Cost analysis of nonsedated fast-spine magnetic resonance imaging in pediatric patients.

OBJECTIVE: MRI is a cornerstone of pediatric spinal evaluation but frequently requires sedation or general anesthesia in young children due to prolonged scan times. This use of anesthesia introduces periprocedural risks and logistical barriers that can delay care and increase burden for families. Fast-spine MRI (fsMRI) protocols offer a motion-tolerant, abbreviated alternative that may allow nonsedated imaging for selected pediatric indications. This study evaluates the clinical feasibility and operational impact of nonsedated fsMRI compared with routine pediatric spine MRI, with secondary analysis of institutional cost. METHODS: All pediatric spine MR studies obtained between January 1, 2023, and December 31, 2024, at the authors' institution were retrospectively reviewed. Imaging protocol, scan duration, and patient age were recorded. Patients were stratified into younger (≤ 6 years) and older (≥ 7 years) cohorts. Financial data, including direct institutional cost, charge amount, payment received, and collection rate, were analyzed to assess economic impact. RESULTS: A total of 2358 pediatric spine MR images were included (643 fsMRI, 1715 routine MRI). Across all patients, fsMRI reduced the mean table time from 100.2 ± 51.3 minutes to 34.6 ± 12.5 minutes (p < 0.0001). The time reduction was most pronounced in the younger cohort (105.9 ± 54.8 minutes vs 35.7 ± 12.7 minutes, p < 0.0001). The mean direct institutional cost for fsMRI was $133.59 lower per scan ($284.12 vs $417.71), with a significantly higher collection rate (53.9% vs 47.4%, p = 0.0054). CONCLUSIONS: Fast-spine MRI substantially reduces scan time, effectively removing the barrier of sedation for many young children. By serving as a rapid, nonsedated screening tool, this protocol offers a safer alternative to routine MRI that significantly expands appointment availability and improves access to care for all pediatric patients.