MRI Utilization and the Associated Use of Sedation and Anesthesia in a Pediatric ACO

Uffman, Joshua C.; Tumin, Dmitry; Raman, Vidya; Thung, Arlyne; Adler, Brent; Tobias, Joseph D.

doi:10.1016/j.jacr.2017.01.025

Cited by 54 publications

(30 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Selecting sedation or general anesthesia for MRI should be made on an individual patient basis, considering the benefits and risks. The goals of sedation or anesthesia for ambulatory pediatric MRI are as follows: (1) to guard the patient's safety and welfare; (2) to minimize physical discomfort and pain; (3) to control anxiety, minimize psychological trauma, and maximize the potential for amnesia; (4) to control movement to allow the safe and efficient completion of the procedure; and (5) to provide early, safe discharge from the hospital [6]. The ideal drug regimen to achieve these goals should have the following desirable characteristics: (1) rapid onset of action; (2) predictable duration; (3) easy titratability within the desired range of the sedation continuum; (4) rapid and consistent cessation of effects; (5) multiple delivery options; (6) a wide therapeutic window; (7) minimal cardiorespiratory depression; (8) minimal drug interaction; and (9) be minimally affected by renal or hepatic disease [7].…”

Section: Consideration In Sedative/anesthetic Regimen Determinationmentioning

confidence: 99%

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Jung

2020

Yeungnam Univ J Med

View full text Add to dashboard Cite

The prevalence of magnetic resonance imaging (MRI) for diagnosing and monitoring a wide range of disease in children continues to expand with the efficacy benefit of providing high-resolution images of tissue anatomy and quantitative function and the safety advantage of a lack of ionizing radiation [1,2]. Aspects of MRI scans such as loud noises, confined bore of the magnet, and the required immobility to prevent motion artifacts are the causes of anxiety and barriers to successful performance of the procedure in children younger than 6 years and those at any age with development delay, claustrophobia, or involuntary movements or con-The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infants or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

show abstract

Section: Consideration In Sedative/anesthetic Regimen Determinationmentioning

confidence: 99%

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Jung

2020

Yeungnam Univ J Med

View full text Add to dashboard Cite

show abstract

“…The effect of motion can be mitigated using sedation or anesthesia; however, while sedation and anesthesia can be carried out safely, they both create a risk of adverse events, including acute respiratory or cardiac dysfunction, and are associated with dramatically increased expense in providing imaging. Consequently, research subjects typically do not undergo sedation or anesthesia, and many patients undergoing clinical imaging participate in programs to minimize the use of sedation and anesthesia 17–21 . The availability of additional motion robust imaging strategies would facilitate the further reduction in the use of sedation and anesthesia for MRI.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Motion and Distortion Correction Using Dual‐Echo Diffusion‐Weighted MRI

Afacan

Hoge

Wallace

et al. 2020

Journal of Neuroimaging

View full text Add to dashboard Cite

Geometric distortions resulting from large pose changes reduce the accuracy of motion measurements and interfere with the ability to generate artifact-free information. Our goal is to develop an algorithm and pulse sequence to enable motion-compensated, geometric distortion compensated diffusion-weighted MRI, and to evaluate its efficacy in correcting for the field inhomogeneity and position changes, induced by large and frequent head motions. METHODS: Dual echo planar imaging (EPI) with a blip-reversed phase encoding distortion correction technique was evaluated in five volunteers in two separate experiments and compared with static field map distortion correction. In the first experiment, dual-echo EPI images were acquired in two head positions designed to induce a large field inhomogeneity change. A field map and a distortion-free structural image were acquired at each position to assess the ability of dual-echo EPI to generate reliable field maps and enable geometric distortion correction in both positions. In the second experiment, volunteers were asked to move to multiple random positions during a diffusion scan. Images were reconstructed using the dual-echo correction and a slice-to-volume registration (SVR) registration algorithm. The accuracy of SVR motion estimates was compared to externally measured ground truth motion parameters. RESULTS:Our results show that dual-echo EPI can produce slice-level field maps with comparable quality to field maps generated by the reference gold standard method. We also show that slice-level distortion correction improves the accuracy of SVR algorithms as slices acquired at different orientations have different levels of distortion, which can create errors in the registration process. CONCLUSIONS: Dual-echo acquisitions with blip-reversed phase encoding can be used to generate slice-level distortion-free images, which is critical for motion-robust slice to volume registration. The distortion corrected images not only result in better motion estimates, but they also enable a more accurate final diffusion image reconstruction.

show abstract

“…Lowering medical spending is a primary goal of ACOs (1,2). To bend the cost curve of ACOs, previous studies investigated care coordination, utilization management, and pharmacy management (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

The Financial Impact of Genetic Diseases in a Pediatric Accountable Care Organization

Miller

Hoyt

Rust

et al. 2020

Front. Public Health

View full text Add to dashboard Cite

MRI Utilization and the Associated Use of Sedation and Anesthesia in a Pediatric ACO

Cited by 54 publications

References 25 publications

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Simultaneous Motion and Distortion Correction Using Dual‐Echo Diffusion‐Weighted MRI

The Financial Impact of Genetic Diseases in a Pediatric Accountable Care Organization

Contact Info

Product

Resources

About