At Oslo University Hospital, we specialize in imaging some of the most sensitive and technically demanding patients: children. Pediatric MRI isn’t just a scaled-down version of adult imaging—it’s a field that requires empathy, ingenuity, and cutting-edge technology. In this blog, we share how we address the unique challenges of pediatric imaging through careful preparation, tailored protocols, and innovative tools that help us reduce sedation and improve outcomes. If you're just curious, or would like to get insight for your own practice, this article is for you!
UNIQUE CHALLENGES OF PEDIATRIC IMAGING
OUR EXPERIENCE AT OSLO UNIVERSITY HOSPITAL
PATIENT POSITIONING TECHNIQUES
One of the most fundamental issues is motion. Young children, especially toddlers, often struggle to stay still for the duration of an MRI scan, which can take anywhere from 15 to 60 minutes. Motion can degrade image quality significantly, sometimes making the results unusable. As a result, radiology technologists must find creative ways to minimize movement—whether through clear communication, distraction techniques (like videos or music), or, in some cases, sedation.
Another layer of complexity is the emotional and psychological comfort of the child. The MRI environment can be intimidating: it's noisy, enclosed, and filled with unfamiliar equipment. Technologists need to build trust quickly and create a child-friendly atmosphere. This might mean using mock scanners for practice sessions, explaining the process in age-appropriate language, or involving parents in the preparation. Even simple things like allowing a favorite toy or blanket into the scanner (if MRI safe) can make a big difference.
Technically, pediatric patients also pose specific considerations in terms of anatomy and development. Protocols must be adapted for smaller body sizes and different physiological parameters, and there's often a narrower margin for error. The use of coils, patient positioning aids, and scan parameters must be optimized to deliver high-resolution images while keeping scan times as short as possible. All this demands strong interdisciplinary collaboration, especially when working with pediatricians, anesthesiologists, and child life specialists. In short, pediatric MRI calls on radiology technologists not just as skilled operators, but as patient advocates, communicators, and problem-solvers. It's a field where empathy and expertise are essential.
At Oslo University Hospital (OUS), we encounter a significant volume of pediatric cases, which present unique challenges due to the different needs of young patients. In cases involving children aged four years and below, it is common to use sedation during MRI exams. This approach ensures the child remains still throughout the scan, enabling precise imaging without motion-related artifacts. Sedation also minimizes potential distress or discomfort for the child. With older children (aged five years and above), using in-bore entertainment systems is an effective distraction technique. This method aims to keep the child relaxed and cooperative during the exam, thereby enhancing their tolerance and decreasing the need for sedation. In some more complex cases, neither sedation-free exams nor sedation may be possible and general anaesthesia becomes necessary. For infants1, we often try to use the feed-and-wrap technique, which has shown success. This involves feeding the infant and then wrapping them snugly (See image below). This helps to keep them calm during the exam.
Image: The feed and wrap technique using the Babyfix Cocoon
Cutting-edge techniques like Deep Resolve have significantly contributed to faster scans, which are crucial for every patient group. Faster scans have the added benefit of providing clearer and more detailed images, which can aid more accurate diagnoses. By employing Deep Resolve when scanning younger children, we can lower the sedation rate, and the associated risks and costs, as well as minimize patient discomfort and potentially enhance the overall patient experience.
After upgrading our MAGNETOM Skyra scanner that ran syngo MR E11C software to a MAGNETOM Vida Fit scanner running syngo MR XA50, we have substantially streamlined our musculoskeletal (MSK) protocols. We have shortened the scan duration and enhanced our efficiency without compromising on diagnostic quality. Several MSK examinations are now around 50% faster.
Along with robust protocols, patient preparation is another crucial factor in pediatric MRI. Last year, we made a preparation video, which is now on our hospital’s YouTube channel (see below). This video was made specifically for our department, so that parents and their children will recognize the facilities, the scanner, and the staff when they arrive. Before the video existed, they often visited us at the MRI lab for a demonstration, which usually happened the day before the exam. This took up time slots, which was problematic for a busy department. The video now allows us to maximize the efficiency of our patient preparation, reduce unnecessary visits, and ensure a smoother MRI experience for parents and their children.
If the MRI exam involves a gadolinium injection, we use a tailored strategy that involves both the MRI lab and the pediatric department. The pediatric department places the cannula prior to the exam, which streamlines the process so the exam can start promptly. Children often feel anxious or fearful about medical procedures like a cannula insertion. Placing it at an early stage provides more time to address any fears or concerns the child might have and reduces the likelihood of the child being upset or uncooperative during the scan. Collaborating with the pediatric department in this way has led to higher success rates in our MRI exams. In fact, it makes the whole hospital experience less intimidating for the children.
Our entertainment system is produced by NordicNeuroLab AS (NNL, Bergen, Norway). The TV screen is located behind the scanner bore, and a tablet is kept in the control room (See Below). The equipment was originally meant for fMRI examinations, but we saw great potential in using it elsewhere. Children can watch a movie, stream from providers such as Netflix, or listen to the radio. Most children between the ages of 5 and 15 prefer to watch a movie. Using an entertainment system to create a positive atmosphere is a strategic way of enabling a smoother and more successful scanning experience for children in this age group, and helps make them cooperative and comfortable during the examination.
Image: TV screen from NordicNeuroLab with a Microsoft Surface tablet. Patients can view the TV screen, which is positioned behind the bore. Depending on how a patient is positioned, they might require a mirror to see the screen. The tablet gives patients various entertainment options.
Fixation equipment is crucial for ensuring patients remain still and comfortable during examinations, especially considering the variation in understanding and cooperation among different patients, particularly children. Our equipment is provided by Pearl Technology AG (Schlieren, Switzerland). We have different pads and positioning aids to suit every anatomy. The equipment is easy to attach, ensuring a consistent approach across radiographers. Having equipment that does not require improvisation and can be quickly placed reduces variability and the reliance on individual radiographer’s techniques. This makes the process more standardized and reliable.
Image: Inflatable Pads (Multipad) from PearlTechnology that we use to achieve proper fixation during the scans.
Our 3T MAGNETOM Vida Fit runs syngo XA50 software, which enables Deep Resolve (Sharp, Gain, and Boost) for our 2D TSE sequences (See image below). Deep Resolve is an advanced image reconstruction technology that enhances image quality for 2D TSE sequences. It uses sophisticated algorithms and deep learning techniques to significantly improve image sharpness, clarity, and signal-to-noise ratio. The aim is to elevate overall diagnostic precision by reconstructing exceptionally high-quality images derived from the initially acquired raw data. Moreover, Deep Resolve is progressively extending its field of application to include other sequences, such as HASTE, DWI, and even 3D sequences like SPACE and VIBE. This will benefit diagnostic accuracy and clinical insights across a broader range of MRI sequences.
The ability to conduct faster scans opens up a number of opportunities for our lab. Firstly, the time gained gives us the flexibility to scan emergency patients who come during the day. Secondly, we can perform multiple examinations for the same patient in a single visit. We are constantly optimizing our lab to increase efficiency.
This illustration of the Deep Resolve technique emphasizes its benefit across different MSK regions. A comparative display shows the difference between conventional imaging and imaging with Deep Resolve. All images were acquired using a 3T MAGNETOM Vida Fit.
To illustrate the measures I’ve mentioned before, I’d like to present a few interesting cases from neuroimaging, ankle-foot imaging, and hand/wrist imaging.
A 7-year-old boy with a porencephalic cyst who has difficulty remaining still during an MRI scan. The 3D CISS images (Fig. 2A, B: MultiPlanar Reconstruction [MPR], and C: MPR) exhibit motion artifacts due to his difficulty in maintaining stillness. In contrast, the T2w 3D SPACE sequence (Fig. 2D, E: MPR, and F: MPR) was successfully completed with good image quality.
Continuing from the first scans, the boy expressed a desire to leave following previous scan but agreed to stay a few more minutes. We then performed a T2w HASTE sequence with DLRecon (Fig. 3A and B), which allowed us to obtain sharp images in just a few seconds. Finally, we conducted the T1w MPRAGE sequence with DLRecon (Fig. 3C, D: MPR, and E: MPR) as he reached his limit of tolerance. Notably, without DLRecon, the routine T1w MPRAGE sequence, which typically requires approximately 5 minutes, would likely have been unfeasible in this case.
For neuroimaging cases like these, we also aim to stabilize the entire head, as the headphones and side pads help prevent lateral movements. However, to control flexion and extension motions, pads on the forehead provide the necessary support, leading us to use the Multipad Bendy on top and the Multipad Plus on the sides.
Images: A healthy volunteer demonstrating how we set up an ankle/foot exam using inflatable pads. One pro tip is to slide the coil all the way to the side, and the healthy foot as far as possible to the opposite side. Place the feet as close as possible to the end of the table. Don’t let the feet be positioned close together. With this setup, you can reduce phase oversampling and save scan time. Coil: Foot/Ankle 16.
A 6-year-old girl with known polyarticular juvenile idiopathic arthritis in the right ankle. Her first MRI ankle exam was performed without sedation on our 3T MAGNETOM Skyra when she was 5 years old. She had an initial evaluation and treatment for the right ankle (Fig. 10) and is returning for re-evaluation of the same ankle. Additionally, there is a request to assess the left ankle during this visit. With the latest techniques provided by our 3T MAGNETOM Vida Fit, we were able to examine both ankles with a gadolinium injection. The right ankle shows synovitis at the first metatarsophalangeal (MTP) joint, and osteochondral lesion at the talus (Fig. 11). Imaging of the left ankle indicates synovitis of the talonavicular joint (Fig. 12).
(10A–10F) First examination (right ankle) with conventional imaging acquired on a 3T MAGNETOM Skyra.
A healthy volunteer demonstrating how we set up a hand/wrist exam using inflatable pads. Coil: Hand/Wrist 16.
A 10-year-old girl with suspected arthritis of the left hand/ wrist: Ultrasound imaging was initially performed with inconclusive findings for arthritis. The referring physician requested an MRI exam, which was performed without sedation. MRI findings indicated bone marrow edema at the second metacarpophalangeal (MCP) joint, and at the third and fourth proximal interphalangeal (PIP) joints, which is not typical arthritis. Post-traumatic injury might be a plausible reason for the observed symptoms and physical changes (Fig. 15).
Images of the left hand acquired using Deep Resolve Boost and Sharp on a 3T MAGNETOM Vida Fit.
Pediatric MRI is a field where technical precision must go hand in hand with compassion, creativity, and collaboration. At Oslo University Hospital, we’ve learned that success in imaging young patients depends as much on preparation, positioning, and communication as it does on the quality of the scanner itself. By combining tailored workflows, dedicated fixation equipment, and advanced technologies like Deep Resolve, we’ve significantly reduced sedation rates, improved diagnostic quality, and made the MRI experience more manageable for children and their families.
Ultimately, our goal is not just to acquire clear images—it’s to create an environment where children feel safe, parents feel supported, and radiographers can focus on delivering the best possible care. As we continue to refine our approach, we remain committed to advancing pediatric imaging.
The MSK Protocol can be found here: https://www.magnetomworld.siemens-healthineers.com/clinical-corner/protocols/pediatric-mri-protocols/deep-resolve-pediatric
1MR Scanning has not been established as safe for imaging foetuses and infants less than two years of age. The responsible physician must evaluate the benefits of the MR examination compared to those of other imaging procedures. Note: this disclaimer does not represent the opinion of the author.