Making Imaging Centers Child Friendly

Movie goggles. Basketball stars. Images of fish swimming through the room. Monkeys on the scanner. A room bathed in color. Not only do these distraction techniques in children’s radiology units make kids and parents happier, they’re often decreasing the need for sedation during the studies.In a non-sedation research study at Children’s National Health System in Washington, D.C., 300 kids who previously would have been sedated have undergone MRI scans without any anesthesia in the last two years, said Raymond Sze, MD, chief of the division of diagnostic imaging and radiology. He attributed this to a combination of creative room design and help from child life specialists, professionals who help children and their families cope with medical challenges. While the study focuses on kids ages 6 to 8, Sze said that kids as young as 2 ½ have laid still for the 30-minute exam.Traditional radiology rooms are very spare and not patient- or child-friendly, said Sze. At Children’s National, they combat that by decorating the rooms and scanners. “I said I’ll know we succeeded when children don’t want to leave,” he said. That happened the first week the new machines and decorations were installed. “What’s the last time anyone you were taking care of refused to leave the hospital?”They collaborated with the GE, whose Adventure series includes equipment and wall decals that tell a story. They created two unique environments for their MRI and CT scanner rooms, an African safari and a camping theme. For the safari theme, when kids walk into the room they’ll see boot prints on the ground. “In one direction you see an elephant family wading in the pool, and in the other direction you see giraffes eating leaves off a tree,” Sze said. Staff points kids to what look like African drums around the room, telling kids that the knocking sound they’ll hear during the MRI scan is someone playing the drums.Their camping room features an MRI machine that looks like a tent, with the gantry like a sleeping bag. They added a decal of a woodpecker perched on a cabinet (designed to look like a tree). “We tell them they can hear the woodpecker, to convince them that the annoying banging sound is a woodpecker banging away,” Sze said.In their outpatient imaging clinic, Children’s National uses a GE Adventure series CT scanner featuring an underwater theme, with the gantry looking like a submarine and the CT doughnut looking like a coral reef. “Meanwhile, you know we’re underwater. There are fish everywhere,” Sze said. Soft lights show ancient Atlantis and the bottom of a boat on the wall.The Adventure series machines cost about $50,000 extra, Sze said. However it doesn’t have to be expensive to make the rooms child-friendly. In their fluoroscopy rooms, they painted murals on the walls, and installed gobo lighting, which spin in a circle showing images like fish and puppies. “It has a nice hypnotic effect on children,” Sze said. And they put stickers on the ultrasound machine. “You don’t need a $60,000 budget to do this.” He likens the environment to a play, complete with a set and actors.Turning Primary Children’s Medical Center’s interventional imaging room into a Utah Jazz themed room was an accident. While tracing out the zones where equipment would move during an exam, putting lines on the floor to indicate the danger zones, it resembled a basketball court. “We thought it looked cool,” said Darin Day, director of imaging at Primary Children’s Medical Center in Salt Lake. They reached out to the hometown basketball team, whose players already visit the kids at the hospital periodically.Since kids are frequently lying down and looking up, they can spot ceiling tiles autographed by the players each year. Above the control booth are autographed player pictures, and a trophy cabinet holds signed basketballs and player shoes. Kids can even try the shoes on to see how big they are. The Utah Jazz players, coaches and cheerleaders made short video clips saying things like “you’re our star today,” “suit up and get ready for your procedure,” and “we’re cheering for you.” The interventional supplies are stashed away in the room’s athletic lockers.The impact? The room distracts kids, which is a major goal.“In our department we’re working on a lot of different ways to distract our patients, putting them at ease to have their procedures,” said Day. It’s helped them build a relationship with the child, giving the child and parents something to talk about while there.In Primary Children’s fluoroscopy room, kids can choose the color they want, and the room turns that shade. When the kids leave, they feel good about their experience, Day said. This is important because most of the kids will return for additional studies. Their parents can say “do you remember that neat room that was purple?” Hopefully they’ll remember that, and not any associated injections or discomfort.“It’s so fun to see the kids go into a room and think it’s cool,” he said. While they do show the kids the equipment and how it moves, “they quickly forget that. Their mind is on the colors and decorations.”In their MRI suite, they offer kids distraction goggles from Resonance Technology, which has decreased the need for sedation. When they’re on the table, the kids get a previously selected movie or music, viewed with distraction goggles. They’re told they can bring in their own movie or iPod. “A lot of times, we use that in negotiating about the patient sedation,” Day said. They’ll take nervous kids into the suite when planning the procedure, so they can see what it will look like, sound like, and that nothing will touch or hurt them. The movies have been so successful that many kids lie still for the full 30 minutes, and then want to finish their movie there.At Johns Hopkins Children’s Center, equipment decoration is one tool staff uses to prepare kids to feel less anxious for their study. They also talk with the kids about what to expect, said Mollie Young, child life specialist at Johns Hopkins Children’s Center, sometimes making a game out of it. They’ll tell the kids there’s a crab on the camera, and ask them to find it.The radiology rooms use wraps from EquipArt on their MRI, CT and fluoroscopy machines. “It was mostly done to make the environment look less sterile,” she said. The kids’ attention is drawn to the equipment, so now it’s less threatening.When kids first walk into the rooms, they’ll walk around the equipment, she said. Young used to tell kids to look on the other side to see that there’s nothing hiding there. Now the machines are more inviting. “Kids take the initiative to do that on their own because they want to see all the different things,” she said.The parents remark that it’s more child-friendly, Young said, “and it makes them feel that it’s a place that really is there to serve children.”At Children’s National, the décor has benefitted kids in two major ways. For those there for a relatively quick exam like a CT, Sze said, it puts them at ease and makes them less nervous. The kids hold still better and image quality is improved. “You don’t get the blurred artifacts.”