Purpose or Case Report: The likelihood of sedation for an MRI exam in a patient under 8 years is high. Disadvantages of sedation usage include direct complications, suspected long-term effects, and higher costs. Sedation reduction techniques include the use of an MRI simulator, accelerated MRI scans, abbreviated protocols, and swaddle and sleep techniques. We evaluated the clinical image quality and cost effectiveness associated with an MRI simulator training program.
Methods & Materials: An MRI simulator program was created, and all patients going through the program from Aug 2014 and Oct 2018 were analyzed. To assess clinical image quality, 20 brain MRIs of age-matched patients were randomly selected including 10 patients who avoided sedation after the simulator program and 10 patients who received sedation for a brain MRI. A blinded pediatric radiologist scored the same 3 sequences on each study on a 4-point quality scale (1=significant limitations for clinical use, 2=moderate limitations, 3=minimal limitations, 4=no limitations). To assess cost effectiveness, success rate of avoiding sedation after simulation was calculated along with average differential cost to payer for a sedated MRI vs. a non-sedated MRI after MRI simulator training.
Results: 592 patients (mean age: 7.9 ± 3.0 years) were enrolled in the MRI simulator program over 4 years with the majority scheduled for a brain MRI (71%). The mean image quality score for sedated brain MRIs was 3.50 ± 0.51, and the mean quality score for non-sedated brain MRIs after successfully completing the MRI simulator program was 3.37 ± 0.49. All examined sequences demonstrated minimal to no limitations for clinical use. No sequence was found to have moderate or significant limitations for clinical use in either group. The success rate of children avoiding sedation after MRI simulation was 87%. The average differential cost to payer was $963 higher for a sedated MRI than an MRI that avoided sedation after MRI simulator training. Factoring in the success rate, the total payer cost savings over 4 years was estimated to be $495,984 for our simulator program.
Conclusions: In addition to reducing sedation rates, our study validates the clinical image quality of non-sedated pediatric MRIs obtained after successful simulator training and demonstrates the cost effectiveness of a simulator program over 4 years. The clinical quality and large payer cost savings should be considered when evaluating future reimbursements and investments for MRI simulator programs in pediatric patients.