At 2 a.m. we had a 3-year-old with RLQ pain; ultrasound was equivocal, and we debated a 10–12 minute non-sedated MRI (HASTE + DWI) with child-life support versus low-dose CT. For those covering peds after hours, how reliably are you getting a confident read from fast MRI without sedation while keeping the child calm, and when do you pivot to CT to give the surgeons a timely answer?
But we’ve had good luck with a 6–8 min fast MRI (ax/cor HASTE + DWI) if child-life can sell the “statue game,” but at 2 a.m. if DWI blurs after one quick repeat or the kid’s under 4, we pivot to low-dose CT so surgery isn’t waiting. One tip: put a headset on the parent and make them the stillness coach during each sequence; motion drops a lot. ACR supports either based on resources, but MRI shines only when it’s truly fast and staffed: https://acsearch.acr.org/docs/3105870/Narrative/.
At 2 a.m., without child-life, we can usually pull off a 10–12 min “HASTE + DWI” if we use a vacuum immobilizer and let a parent run the “statue game,” but — once DWI smears twice, I stop. I call it indeterminate and pivot to low-dose CT so @surgery isn’t waiting, rather than burning another repeat. ACR backs that flow after equivocal US: Preview — do your techs skip axial T2 to shave time?
Switching the axial T2 to BLADE/PROPELLER first has saved our overnight scans — less blurring, and with a quick coronal single-shot T2 it’s often enough to call it… If I need a second DWI repeat or we’re about 8 minutes in with motion, I pivot to CT so the surgeons aren’t waiting; @marcuslee90 this tweak cut our repeats a lot.