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Radiology: How a holistic approach can alleviate children's fears

An innovative, child-centered concept featuring Gerda the Giraffe can help to reduce children's fears of radiology examinations while also improving imaging results.
Katja Gäbelein
Published on May 13, 2024
Using creative methods applied by a multidisciplinary team, we developed a holistic approach that makes medical imaging examinations such as magnetic resonance imaging (MRI), computed tomography (CT), and fluoroscopy less stressful for children, parents, and medical staff. Throughout the whole development process, we interacted closely with our target group of 3- to 9-year-olds. The result? We’re proud to introduce Gerda, the brave giraffe!
<p>No, children aren’t just small adults. They differ from adults physically, cognitively, and also emotionally. However, just like adults, children sometimes need to undergo medical examinations: About ten percent[1] of all MRI, CT, and <a href="fluoroscopy">fluoroscopy</a> examinations are required for children – and the trend is rising.</p>

What is fluoroscopy?

A medical imaging technique that uses X-rays to create images of internal organs and structures of the body in real time. In contrast to static X-rays, a moving image is recorded.

An environment that can be intimidating

<p>Cold, sterile rooms. Not one familiar face among the hospital staff. An injection with a contrast agent that feels oddly hot or cold. Strange machines with narrow tubes where you have to lie very still, alone, and even control your breathing. Noises you've never heard before. Patients sometimes encounter such situations when undergoing CT, MRI, or fluoroscopy examinations.&nbsp;<br><br>What can be unnerving even for many grown-ups, is often just plain scary for youngsters. And many children are simply too young to stay as still as they would actually need to for such scans. This is why the relative risk of non-diagnostic images due to <a href="motion%20artifacts">motion artifacts</a> or scan interruptions is high.</p>

What are motion artifacts?

Image disturbances caused by movement of the patient during a medical imaging examination. They can lead to blurry images, double contours, or other image defects that make diagnosis difficult.

High stress potential for children and parents

In some cases, children even need to be sedated, i.e., they're given medication to put them into a sleep-like state for the examination. However, that approach poses health risks and can increase the stress levels of the children and their parents. Moreover, the examinations then take longer due to the additional work step involved. This, in turn, puts an even higher burden on medical staff. Examination costs increase because additional staff have to be brought in for sedation. Studies have shown that the error rate for scans under sedation is seven percent.[2] All in all, failing to prepare young patients in a child-friendly way for what is to come can severely disrupt the clinical process.
Die Abbildung zeigt eine Illustration im Dschungelthema. Ein fröhlicher Affe hängt an einem Ast über einem großen MRI-Scanner, während ein anderer links vom Scanner verkleidet als Arzt bereitsteht. Zwei neugierige Giraffen schauen zu.

A holistic, human-centered approach

<p>This preparation process has yet to become standardized in many hospitals, explains Alexandra Zahn. “That's why we wanted to create an approach to help children to help themselves: The story of the brave giraffe Gerda and its accompanying materials are intended to empower children to help themselves so that they can feel strengthened as they face this unfamiliar situation.”&nbsp;<br><br>Alexandra Zahn is a Senior Key Expert on the topic of patient-centric healthcare transformation at Siemens Healthineers. About two years ago, she helped establish the Pediatric Radiology Experience. This project takes a holistic approach that includes parents and clinical staff in preventing the cross-transmission of stress and anxiety among all involved.</p>

Multidisciplinary experts working with clinical partners

<p>Hand-in-hand with pediatric patients — this concept applies to the entire patient pathway. It was developed by a team of multidisciplinary experts from fields such as <a href="user%20experience%20design">user experience design</a>, product design, and mechatronics. In numerous co-creation sessions with children between the ages of three and ten, problems were defined and solutions tested in practical settings with the children, then further explored and developed from a child's perspective.</p>

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Portrait von Alexandra Zahn, Senior Key Expert Patient Centric Healthcare Transformation, selbst mehrfache Mutter und Leiterin des Projektes Pediatric Experience. Alexandra trägt eine weiße Bluse mit einer zeitlos designten goldfarbenen Kette und ist vor einem hellgrauen Hintergrund fotografiert.

We believe that the needs of patients are at the heart of everything and must be taken into account early on in the development process of medical technology solutions.

Alexandra Zahn, Senior Key Expert, Patient Centric Healthcare Transformation, Siemens Healthineers

<p>Regular workshops were held with radiologists, radiology technologists, psychologists, child life specialists, educators, play therapists, and parents. To formulate the problem in detail and conduct practical tests, our team worked closely with leading clinical partners such as the University Hospital Carl Gustav Carus in Dresden, Universitätsklinikum Erlangen, and Charité – Universitätsmedizin Berlin in Germany, and the University Hospital Basel in Switzerland.&nbsp;<br><br><strong>Human-centered design - what does that mean? Watch the video to find out more:</strong></p>
<p>For this large-scale project, the team took a very methodical approach, integrating <a href="design%20thinking%20methods">design thinking methods</a> and various innovative approaches. They inched their way forward step by step – even sometimes taking a step backwards, figuratively speaking. This is intentional and part of the process, Zahn explains, as it's an iterative approach in which all process steps can be repeated at any time to optimize the product design and further develop the approach.</p>

What is design thinking?

A human-centered method of innovating that seeks to solve problems and generate new ideas. Interdisciplinary teams come together and work through a multistage creative process. The goal is to find the best solution for users.

Step by step to the first prototype

<p>After the team had focused extensively on <strong>understanding</strong> the problem space in close exchange with all target groups, and had <strong>defined</strong> a solution framework, it kicked off the <strong>ideation phase</strong>. This phase involves searching for concrete solutions in brainstorming sessions. This led to the idea of producing a book to help children prepare for their medical examinations. The first <strong>prototype</strong> was created:</p>
<p>The team gave the prototypes to our clinical partners for <strong>implementation</strong> in their medical practice, meaning that children and parents tested them under the guidance of medical staff:</p>

These materials were launched first: a "Gerda Universe" that turns the radiology unit into a jungle for young children along the entire patient pathway:
Book: Gerda, the Brave Giraffe

This book prepares children for their medical examination and is available in printed and digital formats in three versions: one each for CT, MRI, and fluoroscopy examinations. It contains an explanatory section for parents. The link to the download can be found here.

<p>In 2022, the Pediatric Radiology Experience concept was awarded the UX Design Award by the International Design Center Berlin. But the team didn't rest on its laurels after this success: With the experience gained from the first clinical deployments and practical feedback, it was time to go "back to square one” – to the <strong>understanding</strong> phase.</p>

What is the UX Design-Award?

Click here for the UX Design Award page about the Pediatric Radiology Experience:
Learn more

Learn fast. Fail fast. Adapt fast.

<p>The feedback from the clinical partners highlighted challenges which the previous approach had not addressed, says Zahn: "With our human-centered approach, it's incredibly important that our ideas fit the needs of the users. That's why we're continuously making adjustments. Our motto is: Learn fast. Fail fast. Adapt fast." After <strong>defining</strong> the new challenges, we quickly moved on to the next <strong>ideation</strong> session:</p>
<p>The team continued pursuing the idea of a learning simulator. This led to the creation of the first <strong>prototype</strong>, which would later become a real product:</p>

Gerda goes digital

The ideas for the learning simulator were still missing interactive, digital components. So the team decided to use a new innovation method to further refine the concept: In May 2023, the team took part in a hackathon with the project.

18 teams with over 100 hackers worked on the challenge for two days. "The atmosphere was simply fantastic: full of energy, creativity, and innovation. The resulting contributions are invaluable to us," says Zahn. The winning team, GAMINEERS, produced impressive digital prototypes that were subsequently further developed. 

Here's what resulted for the learning simulator: the MINITOM Kids training device and digital app. This model-based approach is designed to encourage children to explore, distract them from negative emotions, and train their coping strategies through their own discoveries:

Abbildung des neuen Minitom Kids. Dies ist einem CT oder MR nachempfundendes kindgerechtes Modell. Er ist mit lebendigen Illustrationen im Dschungelthema verziert, darunter verschiedene Tiere wie Giraffen und Zebras. Oben befindet sich eine kleine Gantry, davor eine bewegliche Liege für ein Kuscheltier sowie ein Tablet für die simulierte Bedienung. Das Modell steht auf einem Tunnel, der den Maßen einer original Gantry im Durchmesser ähnelt.
Training for the examination

Thanks to MINITOM Kids, children can practice MRI scans with their stuffed animals in the waiting room, for example.

The project has been well received in clinical practice: "For example, we hear from our clinical partners at Dresden University Hospital that they receive very positive feedback on our concept from children, their parents, and clinical staff," says Zahn.

An approach that can help everyone involved

<p>Ultimately, this holistic approach can help everyone involved in the examinations to be happier and more relaxed: It can help clinical staff to follow a standardized process for preparing pediatric patients in the hectic daily routines of their hospital. They can also achieve better imaging results, reduce sedation rates, and thereby reduce the risks, time, and costs involved in the examinations.&nbsp;<br><br>It can help parents navigate the "medical jungle" in a relaxed manner, enabling them to accompany and support their children better, both before and during the examination. It takes children's needs seriously and helps them to cope with the unfamiliar situation — using both information and distraction. It also has the potential to encourage children to participate in actual therapy, which often follows an imaging test.</p>
Eine farbenfrohe Kinderzeichnung zeigt eine gelbe Giraffe mit braunen Flecken und den Text “siemens helfinirs” in mehrfarbigen Buchstaben.

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An approach for those who need particularly empathetic treatment

<p>The concept could be extended to a therapy itself, such as radiotherapy for cancer, says Zahn. Gerda and her friends could accompany children throughout their illness. The approach could also be adapted to other patient groups that need particularly empathetic treatment, such as people with autism or patients with dementia.&nbsp;<br><br>Gerda the giraffe will certainly not be the right protagonist for these last groups. But Zahn and our creative team will undoubtedly come up with a suitable replacement. Because it all comes down to <strong>understanding</strong>. First, however, let's sing the Magic Song together!</p>

​The Magic Song

The Magic Song
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The Magic Song
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By Katja Gäbelein

Katja Gäbelein is a digital editor and content creator for multimedia content at Siemens Healthineers. She specializes in technology and innovation topics.

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  1. [1] Pediatric Imaging Market Size, Share & Trends Analysis Report By Modality (X-ray, Ultrasound, MRI, CT), By Application (Gastroenterology, Cardiology, Oncology), By End User, By Region, And Segment Forecasts, 2020 – 2027.

    [2] Holt, D. E., Hiniker, S. M., Kalapurakal, J. A., Breneman, J. C., Shiao, J. C., Boik, N., ... & Milgrom, S. A. (2021). Improving the pediatric patient experience during radiation therapy-a children’s oncology group study. International Journal of Radiation Oncology* Biology* Physics, 109(2), 505-514.

    Malviya, S., Voepel-Lewis, T., Eldevik, O. P., Rockwell, D. T., Wong, J. H.,& Tait, A. R. (2000). Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth 84. 743–748

    Khan, J. et al. (2007). A program to decrease the need for pediatric sedation for CT and MRI. Applied Radiology.


    All assets are in clinical evaluation. Future availability cannot be guaranteed. MR scanning has not been established as safe for imaging fetuses 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.