Clinical practices for obtaining MRI in pediatric patients with tracheostomy tubes: Case series and proposed protocol.

INTRODUCTION: Pediatric patients with tracheostomy tubes often require Magnetic Resonance Imaging (MRI); however, not all tracheostomy tubes are MRI-safe. Many are MRI-conditional. There is no unified protocol for obtaining MRIs for patients with MRI-conditional tracheostomy tubes. This lack of standardization puts patients at risk of unnecessary tracheostomy changes. OBJECTIVES: The goal of this case series and proposed protocol is to describe the MRI characteristics of commonly available tracheostomy tubes and describe one institution's protocol for MRIs for pediatric patients with tracheostomy tubes. METHODS: The Otolaryngology and Neuroradiology Departments developed a new protocol for performing MRIs for children with tracheostomy tubes. The development of the protocol began by categorizing and determining MRI compatibility of the most commonly available tracheostomy tubes. The new protocol was then developed and implemented in 3 cases. RESULTS: Tracheostomy tubes are commonly composed of polyvinyl chloride (PVC) or silicone with reinforced wire. There are 3 widely available brands: Bivona, Shiley, and Tracoe. PVC tubes (all Shiley models, some Tracoe models) are MR-safe, whereas silicone with reinforced wire tubes (all Bivona models, some Tracoe models) are MR-conditional. We propose a 3-step protocol. Step 1, pediatrics identifies the current tracheostomy tube. Step 2, depending on the type of tracheostomy tube, it is classified as MRI-safe or MRI-conditional. If MRI-safe, proceed with MRI without restrictions. If MRI-conditional, proceed to Step 3, where the pediatrics team determines if the patient is high-risk. If not high risk, proceed with tracheostomy tube change. If high-risk, proceed with MRI under restricted conditions. We also describe 3 cases in which this protocol was developed and utilized. CONCLUSIONS: This MRI tracheostomy protocol provides guidance for evaluation of a patient with a tracheostomy tube prior to performing an MRI and sets clear criteria for when a tracheostomy tube change is indicated. This protocol improves standardization of care, resource utilization, and patient experience. It provides a foundation for developing evidence-based guidelines that can improve safety and quality of care while simultaneously reducing unnecessary procedures.