MR tech here. MR scanners could sure look better for kids. A few observations. If the kids parents are fine and not bothered by the scan (or act like they aren't bothered) the kid usually does fine. If the parents are begging for sedation from the moment they hit the front desk, it goes badly even with sedation (we don't do any GA where I work).
Claustrophobia is a funny thing and females seem to deal with it better than males. Females seem to tell us earlier in the piece and can then be coached though it. Males say nothing then freak out, and flat refuse to come back. I have worked at scanners in very poor areas and very wealthy area. The scanners in poor areas seem to have far fewer claustrophobic patients. The sicker people are, the less claustrophobia seems to stress them out. These observations may only apply in the areas (NZ) where I have worked.
I've been getting MRIs every four months for 9 years now. (I had a very rare type of cancer.) My admittedly anecdotal experience is that most places seem to be getting worse at administering them. I suspect they are being prescribed for diagnosis much more, and the techs are somewhat harried by the stricter schedules. GE's Adventure Series is certainly a good idea, but I think it's easy to forget how important it is for the techs to administer them well, and how an overworked problem may exist for them.
As for the noise (that other people were flippantly dismissing), it really can be jarring. Cover your ears with your hands, with your fingers pointed towards the back of your head at about at 45 degree upward angle. Then, repeatedly bang your head with your middle fingers while your ears are still covered. That's roughly the a quieter version of one of the more unsettling sounds.
I'm quite used to it -- to the point that I always ask the tech to tape my head in case I fall asleep and move -- but still. That sound is not just the rhythm backing a techno song; it's the sound of parts swirling around you with massive energy.
It maybe safe, but so are roller coasters. Yet, while you go on a roller coaster looking for a thrill, you enter an MRI machine with the very real fear that something could be very wrong with you. That's not going to make for a pleasant experience. And, it's not surprising that that underlying fear might be projected elsewhere.
I agree, I got a CT for something they could have stuck a camera or mirror in my mouth to see. They also billed me directly instead of my insurance. I can't help but think it had more to do with them making money than treating me.
I fully get the noise thing, and I find it hard to believe that anyone would do a scan without giving hearing protection. Possibly on old, low field magnets? At 3T it would exceed 100db no problem. In the control room I've measured 90+ db on my (highly calibrated) phone. It's loud and its negligent not to give hearing protection.
The issue is parents are the most scared they have ever been in their lives. They would rather take what ever their child has and die than have to see them go through the hell that they will be shown in the report, or find out something was missed 6 month prior. It might seem routine to others but I always go extremely stressed a week before any scan. First time parents will be praying that their child isn't going to die so they might be on edge.
hmmm. maybe it's not easy, but you need to switch your perspective. mri machines (at least) are awesome things that are there to help. i'm not saying this as some kind of outsider with no understanding - i spend a lot of time in them myself. and to me they have always been the magical robot monster that can help me. they see inside. they let the doctors understand. they're one of the good guys. really.
you're in a fight. you want to win. you don't hate the guy that's giving you the good data.
sorry if that doesn't help. i'm not trying to bash you. i'm just trying to show there's an alternative. i'm as scared as anyone when i open the envelope. but those machines have helped me a lot....
[also, as physics machines, they're pretty awesome. if you're an engineer or scientist and don't know how they work, read up on them. they have huge supercooled magnets that flip the nuclei of atoms. it's amazing stuff. despite the noise there's nothing moving - that's just the coils shifting as the fields / current change (and maybe the chug chug chug of a cooler / vacuum pump). you're basically lying inside a human sized speaker coil!]
I am not someone who generally suffers from claustrophobia, but as a tall person (6ft 5in) who is by no means fat, I can honestly say it was one of the worst things I've had to do. My shoulders are broad enough that it felt as if I was uncomfortably wedged within the machine, and that I was far enough inside the machine that should something go wrong it would be impossible for me to get out unassisted.
Perhaps it wasn't so much claustrophobia in my case, more my total dependence on someone else to get out. I am definitely not looking to go through that experience again any time soon.
I think there are definitely things that can be done to improve the experience.
Also worth noting: I do realise that these machines come in different sizes, but they are also expensive to purchase (replace), so I am not holding my breath for regular updates at every hospital when they can add another inch to the diameter of the chamber.
The sicker people are, the less claustrophobia seems to stress them out
Medical-tech-in-a-past-life here. I think it's more that the sicker people are, that both they have more experience with getting tests, and they're more interested in fixing the problem than feeding on the attention. Really sick people are tired of being sick - a test at a hospital is not a highlight of the day, but a drudge. It was rare, though not unknown, to see either a very sick person or a long-term sufferer make a fuss in my experience.
Someone who does make a fuss could very well be genuinely sick, but usually they hadn't really mentally accepted that fact yet.
As a brother and a parent who had went through the cancer journey. My son had bone cancer(passed away in April 2013, age 12.5) and my sister who had brain cancer (passed away 1996, age 15)
1) Open Standards: Images need to be shared from any hospital or lab to any doctor via internet! I had to go through the scan praying that there wasn't a new tumor or that the tumor was small etc... Wait 15 minutes for the CDs to be printed and my son was in pain and just wanted to go home. OR I forget and have to go through an hour or two days to get a copy BEFORE I can see the doctor. Also doctors should feel comfortable using whatever program they want to view MRI or CT scans!
2) Video: My son loved going to one hospital because they had a video player that went over his eyes! Awesome lets raise the money to get one at our local hospital. it cost over $40,000 :(. Really????
First of all, I'm so sorry for your losses. I can't imagine how devastating that must be (coming from someone who just lost two parents to cancer and went through treatment himself earlier this year).
Open standards would be awesome. I thankfully went through treatment at an integrated system so everything was just "in the system" for all of my doctors, but if I were hopping around between systems that would be extremely useful.
As far as the video thing, the only reason I can imagine is because MRIs are basically huge magnets so they have to build the whole thing out of non-ferrous materials. Plus the customary medical equipment mark up, but still that can't actually be $40k.
> As far as the video thing, the only reason I can imagine is because MRIs are basically huge magnets so they have to build the whole thing out of non-ferrous materials. Plus the customary medical equipment mark up, but still that can't actually be $40k.
There is another solution, which is to use a reflective surface at 45 degrees to your eyes and a video projector the other end of the room focused down the scanner. A few years ago I volunteered for a functional MRI brain scan which required me to watch various video clips, that's how they did it for me. I guess it might be slightly cheaper, but knowing medical equipment maybe not.
The giant rotating ring of magnets is about 8 inches in front of your face when you're getting a head MRI so there isn't much room to get things focused properly.
Or perhaps a periscope, so the patient sees a view of the room, rather than the inside of the magnet? The periscope could be built out of plastic, like a fat optical fibre, with the reflection being done by "total internal reflection" at the plastic/air interface. That way there are no metallic reflecting layers in it.
Lay in this tunnel. You're immobilized and can't move. Oh and no one can hear you call for help because of the loud jack-hammer like sounds. Wear these head-phones and we'll blast music into them so you'll feel better. Squeeze this little thing if you panic and we may come and help you.
The trick is to ask them for a Xanex when you check in.
I've had two MRIs. One with Xanex, one without. I actually enjoy the sound of the machine, it can be rhythmic and pleasing.
The only time I had an MRI without Xanex, was a religious experience. Things were going well for 20 minutes (they had me in for just under an hour total) and then the thoughts of how people die in MRI machines came on strong. I'd seen a few videos of how strong they are [0] and the thought of being crushed or otherwise mutilated by a million dollar magnet, along with the confined space, was too much. I felt panic coming from a mile away, and it engulfed me. My brain was telling me to 'get the fuck outta here!'. I knew it was irrational fear. I took labored breaths. The fear moved from my feet to the top of my head and exploded. The pulse oximeter must have been going crazy because the tech asked how I was doing. "I'm fine." The lie worked, the fear immediately dissipated and a wave of euphoria rushed over me. I'm not going to die. I'm going to live! What should I do with my life? The best I can. I fell asleep a few minutes later. I woke up feeling fantastic.
We discourage self medication as it makes sedation complicated. If someone took oral sedation, then is still needing sedation, we don't know if their medication hasn't worked, or is still coming on. We use IV sedation, its controllable, easily reversible, easy to top up. Getting an OD under control when they are still absorbing from their gut is not easy. We like to think we learn from experience!
The availability of sedation is often 'under advertised'. More doctors need to advise that 'yes you need an MRI, don't worry, if its freaking you out too much, you can get sedation and it will be like a 60 minute nap'
We don't advertise it but do screen people for claustrophobia instead. The doses we give of midazolam are usually small, but we have had respiratory arrests and significant cardiac events. It isn't something we like to give often. Between our 3 scanners it would be a dose per day.
I went through one in university as an electrical engineering studies "field trip". It's a lot of fun if you aren't worried about an actual medical condition at the time TBH.
I've had one as part of a brain science study at my undregrad school and aside from the loud noises (which can mostly be muffled enough by some good earphones), it's pretty okay. In fact, with the muffled MRI noises, I honestly nearly fell asleep every time I went in there.
I'm a big, broad man and was concerned whether my shoulders would even fit in the thing, and have very mild claustrophobia. I was tired... and had trouble staying still because I found it so funny - the noise made me think of bad scifi space battles: brrrrrr pewpewpew chchchchch
The MRI in which I was scanned had a headset with a noise cancelling mic so I could talk to the team behind the glass - that was nice.
On the other hand, the stance I had to adopt (even though lying down) meant I had to support the weight of my arms from shoulder to wrist, and after a while this became uncomfortable and caused them to shake a bit, at which point the MRI team thought I was freaking out - which I wasn't. Maybe this was just down to bad packing and could have been avoided.
The aircon in the room had also failed so I had a combined MRI and sauna; which meant the sensor pads kept coming unstuck and so I kept 'flatlining' and had to be removed from the scanner a couple of times for more bits of surgical tape.
Exactly! My mom had to take one recently (she is about 70) and she was sick with worry, had a panic attack inside the machine. The crude, no-nonsense manner in which the technician handled her was the main cause.
The cute pictures, etc. definitely help, at least with kids. But the real improvement would be a 5-min intro to the patient, perhaps a simple video clip, explaining the technology to put them at ease. Just reading his description of the response of the technician to the child's fear, you can see that it could have been handled much better.
The problem here is that you can't really explain the technology without freaking people out even more.
Well, at least not without leaving out the "1 ton magnet spinning around you at crazy speeds" part.
In any case, everybody goint into one of these things should at least be told that the machine works without ionizing radiation, i.e.: "Unlike a CT scanner, you are not at risk of getting cancer from this."
As far as I know, MRI machines have no moving parts aside from the bed that slides the patient in and out of the bore - the noise is entirely from coils expanding and contracting.
I wasn't aware you could have headphones! I would have asked.
To be honest, the only time I had to go through this, I was not scared about anything else than the possible result of the scan, but the noise was disturbing at best.
I give everyone earplugs too. Without hearing protection you would get damage. Its 95db outside the scan room. Dunno what it is in the bore, but it is loud.
It's different when you're told not to move for the next hour. Oh and the walls of the tube are about 4 inches away from your face. Oh and don't mind the sound what seems to be the damn thing ready to fall apart at any moment.
I had an MRI done and it took about 5 minutes to just gather in all the details of the situation. After that it was okay.
Academia struggled with this problem for a number of years. When I started in 1999 it was typical to toss 50% or more of data from kindergarteners. Then around 2002-2005 I saw a few independent groups take this tact. Some gave stories to kids (e.g., about a spaceship or giant camera). Another group used head-mounted motion tracking to train children to lay still while watching movies.
I don't know from this story when Doug had his epiphany. But by 2005 it was becoming increasingly common to skin the MRI and even whole rooms. It became clear that you could get better results with a friendlier room and machine. But the bigger difference was an explicit training session. Kids are seldom told to lay absolutely still and for no apparent reason. The challenge was understanding that as the problem to be overcome. The design helped wrap the experience and the memory.
There's more to this than just painting the machine -- one of the primary concerns of hospitals (and thus medical device makers) is whether the equipment is easy to clean. So just slapping some paint on there isn't enough -- the design has to be embedded into the plastic (which commonly has silver ions in it to help kill germs), or as a single plastic decal that has similar properties.
To reduce the noise, I wonder why they haven't investigated active noise cancelling like the engine mounts used by some auto makers. The computer introduces waveforms that are the inverse of the frequencies they want to reduce. Or at least added mass to panels that conduct noise, using material like Dynamat eXtreme (common in car audio).
The environment around the machine is a pretty hostile one to most technology.
I do think that active noise cancellation is a brilliant tool for solving many repetitive noise issues ( I explored its use in a server room, dual purpose was, if anything was 'wrong', I could hear the room get louder as the fans lost sync with the inverse waveform. )
However given the sensitive nature of the machines, I wonder if there would be any issues caused by projecting loud inverse waves into the room the machines operate, since it would be very strange if these equipment manufacturers didn't explore the active noise cancellation technology as a way to mitigate the ear splittingly loud noise they produce.
The car makers use two kinds of active noise reduction. One is the injection of inverse waves into the car's stereo, to reduce road noise and body panel vibration. This is controlled by a microphone in the cabin (probably the same one used for hands-free phone calls).
The other one is in the engine mounts, where they have a liquid inside the rubber mount that can stiffen up on command (maybe magnetorheological[1], maybe some other kind), and this is used to counteract the vibrations the engine would transmit to the body/chassis. This is controlled by the ECU because it knows when the engine is on a power stroke and can thus apply correction on a timing basis.
I would think the latter would be what the MRI makers would want to investigate -- they've got a huge spinning mass[2] with components that vibrate. Much like an engine. :)
I've had two MRIs when I was a child. For some reason the "thunks" are relaxing to me and I fell asleep during both procedures. I even pressed the "panic button" by mistake when I had a sleep spasm! MRIs are nap time for me :)
"The outcome of this MRI will determine whether your surgery is go or no-go, the surgery can leave you with a colostomy bag for the rest of your life."
Add to that feeling very ill and weak and having a headache. The thunks are equally likely to be experienced as a pleasant rhythmic music or cause your head to spin and make you throwup.
Things that appear trivial and insignificant can cause a great deal of discomfort for people. I actually felt anguish because of a cracked ceiling for example (you're stuck looking at it for days).
I get why people might be scared, but I just don't, and can't see the scary in MRIs. I can fear the outcome, but not the procedure itself.
I'm just curious about what's scary about it. Perhaps fear of the unknown? I knew why that machine was making those noises (my dad was cool and he taught me the basics about MRI machines). Or is just a personality trait, just like fear of cockroaches?
I knew the basics of how the MRI machine worked at the time as well, but its discombobulating for one. Also, you can rationally know a dark cave is empty but still something about it can be foreboding.
Its why they are called feelings and not thinkies. :)
You're ill, it makes it sucks more somehow.
This decal idea in the article takes the drama out of it I suppose is the best explanation I could offer.
Glad they were able to frame a scary experience as a voluntary adventure. Gamification has great potential for solving motivational problems.
I see opportunities for gamification quite often. If we took any tedious or daunting task and broke it down into a fun, easy, and simple problem for everyone, society in general would benefit from a harvesting a lot of wasted productivity.
Instead of seeing dozens of people on the subway playing Candy Crush, if they enjoyed answering questions on StackOverflow just as equally, how much faster could we advance our knowledge and solve unique problems?
This is a great example of somebody closing a broken feedback loop.
One of the worst things about web-based businesses is that the people working on them are cut off from a vast amount of data about their users. It's a giant broken feedback loop, and I'm glad that user-centered approaches like this are getting developers to realize that great benefits come from reconnecting with their users.
If the kid was young enough, they could give them the story of their lives by telling them it was a transporter and change the room from one color to another or something (via lighting) and move furniture while they were in there.
Then when they came out they might really believe it and be thrilled. This would help for the next visit. Though it might be disappointing to figure out years later.
It's a cute idea. Unfortunately (and I mean that sincerely in this case because it's a nice idea), deceiving children is unethical.
In medical school I worked with a pediatrician who had a patient brought by her mother, a foreign physician. She had told her daughter she was taking her to visit "a friend" to help reduce the time that she would worry about shots and other unpleasantries.
The physician, upon hearing her ruse, explained the ethical landscape in the United States and referred the family to a different doctor, feeling that he would never be able to restore the bond of trust that the mother had frayed.
I don't think this is on the side of deceiving a child. This is really a imaginative aid to a normally traumatic experience, the child knows its not a pirate or spaceship, that's rather obvious even to a 2 year old.
I do agree with the example you give tho, that truly is a blatant deterioration or trust. I don't feel that this is on the same level of destructive misrepresentation.
I believe the ruse is that the kid was expecting a normal visit to a parent's friend, not having a stranger poke holes in you with strange instruments.
I actually had the same idea while laying in an MRI machine as a child. Problem is, nobody would take me seriously. And I still don't work for GE, so nobody would take me seriously suggesting this now -- hospitals are frustrating places.
As great an idea as this is, GE would do better if they made their scanners work. Their software is a dire mess, buggy as hell and the image quality is low. I use their flagship scanner 750w 3T.
Yeah, I had the same idea while reading the title of the post, having only seen MRI machines on TV. So yeah, this isn't rocket science. They're just not focused on that aspect.
On topic: His solution was pretty smart. One of those elegant solutions that seem obvious in retrospect. Hopefully it helps make the process a lot less stressful for some kids.
I don't know who thought binding the arrow keys to change articles was a good idea. I'm still reading on my netbook and instead of scrolling the page so I can fit the text on the screen, it decided that what I actually wanted was to flick articles. No thanks.
"You can be brave", "there's nothing to worry about" do not work, because even brave people feel fear and there are things to worry about; those big clunk noises.
"It's a bit scary isn't it! Look, it's a big machine! It makes lots of loud noises, and you're in a little space. But it's an adventure!" changes expectations. You're allowed to have fear and express it. But you're allowed to enjoy it too.
> Just before the whirring and banging of the machine gets louder, the operator encourages young patients to listen closely for the moment that the craft “shifts into hyper-drive.” This reframing transforms a normally terrifying “BOOM-BOOM-BOOM” sound into just another part of the adventure.
The only problem is if you are in between a metal object and the MRI machine however.
Unless you're planning on augmenting yourself like in Deus Ex I agree its not a big deal. But a big thing coming at you at high speed would ruin your day.
I can point you at a similar issue anywhere in a hospital. Hospitals are dangerous places when there's a misstep, which is why they spend so much time training on procedure.
Probably because you have at least a semi-realistic view of them. Pirates have now been thoroughly neutered for children, which you may not realize if you don't have children of your own right now. Disney has a popular show "Jake and the Neverland Pirates" in which the maximum threat level from the bad pirates is that they might briefly steal your lunch, but only briefly, because you'll have it back by the end of the short episode.
It's like dressing up as a witch for Halloween, you know; there's a lot of horrifying history if you know about it, but if you don't, it's a black cape, a pointy hat, and lots of strained cackling, and little more.
This is why I recommend "Treasure Island" by Robert Louis Stephenson every chance I get. They're all "Walk the plank, me hearties" but they're also blood-thirsty scumbags.
I couldn't even get a chest ultrasound when I was a kid.
Medical equipment looks way too scary to children. It's all cold, white, sterile, and aluminum machinery. The smell of latex and alcohol don't help, and overall, the hospital seems like a very scary place. Heart monitors beeping every minute, weird blipped lines on EKG machines, and electrodes attached to your chest: is this a healing center or a torture prison?
Sedation is the problem with healthcare exemplified. Instead of creating a hospitable (no pun intended) pediatric environment that's comfortable for kids, knock 'em out and bombard them with EM radiation. That's sure to make the kid and the parents more comfortable.
Hospitals need to be designed with a human factor. The way they're designed right now makes them seem like robotics factories.
Huge props to Doug for trying to change the medical landscape to make it more comfortable for younger children. I was hospitalized several times as a young child, and I used to be terrified every single time. I know I would have appreciated this level of attention to design. I know many other children who need medical attention will too.
