Patient management strategies

In this final installment of “Best practices in pediatric radiology”, Dr. Bhargava discusses patient management strategies. There are important factors to realize when injecting MRI contrast into pediatric patients. One factor is that the volume of contrast is going to be very small for pediatric patients. To avoid having contrast adhere to the sides of the IV, it is recommended to use a relatively large saline flush in the range of 5-10 mL. It is also important to understand time delays. For many applications, what we want to know is whether or not the lesion enhances. The time delay is not an issue in these situations. An application where timing becomes critical is in the use of contrast for assessing the liver.

Another area that requires extra attention in pediatric MRI is patient motion. Various considerations include the difficulty of getting children to hold their breath, the faster heart rate of children compared to adults, and a general lack of understanding of the MRI procedure and the need to stay still, particularly for very young patients. Techniques for dealing with these different sources of patient motion include respiratory triggering, signal averaging, faster sequences, and non-cartesian k-space filling. Each of these techniques and more are discussed by Dr. Bhargava.

Dr. Bhargava finishes with tips for decreasing the need for sedation in pediatric MRI, the role of child life specialists, and when to screen for renal function.