

Kids Were Terrified of Getting MRIs. Then One Man Figured Out a Better Way - rfreytag
http://www.slate.com/blogs/the_eye/2013/10/18/creative_confidence_a_new_book_from_ideo_s_tom_and_david_kelley.html?wpisrc=burger_bar

======
baldfat
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????

3) Open MRI systems are great.
[http://www.mrispecialists.net/Equipment.shtml](http://www.mrispecialists.net/Equipment.shtml)

~~~
zrail
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.

~~~
darkmighty
Wouldn't it be simpler to just project the film on a screen on top of the kid?

~~~
zrail
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.

------
lostlogin
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.

~~~
pathdependent
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.

~~~
AUmrysh
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.

------
16s
Any sane person would be afraid of them.

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.

~~~
seiji
_You 're immobilized and can't move. Oh and no one can hear you call for
help._

Do you also avoid sleeping?

~~~
gohrt
You can move whenever you want you are asleep (you just usually don't want
to), and people can hear you call for help.

~~~
seiji
[http://en.wikipedia.org/wiki/Sleep_paralysis](http://en.wikipedia.org/wiki/Sleep_paralysis)

~~~
baddox
But sleep paralysis is terrifying.

~~~
Coincoin
I can't imagine anything more frightening than a sleep paralysis episode in
one of those machines.

------
robg
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.

------
ck2
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.

~~~
carbocation
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.

~~~
chris-allnutt
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.

~~~
Ellipsis753
I think he means the idea of pretending it's a transporter. I would be against
that too as I would feel bad deceiving kids.

------
chiph
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).

~~~
techdragon
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.

~~~
chiph
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. :)

[1]
[http://en.wikipedia.org/wiki/Magnetorheological_damper](http://en.wikipedia.org/wiki/Magnetorheological_damper)

[2] At work, so can't post a video link, but if you look for "cover off mri"
it's really scary/impressive how they work.

------
stusmith1977
It's not just kids who are reassured by cosmetic changes. MRIs used to be
called NMRs. People freaked out because of the word 'nuclear'.

------
kaoD
I never got why MRIs are scary for anyone.

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
:)

~~~
recuter
"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).

~~~
kaoD
I might have worded that wrong.

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?

~~~
recuter
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.

------
ck2
I don't think it is how they look.

MRI machines are incredibly loud and "thunk" repeatedly.

~~~
xyzzy123
This is addressed in the article; the "thunks" get incorporated into the MRI
"adventure".

~~~
mitchty
After dating a nurse and finding out about a bed that was just a bit too close
to the thing getting sucked in.

Yeah, MRI's aren't exactly risk free "adventures".

~~~
gohrt
Fortunately, most humans don't spontaneously generate ferrmagnetic materials.

Only Wolverine is at risk in that regard.

~~~
mitchty
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.

------
sparktherapy
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?

------
wpietri
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.

------
recuter
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.

~~~
lostlogin
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.

------
JonSkeptic
Slightly off topic: This title made me think of a scene from Futurama.

[http://futuramarama.tumblr.com/post/92077790/ooh-whats-
this-...](http://futuramarama.tumblr.com/post/92077790/ooh-whats-this-ah-is-x-
ray-eye-see)

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.

------
bayesianhorse
I wasn't afraid the first time I got into one. But I did have to fight some
low-level emotional terror creeping up on me once I was inside.

It's a tight space, and the device is noisy. Pretty much designed to trigger
these emotions, even though I knew it wasn't dangerous.

Second time I almost fell asleep.

------
endgame
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.

------
nashequilibrium
Here is a video discussing the process, the actually gets very emotional
talking about it. [http://vimeo.com/28420510](http://vimeo.com/28420510)

------
ape4
I am afraid of pirates.

~~~
jerf
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.

~~~
officemonkey
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.

------
marshray
Are you ready kids?!

Aye, aye Captain!

------
kunai
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.

------
mekishizufu
If you're afraid of MRI, you can always try JRuby or Rubinius! :)

