Understanding and Enhancing the Pediatric Radiology Patient's Experience

Abstract

M any radiology residents spend only a few months on rotations in pediatric radiology, and important topics do not get the attention they deserve. Yet there are crucial differences between the radiology of adults and children that every resident needs to learn about. Those who may be called on to care for infants and children need to understand how to approach the challenges younger patients can present. This article provides an overview of the pediatric patient’s experience. Signs of distress among pediatric imaging patients are not uncommon. In many departments, patients can be seen weeping, protesting, and even actively resisting the efforts of radiology personnel (1). In some cases, examinations must be cancelled for lack of patient and/or family member cooperation, wasting time and resources, fomenting frustration, and delaying or even preventing an important step in the patient’s care. Also, the distress of one patient, as manifested by cries of distress, can ripple through an entire department, heightening the anxiety of others. The “contagion” of anxiety applies not only to patients, but also to family members. Sometimes the greatest source of a pediatric patient’s distress lies not in the patient but in the fears of a parent (2). On some occasions, patients arrive for their imaging procedure positively terrified because of what they have been told by a family member. Efforts to calm fears frequently need to take into account the patient’s family, and some of the most important work is often done before the patient even arrives in the radiology department (3). Potentially frightening aspects of the pediatric patient’s imaging experience include the hospital’s sights (obviously sick people), sounds (patients in distress), odors (rubbing alcohol), the equipment (which might be mistaken for an instrument of torture), prolonged isolation and/or immobilization, and the discomfort and even pain associated with imaging procedures themselves, such as the insertion of an intravenous line or nasogastric tube. One key to reducing this anxiety is to anticipate both immediate and longer-term adverse effects of imaging procedures. The immediate effects are obvious: the patient recoils in fear, fights against the technologist, nurse, or radiologist, or bursts into tears. But the effects of anxiety can also be longer term, manifesting only after the patient and the family have left the radiology department. For example, children who have endured one stressful experience may develop heightened anxiety toward future healthcare encounters (4). Consider how “unnatural” some imaging procedures, such as a voiding cystourethrogram, may seem to a pediatric patient. Many children have been repeatedly told by parents and teachers that they should never let anyone see or touch their “private parts.” Many have also been encouraged to void only on the toilet and chided for doing so under any other circumstances. Now, however, they are being asked not only to allow a stranger to see and touch but also to insert a catheter into this private anatomy, and then they are told to void on a table in front of strangers. Moreover, it is not infrequent that patients referred for voiding cystourethrogram have a history of a failed catheterization at an outside facility. Such experiences naturally evoke confusion and distress, which can be further compounded if radiology personnel are not understanding and patient. There are many ways to reduce the anxiety and distress associated with pediatric imaging. A great source of fear is the unknown, which places a premium on educating patients and family members. This can occur both at home, using such materials as coloring books and videos that describe the setting, procedure, and personnel, and in the radiology department, using such aids as a doll on which the procedure can be demonstrated or a mock computed tomography or magnetic resonance table on which the patient can lie down (5). Equally important is the ability to tailor such education to the developmental level of the patient (6). Whereas hyperanxious or angry parents can magnify challenges, well-prepared and calm parents can often play an Acad Radiol 2016; 23:262–263