The Playful Protocol
How Colombia is Revolutionizing Brain Scans for Children
A low-cost, play-based training protocol is making non-sedated MRI scans possible for children in resource-limited settings
Discover the InnovationIntroduction
For doctors and scientists trying to understand the developing brain, magnetic resonance imaging (MRI) provides an invaluable window. This powerful technology allows researchers to peer non-invasively into the brain's intricate structures without the use of harmful radiation 1 . Yet for young children, the experience can be terrifying—the loud, repetitive noises, the confined space, and the requirement to remain perfectly still for extended periods.
Loud Noises
MRI machines produce sounds up to 110 decibels, equivalent to a rock concert.
Confined Space
The narrow MRI tube can trigger claustrophobia in both children and adults.
Traditionally, the solution has been to use sedation or general anesthesia, but this approach carries risks, additional costs, and logistical complexities that are particularly challenging in resource-limited settings 1 3 .
In rural and semi-rural Colombia, a team of researchers faced this exact challenge. They needed to conduct brain MRI scans on 7-year-old children as part of a neurodevelopment study, but wanted to avoid sedation. What they developed—a simple, low-cost, and playful training protocol—not only achieved remarkable success but also offers a blueprint for making pediatric medical procedures less frightening for children and families worldwide.
The Problem with Sedation and the Promise of Awake Scans
Pediatric sedation and anesthesia, while effective for ensuring image quality, present significant hurdles. They require additional medical personnel, carry potential side effects, and increase costs substantially. For research studies, sedation often cannot be justified due to ethical considerations regarding "more than minimal risk" 3 . Furthermore, in rural areas of low and middle-income countries (LMICs) like Colombia, the specialized equipment and trained anesthesiologists needed may simply be unavailable 5 .
Risks of Pediatric Sedation
- Potential long-term effects on brain development
- Requires specialized personnel
- Significantly increases costs
- Extends procedure and recovery time
Perhaps most concerning are the emerging questions about potential long-term effects of anesthesia on brain development, particularly in young children 3 . While research is ongoing, these concerns have prompted the U.S. Food and Drug Administration to issue warnings about repeated or lengthy use of anesthetic drugs in young children 3 .
The alternative—successfully scanning children while they're awake—has proven difficult. Children naturally move, become anxious, and find it challenging to remain still for the 30-40 minutes required for a comprehensive brain MRI. Previous studies have shown that children over six years old are often capable of completing awake MRIs, but success depends heavily on preparation and familiarization with the intimidating scanning environment 3 .
A Colombian Innovation: Play-Based Preparation
Faced with these challenges, researchers working in the Municipality of Sabanalarga in Colombia's Atlántico department developed and tested a novel, low-cost MRI training protocol adapted from methods previously used in the United States 3 . Their approach was simple yet revolutionary: turn the frightening into the familiar through play-based group training.
Group Training
Children trained in small groups of 5-10 at community sites
Play-Based Approach
Used toys and games to familiarize children with the MRI process
Parental Involvement
Mothers invited into scanning room to comfort their children
Training Protocol Timeline
Group Session
Children attended training sessions in small groups where they learned about the MRI procedure through interactive activities.
Mock Scanner Practice
Each child practiced lying still in a collapsible play tunnel while listening to recorded MRI sounds through headphones.
Peer Support
Watching other children go through the same process created a supportive group dynamic that reduced anxiety.
Scan Day Preparation
Children transported in small groups, provided with lunch, and waited in family-friendly areas separate from clinical patients.
The study involved 57 typically developing 7-year-old children from Colombia's lowest socioeconomic stratum, all from rural and semi-rural towns where resources are scarce 3 4 . These children were part of a larger neurodevelopment study investigating the effects of antenatal viral exposures 3 .
The Scientist's Toolkit: Low-Cost Materials for Big Results
The Colombian protocol demonstrates that effective medical preparation doesn't require expensive technology. The entire toolkit cost less than $100 USD for all participants 3 .
| Item | Function | Cost & Accessibility |
|---|---|---|
| Playmobil Radiology Playset | Demonstrated the scanning process using miniature models | Low-cost, reusable toy set |
| Colorful collapsible play tunnel | Simulated the MRI scanner environment | Inexpensive, portable |
| Customized illustrated booklet | Explained MRI procedure with photos of local radiology suite | Printable, customizable |
| Headphones connected to phone/computer | Played authentic MRI sounds during mock scanning | Used existing technology |
| Dishware container | Modeled the head coil at top of play tunnel | Repurposed household item |
Toy MRI scanner used for demonstration
Collapsible play tunnel simulating MRI machine
Customized educational booklet
During the mock scanner session, each child practiced lying still in the tunnel for three to five minutes while listening to recorded MRI sounds through headphones. The research coordinator provided gentle reminders when children moved, helping them understand what "holding still" really meant in this context 3 . This hands-on practice, combined with watching their peers undergo the same process, created a supportive group dynamic that reduced anxiety.
Remarkable Results: Beyond What Anyone Expected
The results, published in Pediatric Radiology, were impressive by any standard 1 4 . Of the 57 children who underwent the training protocol, 51 (89.5%) successfully completed the MRI across two attempts, with 44 (77.2%) succeeding on their very first try 3 4 . Only six children (10.5%) were unable to complete the scan due to refusal or excessive motion 1 .
| Metric | Result |
|---|---|
| First-attempt success | 77.2% (44/57 children) |
| Overall success | 89.5% (51/57 children) |
| Unsuccessful scans | 10.5% (6/57 children) |
| Assessment Domain | Specific Tool | Finding |
|---|---|---|
| Intelligence | Wechsler Preschool and Primary Scale of Intelligence (WPPSI) | No significant association with MRI success |
| Motor abilities | Movement Assessment Battery for Children (MABC) | No significant association with MRI success |
| Executive function | Behavioral Rating Inventory of Executive Function (BRIEF) | No significant association with MRI success |
| Adaptive behavior | Adaptive Behavior Assessment System (ABAS) | No significant association with MRI success |
The researchers went further, investigating whether certain neurodevelopmental factors might predict which children would succeed at the scan. They administered a comprehensive battery of assessments measuring intelligence, motor skills, executive function, and adaptive behavior 3 4 . Surprisingly, they found no significant associations between any of these scores and MRI success 1 4 . This suggests that their preparation protocol was broadly effective across children with varying developmental profiles.
When compared to other approaches for unsedated MRI, the Colombian protocol holds its own. A Canadian randomized controlled trial found similarly high success rates (91%) across different preparation methods, including mock scanner training, child life specialist support, and home-based materials 7 . Recent European research has also demonstrated that child-friendly audio-visual interventions can significantly reduce stress in children aged 6-10 during MRI scans 9 . What makes the Colombian example exceptional is achieving these results with minimal resources in a challenging setting.
Beyond Colombia: A Global Perspective on Accessible Medical Care
The implications of this success extend far beyond rural Colombia. The World Health Organization estimates that over half the global population lacks access to basic diagnostic imaging 5 . In sub-Saharan Africa, the situation is particularly dire—there's an average of just 0.3 MRI units per million people, with 11 countries having no MRI scanners at all 5 .
Global MRI Access
MRI units per million people by region
Protocol Benefits
In such environments, where even basic imaging is scarce, protocols that reduce the need for sedation become even more critical. They potentially allow limited scanners to serve more patients by eliminating recovery time and specialized monitoring requirements. The Colombian approach aligns with other innovative strategies being implemented in resource-limited settings, such as Nigeria's hybrid cloud-based picture archiving and communication system that incorporates locally validated AI software for interpreting chest radiographs 5 .
The success in Colombia also represents an important step toward diversifying pediatric research populations. For too long, neuroimaging studies have predominantly featured participants from high-income, Western countries, limiting the applicability of findings across global populations 3 . By developing feasible methods for conducting research in under-represented communities, scientists can build more inclusive understanding of brain development across diverse human experiences.
Conclusion: A New Paradigm for Pediatric Medicine
The Colombian MRI training protocol represents more than just a technical solution to a research problem—it embodies a shift in how we approach pediatric medical procedures worldwide. By centering children's emotional needs and leveraging the universal language of play, the researchers achieved what might have otherwise required expensive technology or pharmacological intervention.
Child-Centered
Focuses on children's emotional needs and perspectives
Globally Applicable
Designed for resource-limited settings with minimal costs
Perhaps the most powerful lesson lies in the protocol's emphasis on dignity and empowerment. The children weren't simply passive subjects; they were active participants who understood the process, practiced the required skills, and ultimately conquered their fears. The instant-print photos taken of them in the radiology suite—attached to their booklets as prizes for their "MRI day"—celebrated their achievement and made them heroes of their own medical narratives 3 .
As healthcare continues to globalize and technology reaches more remote communities, it's not just advanced equipment that we need, but human-centered approaches that work within local constraints. The Colombian protocol demonstrates that sometimes the most sophisticated solution is also the simplest: replacing fear with familiarity, anxiety with play, and isolation with compassionate presence. In doing so, it offers hope that quality healthcare can be both accessible and humane, even in the most challenging circumstances.