real astronaut!’” recalled Traci Foster, who at the time was assistant director of radiology at Texas Children's Hospital The Woodlands.

Fear of imaging exams is common among pediatric patients, and can lead to repeated scans or the need for sedation, which comes with risks. Many hospitals and imaging centers have redesigned spaces to be more welcoming and relaxing for young patients and their families and have staff prepare children for exams, during which they need to remain still.

Foster recalled another young patient who had undergone a number of MR exams under sedation.

“He came in, shortly after we finished up the room, and we were talking about how it's an outer space theme, and he was so excited,” Foster said. “And he did not want to have sedation because he wanted to be able to see the room and basically go to outer space. … The patient was actually able to get through the entire exam; the first time he had had an MR scan without sedation. After the exam, he couldn't wait to come back for his next one.”

David Mathieu, founder and chief creative officer of Comfort Health Solutions, which is Siemens Healthineers’ exclusive patient experience provider, said the experience at Texas Children's Hospital the Woodlands underscores the company’s mission.

“Everyone here at Comfort Health Solutions was extremely honored and excited to work with Traci and her team at Texas Children’s Hospital the Woodlands to transform their suites into wonderful and exciting environments for all young patients,” Mathieu said.

PeaceHealth in Oregon has had similar success using installations from PDC, which provides what it calls the Caring MR Suite, with HD ceiling, wall and portable in-bore viewing video displays that can showcase the patient’s choice of nature videos, movies, lighting and music.

“The kids can walk right up to it and we can change things right in front of them, pick scenery, change lighting color,” said Adam Mellott, director of radiology at PeaceHealth.

The environment also helps the parents, which in turn helps the young patients.

“The parents’ anxiety drops because they're kind of looking around, they’re smiling a little bit, taking their mind off of everything that's going on,” Mellott said. “And then you can see the kid follow suit. They're not so scared. They're not so anxious.”

Many portable X-ray units can be “dressed up” with child-friendly decals. Carestream’s portable X-ray units, the DRX-Revolution and DRX-Revolution Nano, can have a variety of whimsical images affixed to the system. Images of sunflowers and butterflies, aquatic images and even an image to make the system look like a race car, said Jill Hamman, worldwide marketing manager for global X-Ray solutions at Carestream.

“The images are fun and engaging and help make pediatric patients feel more comfortable and more at ease when they see this big machine rolling up to them to take the images,” Hamman said.

Screen time
Manufacturers have also developed more advanced entertainment systems to help distract from medical procedures and tout technology that helps shorten exam time.

In early summer, Resonance Technology is planning to launch an upgrade of its goggle-based entertainment system that will be lighter and have higher-resolution, 4K video.

Manufacturers have also developed more advanced entertainment systems to help distract from medical procedures and tout technology that makes the exam feel shorter.

NordicNeuroLab, which manufactures hardware for functional MR, developed software that turns the screens that stimulate patients during a scan into a patient entertainment system.

Christoffer Endresen, marketing manager for NordicNeuroLab, says that the 40-inch screen is one of the largest MR-compatible screens on the market, and it allows more content via a Microsoft Surface tablet that can connect to various streaming services.

While some vendors don’t have free-standing mirrors, NordicNeuroLab developed its own.

“That opens up the opportunity for a lot of different MR sites to have a complete solution,” Endresen said.

Siemens Healthineers recently received FDA clearance for its Innovision in-bore entertainment system.

The entertainment starts before the patient goes into the bore.

“The fact that the patient is already being immersed in that entertainment before they enter the bore really allows them to feel more comfortable as they enter into that space,” said Jackie Morley, MR product manager at Siemens Healthineers North America.

The display is curved, so that it gives the patient the feeling of being in larger space. It’s also designed to reduce the scan noise while still maintaining sound quality for the voice commands from the technician, and indicates the scan time on the display.

Innovision, which comes with a memory foam pillow, is available on the company’s MAGNETOM Altea and Sola 1.5T systems and MAGNETOM Vida and Lumina 3T systems.

Philips Ambient Experience is a solution that integrates architecture, design and enabling technologies, such as dynamic lighting, video projections and sound, to allow patients and staff to personalize their environment to create a relaxing atmosphere.

Data from Philips shows a 70% reduction in the number of the interrupted exams in 3T MR scanners with Philips Ambient Experience and a 91% decrease in the need for anesthesia for children aged four to six.

Last year, the company announced that it was partnering with Disney EMEA on a research project to offer custom-made animations, studying their impact at six European hospitals, with results pending.

At RSNA 2021, the company released its new pediatric coaching solution, which provides a gaming experience to guide the patient before the exam, said Dr. Julia Dmitrieva, KOL engagement leader for precision diagnosis at Philips.

“The kids are very used to playing games and so this way they are prepared; they are much more relaxed and they are able to understand what's going to happen beforehand,” Dmitrieva said.

The kids meet characters during the preparation and those same characters guide them through the exam.

“The voice commands that come through while they're in the bore is that same familiar voice of the character, so that will help ease their fears and actually empower them more,” Dmitrieva said.

Screens can also be part of creating a calming atmosphere. Sky Factory, which manufactures visual and spatial compositions that create the perception of a real skylight, complete with trees and birds, recently started offering a presentation and online course on The Neurobiology of Biophilia & Spatial Cognition, which delves into what happens inside the brain when people are exposed to an open environment.

David Navarrete, director of research initiatives and accredited education for Sky Factory, said the idea is to move beyond distraction techniques and allow young patients to be more impacted by their surroundings.

“When you walk into a space, your body gets a sense of whether that space is safe, whether it's fun to explore, or whether (you’re) apprehensive, and this is a chemical and neural change that happens in your brain,” Navarrete said. “If you're teaching your kid that when you're stressed or anxious, you’ve got to seek a distraction, in a way, you're rewiring their response to stress. Whereas if you teach them to be calm and that they can master the situation by just being aware of their environment, particularly when it has a view to nature, then they also become more resilient.”

Facilities with SkyFactory installations see the impact it has on their patients.

"By using new wide bore MR technology and teaming the equipment with the Luminous SkyCeiling experience, we have found pediatric patients are much better able to cope with their MR examinations, and we have noticed a considerable drop in cancelled examinations," said Keith Gray, quality manager at Benson Radiology in South Australia.

Tech help
New technologies can also help speed up exam times and help decrease the discomfort of exams for young patients.

Carestream and Fujifilm both offer long-length, single-shot detectors — Carestream’s is the DRX-L and Fujifilm’s is called the FDR D-EVO GL — with large fields of view that capture long-length images in a single exposure.

“It really helps alleviate discomfort for a patient, particularly for a small child being imaged for [something] like a scoliosis exam,” said Hamman, of Carestream. “They only have to stand very still for that one second that it takes to acquire the image. It's much better for treatment planning as well, since there is no need to manipulate and stitch images together due to patient movement. And it also helps to reduce repeats due to patient movement, as the image is acquired in about a second compared to 15 seconds or more with a multi-shot DR solution.

Nicole Lucking, senior radiologic technologist at Shriners Children's Twin Cities, uses Fujifilm's FDR D-EVO GL detector for lower extremity and spine exams, and sees its benefits.

“With pediatrics, as fast as we can get through the exam, the better,” Lucking said. “You are able to hold their attention and keep them from worrying about what could be next, if you can get through the exam efficiently, it's best for everybody. We do most of our X-rays standing if the patient can stand, and I think that helps a lot, too, because it's less intimidating. When we have to lay them down, they feel less in control and sometimes associate lying down with having a procedure done.”

Carestream also has a software called Pediatric Image Optimization and Enhancement that automatically provides default acquisition techniques and image processing parameters that are optimized specifically for each patient's body size, as well as detector verification software to ensure the correct detector is being used, so exam times can be shortened and patients feel less discomfort.

Philips’ Collaboration Live solution, which allows more experienced technologists to dial in remotely to ultrasound machines and help the technologist with the settings.

“Imagine that you are the technologist in the hospital where everyone called out sick, and you have a six-year-old who comes in with a suspicion for appendicitis,” said Dmitrieva, of Philips. You don't want to put that kiddo into the CT scanner unnecessarily. So the technologist could take a look remotely into that machine, changing the settings.”

Scaling down the systems can also help reduce fear. Orthoscan offers a mini C-arm that can be used for pediatric orthopedic exams, which can be used in place of a standard X-ray room.

“Because of the size of mini C-arm, it's a lot less intimidating for the patients to use versus sending them to an X-ray room, not being able to have their parents around them,” said Travis Prikryl, vice president of surgical sales at Orthoscan. “Whereas [with] a mini C-arm, the parents can hold the children and can be there with them throughout.”