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Imaging Children Without Anesthesia The "MoCo" project · Elsass Fonden, PI · 2019–2024

"How can you avoid putting children with cerebral palsy in general anesthesia while they are in a brain scanner?" — funded by the Elsass Foundation (nearly 3.9 mio DKK), hosted at NRU from April 2019 until the end of 2024.

Project abstract

It is standard procedure in most Danish hospitals to employ general anesthesia when small children are in need of medical imaging procedures that demand anesthesia. Anesthesia is used to prevent the child from leaving the scanner, to reduce motion artefacts and for dealing with children that are too anxious to enter the scanning environment. Movement during the image acquisition can cause serious distortions of the imaging data, which can invalidate its quality and potentially lead to an erroneous conclusion. Even though complications directly related to general anesthesia are rare, there is an increasing concern about the potential neurotoxic effects of general anesthesia. Additionally, there are logistic and financial challenges associated with the use of general anesthesia.

The aim of our project is to utilize recent developments in medical imaging hardware technology in order to show that most young children can undergo medical imaging procedures without anesthesia and that it is still possible to obtain a high-quality diagnostic scan. We want to test the clinical efficacy of a marker-less motion tracking device that can register the child’s movements while scanning, which allows for motion correction of the acquired images.

Our goal is to demonstrate the clinical utility of a novel approach to imaging – including training, preparation and the use of the tracking device – in children with cerebral palsy that undergo MRI scans for diagnostic purposes. Results from this project have informed the new dedicated childhood brain damage MRI system funded by the Elsass Foundation, installed at BørneRiget, the new Mary Elizabeth's Children's Hospital in Copenhagen.

Outcome

By September 2023 we had scanned the last of 50 children referred for cerebral MRI in anesthesia — 47 of 50 (94%) were successfully scanned without anesthesia. This success rate was recognized by hospital management, and the default of putting children under 10 years of age in anesthesia for these scans has been revoked, effectively changing clinical practice. A follow-up "mini-MoCo" project, driven by radiographers without the mock scanner, continued afterwards with 20 more children, to give solid recommendations to the MR group designing the MRI process at BørneRiget.

The project hosted a MICCAI 2021 challenge (RealNoiseMRI), reopened for a second round at MedNeurIPS 2021. Data has been released via OpenNeuro (with a preprint on PsyArXiv), and analysis code is on GitHub. If you'd also like access to k-space data, get in touch — those data could not be anonymized for open release.

The dataset has since been published in full as two Scientific Data articles: "A dataset of clinical pediatric brain MRI with and without motion correction" (Coll, Waagstein Madsen, Skak Madsen & Ganz, 2026) and "Brain MRI Dataset Featuring a Full Clinical Protocol With and Without Intentional Motion" (Skak Madsen, Ruschke, Eichhorn, Rising & Ganz, 2026). The image quality metrics used to evaluate the motion-corrected scans are described in "Agreement of image quality metrics with radiological evaluation in the presence of motion artifacts" (Marchetto, Eichhorn, Gallichan, Schnabel & Ganz, MAGMA, 2025).

The project has been covered by DR (Danish national evening news), Rigshospitalet's IndenRigs magazine, and Siemens' Next Level magazine (article titled "Mock-up MR scanner helps to reduce anxiousness for children").

Meet the team

  • Melanie Ganz – Project PI, Researcher, NRU, Rigshospitalet.
  • Alfred Peter Born – Project Co-PI, Overlæge, Juliane Maries Center, Rigshospitalet.
  • Thurid Waagstein Madsen – Project Nurse, Nurse practitioner, Rigshospitalet.

Collaborators: Andre van der Kouwe and Stephen Robert Frost (A.A. Martinos Center for Biomedical Imaging, MGH), Vibeke Andrée Larsen (Head of Radiology, Rigshospitalet), Kathrine Skak Madsen (Lektor, Professionshøjskolen Metropol; project researcher), Lise Borgwardt (Overlæge, Rigshospitalet), Nitesh Shekhrajka (Neuroradiologist, Rigshospitalet).

Alumni: Hannah Eichhorn (physicist, Niels Bohr Institute, University of Copenhagen), Maria Christiansen (BSc psychology, student worker), Kathrine Christensen (MSc psychology, student worker), Evangelos Vouros (MSc student, Niels Bohr Institute), Simon Chemnitz Thomsen (MSc student, DIKU), Asta Kongsgaard (project nurse), Bianca Pedersen and Martin Riis Rassing (BSc radiography, KP Metropol), Andreea-Veronica Vascan (MSc student, DIKU), Ditte Busk Nielsen (project nurse).

Publications, talks & media

Invited talks

  • Cardiff Vlunch seminar 2026 – "Automated Image Quality assessments – a solved problem?"
  • ISMRM MoCo seminar (online) 2025 – "The value of motion correction in clinical neuroimaging".
  • ISMRM Motion Correction workshop 2024 – "Image Quality Metrics for Motion Assessment".
  • DSMMR (Danish Society for Magnetic Resonance) annual meeting 2024 – "Experiences scanning small children without sedation in a clinical setting: the MoCo project at Rigshospitalet".
  • FLUX and FIT'NG 2023 – symposium "Emerging Methods for MRI in Infants and Young Children" with Rhodri Cusack, Cameron Ellis, Brittany Howell and Aine Dineen (slides on OSF).
  • Siemens User Meeting Denmark 2023 – "MR scanning in children: understanding the concepts and requirements from pre-scan mock-up training, motion correction techniques and image quality".
  • ISMRM Motion Correction workshop 2022 – "Characterisation of Children's Head Motion for Magnetic Resonance Imaging With & Without General Anaesthesia".

Conference abstracts

  • ISMRM 2026 – "Large sample evaluation of AI accelerated Clinical Pediatric Neuroimaging", Karen J. Kettless, Camilla D. Hansen, Llucia Coll, Marcel Dominik Nickel, Adam E. Hansen, Melanie Ganz (Cape Town).
  • ISMRM 2025 – "Assessing the influence of preprocessing on the agreement of image quality metrics with radiological evaluation in the presence of motion" (power pitch), H. Eichhorn, E. Marchetto, D. Gallichan, J. A. Schnabel, M. Ganz.
  • FLUX and FIT'NG 2024 – "Behavioral strategies to minimize head motion reduce the need for general anesthesia in pediatric patients undergoing cerebral MRI", M. Ganz, T. W. Madsen, A. P. Born, T. Gaas, R. Frost, A. van der Kouwe, V. A. Larsen.
  • ISMRM MoCo workshop 2024 (three abstracts): "Generative Models for Children's Head Motion in Resting-State fMRI" (H. A. Georgiev, J. F. Sheye, V. Beliveau, M. Ganz); "Head Movement in the Resting-State fMRI Data of the ABCD Study" (J. F. Sheye, H. A. Georgiev, M. Ganz); "Simulating Head Motion in MRI: A Silicone Phantom Approach with Machine Learning Integration" (M. Daugaard, E. Riis-Jacobsen, H. Yin, K. Erleben, M. Ganz); and "Hybrid Motion Correction: Combining Prospective & Retrospective Motion Correction" (M. Laustsen, S. Glimberg, J. Slipsager, R. Frost, M. Ganz, A. van der Kouwe, T. Gaass).
  • ISMRM 2024 – "Assessing Image Quality Metric Alignment with Radiological Evaluation in Datasets with and without Motion Artifacts" and "Hybrid Motion Correction: Prospective Thresholding and Retrospective Residual Correction" and "Hybrid Motion Correction: Latency Compensation In The Presence Of Respiratory Motion".
  • FLUX and FIT'NG 2023 – "Reducing the Need for General Anesthesia in Children Undergoing Neuroimaging by Preparation and Motion Correction", M. Ganz, T. Waagstein Madsen, K. Søndergaard Christensen, K. Skak Madsen, A. Peter Born, V. Andrée Larsen.
  • ISMRM 2023 – "Selective MRI reacquisition to extend the working range of retrospective motion correction", M. Laustsen, J. Slipsager, T. Gaaß, A. van der Kouwe, M. Ganz, L. G. Hanson.
  • ISMRM 2022 – "Evaluating the match of image quality metrics with radiological assessment in a dataset with and without motion artifacts", H. Eichhorn, S. Chemnitz-Thomsen, E. Vouros, N. Shekhrajka, R. Frost, A. van der Kouwe, M. Ganz.

Articles & preprints

  • Coll L, Waagstein Madsen T, Skak Madsen K, Ganz M. A dataset of clinical pediatric brain MRI with and without motion correction. Scientific Data, 2026.
  • Skak Madsen K, Ruschke T, Eichhorn H, Rising P, Ganz M. Brain MRI Dataset Featuring a Full Clinical Protocol With and Without Intentional Motion. Scientific Data, 2026.
  • Marchetto E, Eichhorn H, Gallichan D, Schnabel JA, Ganz M. Agreement of image quality metrics with radiological evaluation in the presence of motion artifacts. Magnetic Resonance Materials in Physics, Biology and Medicine (MAGMA) 38(6), 991–1002, 2025.
  • Eichhorn H, Vascan A, Nørgaard M, Ellegaard AH, Slipsager JM, Høgild Keller S, Marner L, Ganz M. Characterisation of children's head motion for Magnetic Resonance Imaging with and without general anaesthesia. Frontiers in Radiology 1, 789632, 2021.
  • Eichhorn H, Frost R, Kongsgaard A, Kettless K, Slipsager J, Glimberg S, Shekhrajka N, Tisdall MD, Wighton P, Borgwardt L, Born AP, Andrée Larsen V, Skak Madsen K, van der Kouwe A, Ganz M. Evaluating the performance of markerless prospective motion correction and selective reacquisition in a general clinical protocol for brain MRI. Preprint.

Media coverage

  • DR (Jan 2020): Featured in the national evening news, showing prospective motion correction on the new NRU scanner.
  • IndenRigs (Dec 2020): Featured on the back cover of Rigshospitalet's staff magazine ("Smart kamera sparer børn for fuld narkose"), and again in "Legeskanner er ikke for sjov" (Nov 2021).
  • Siemens Next Level (Aug 2021): "Mock-up MR scanner helps to reduce anxiousness for children".

Related resources

  • The new NRU scanner – a virtual tour is available on request.
  • MICCAI 2021 / MedNeurIPS 2021 challenge: RealNoiseMRI.
  • Data release: OpenNeuro ds004332 (anonymized data), with raw ISMRM-RD data shared via PublicnEUro under a data-use agreement.
  • Code: github.com/melanieganz/MoCoProject, covering sub-projects on children's head motion characterisation, image quality metrics, the "Kom med i scanneren" preparation app, and the ABCD study motion analysis.
  • Slides from talks and seminars: outreach folder on GitHub.